The insulin-like growth factor 1 gene (IGF1) is a strong candidate gene for a breast cancer susceptibility model. We investigated a dinucleotide repeat 969 bp upstream from the transcription start site of the IGF1 gene for possible associations with plasma IGF1 levels and breast cancer risk in a multiethnic group of postmenopausal women. Furthermore, we investigated the relation between race/ethnicity, mean plasma IGF1 levels and breast cancer rates in the Hawaii/Los Angeles Multiethnic Cohort. The mean ageadjusted IGF1 level among Latino-American women, 116 ng ml Ă1 , was statistically significantly lower than the mean age-adjusted IGF1 levels for each of the three other racial/ethnic groups, African-American, Japanese-American and Non-Latino White women (146, 144 and 145 ng ml Ă1 , respectively) (Po0.0001). Latino-American women have the lowest breast cancer rates of any racial/ethnic group in the cohort. These results support the investigation of an expansion of the hypothesis for an important role of IGF1 in breast cancer tumorigenesis to different racial/ethnic groups and to postmenopausal women. It is unlikely that any involvement of IGF1 in breast cancer aetiology is mediated by the IGF1 dinucleotide repeat polymorphism, which was not significantly associated with circulating IGF1 levels nor breast cancer risk in this study. Research into relevant determinants of IGF1 levels in the blood must continue. British Journal of Cancer (2003) The insulin-like growth factor 1 (IGF1) protein has been implicated in breast cancer because of its mitogenic and antiapoptotic effect on mammary epithelial cells (Furlanetto and DiCarlo, 1984;Westley and May, 1994;Kleinberg, 1998). Epidemiological work epitomised by a paper from Hankinson et al (1998) has shown an increased risk for breast cancer in premenopausal women with high prediagnostic plasma IGF1. Byrne et al (2000) subsequently showed that mammographic density, one of the strongest breast cancer risk factors, was positively correlated with plasma IGF1 in premenopausal but not postmenopausal control women. Although these initial findings were limited to premenopausal women, postmenopausal IGF1 levels may also be an important determinant of breast cancer risk if considered as a component of lifetime or intratissue exposure. Assessment of lifetime or intratissue exposure may be improved by the availability of genetic determinants. An early report suggested that the homozygous status for a (CA) 19 microsatellite variant 969 bp upstream from the transcription start site in the IGF1 gene (IGF1) was predictive of low serum IGF1 in Caucasian men and postmenopausal women. We hypothesised that the (CA) 19 homozygous genotype (19/19) might indicate women with a decreased lifetime exposure to IGF1 and consequently, a decreased susceptibility to breast cancer. We examined the role of IGF1 in postmenopausal breast cancer among women from four major racial/ethnic groups (African American, Japanese American, Latino American, White) in the Hawaii and Los Angeles Multiethnic Cohort...