Objective-To evaluate reproductive history risk factors in breast cancer among Hispanic (HISP) women in the U.S. southwest, a population with approximately 33% lower breast cancer incidence than non-Hispanic whites (NHW).Methods-Population-based case-control study of HISP (796 cases, 919 controls) and NHW (1,525 cases, 1,596 controls) women.Results-19.3% of HISP women reported five or more births and had a reduced risk of breast cancer, adjusted odds ratio (OR) 0.70 (95% confidence interval (CI): 0.50, 0.98) compared to those with one or two births. Breast cancer risk for HISP increased with older age at first birth, p trend = 0.008. Parity and age at first birth associations were specific to ER positive tumors. HISP women who had given birth within five years had higher breast cancer risk than women with 16-25 years since a birth, OR 2.62 (95% CI: 1.44, 4.78); the tend with years since last birth was stronger than for NHWs, p interaction = 0.05.Conclusions-Reproductive history influences on breast cancer risk among HISP were similar to associations reported for NHWs. Differences in the prevalence of reproductive risk factors would explain an estimated 6.6% lower breast cancer incidence for HISP compared to NHWs.
Keywords
Breast neoplasms; Reproductive history; Hispanic AmericansHispanic women in the U.S. have a lower incidence of breast cancer than NHW [1]. Racial and ethnic differences in disease incidence may be related to one or more factors: differences in the prevalence of environmental and lifestyle risk factors for the disease, differences in susceptibility to the influence of risk factors, or differences in genetic risk. Possible differences in the role of reproductive and other risk factors in breast cancer among HISP compared to NHW women have been suggested [2][3][4].Several aspects of reproductive history, including age at menarche, age at first birth, and parity, have been consistently reported to affect breast cancer risk [5][6][7][8][9] based on studies in predominantly NHW populations. Some reproductive history exposures appear to affect incidence of estrogen receptor (ER) positive tumors specifically [10,11], and the proportion of breast cancers that express the ER differs between HISP and NHW populations [12,13]
Subjects and methods
Study populationParticipants were recruited and interviewed for a case-control study of breast cancer in the U.S. states of Arizona, Colorado, New Mexico, and Utah. Methods for identifying, recruiting, and interviewing subjects have been described previously [4,14]
InterviewA questionnaire was administered by a trained interviewer using computer-assisted personal interview software. Interviews were audio-recorded for quality assurance [17]. The complete text of the questionnaire is available at https://www.zorro.hrc.utah.edu/breast.html. Information was obtained about diet, medical history, physical activity, menstrual history and use of hormones, pregnancy history, family history of cancer, history of mammograms, and tobacco and alcohol exposures. Exposu...