Endogenous steroid hormone concentrations and risk of breast cancer: does the association vary by a woman's predicted breast cancer risk?
OBJECTIVE
To examine whether the associations of endogenous estrogens and testosterone with breast cancer risk differ between high- and low-risk women, as determined by the Gail model and the Rosner and Colditz model, and by family history of breast cancer.


METHODS
We conducted a prospective nested case-control study within the Nurses' Health Study. From 1989 or 1990 until June 2000, blood samples were collected, 418 breast cancer patient cases were identified, and two controls (total n = 817) were matched to each case. We classified women as high or low risk based on their family history of breast cancer, their 5-year Gail risk score, and their 5-year Rosner and Colditz risk score. Multivariate relative risks (RR) and 95% CI were calculated by unconditional logistic regression, adjusting for matching and breast cancer risk factors.


RESULTS
Estrone sulfate was statistically significantly associated with breast cancer risk among women with low (< 1.66%) and high (> or = 2.52%; 75th percentile) Gail predicted risk (fourth v first quartile RR = 3.6; 95% CI, 1.9 to 7.0; RR = 2.5; 95% CI, 1.2 to 5.1, respectively). Testosterone results were similar across strata of predicted risk, with two times the risk in the fourth (v first) quartile. Estradiol appeared more strongly associated with breast cancer in women with higher predicted risk (RR = 4.5; 95% CI, 2.1 to 9.5) compared with women with lower risk (RR = 2.1; 95% CI, 1.2 to 3.6), but differences were not statistically significant. Results were similar across predicted Rosner and Colditz risk scores.


CONCLUSIONS
These data suggest that higher levels of endogenous estrogens and testosterone are associated with increased breast cancer risk, regardless of predicted risk or family history of breast cancer.
Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115, USA. heather.eliassen@channing.harvard.edu
A Heather
AH
Eliassen
Stacey A
SA
Missmer
Shelley S
SS
Tworoger
Susan E
SE
Hankinson
D000328:Adult; D001943:Breast Neoplasms / Q000209:etiology* / Q000235:genetics; D016022:Case-Control Studies; D004958:Estradiol / Q000097:blood*; D004970:Estrone / Q000031:analogs & derivatives* / Q000097:blood; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D010375:Pedigree; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*
D004970:Estrone; D013739:Testosterone; D004958:Estradiol; C017296:estrone sulfate