title: The modifying effect of social class on the relationship between body mass index and breast cancer incidence.
abstract: OBJECTIVE
  We sought to determine whether social class modifies the effect of BMI on breast cancer incidence.
  
  
  METHODS
  Participants included 5642 postmenopausal White women recruited in 1989 to CLUE II, a prospective cohort study in Washington County, Maryland. We obtained exposure data from CLUE II and the 1990 US Census. We used survival and random-effects Cox proportional hazards analyses to determine the association of social class and BMI with breast cancer incidence.
  
  
  RESULTS
  Education was independently associated with increased risk of breast cancer incidence (hazard ratio [HR]=1.06; 95% confidence interval [CI]=1.01, 1.11; P<.05); contextual measures of social class were not. Education modified the effect of BMI at age 21 years (HR=0.98; 95% CI=0.97, 0.99); area-level social class modified the effect of BMI at baseline (HR=0.97; 95% CI=0.94, 0.99) and BMI change (HR=0.98; 95% CI=0.95, 1.00). Subpopulation analyses that were adjusted for hormone use, parity, and breast-feeding found similar effects.
  
  
  CONCLUSIONS
  Social class moderates the influence of body size on breast cancer incidence. Public health efforts, therefore, should advocate for policies that improve social conditions to decrease the burden of breast cancer.
authors.affiliation: Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ctorio@rwjf.org
authors.forename: Celeste Marie
authors.initials: CM
authors.lastname: Torio
authors.forename: Ann C
authors.initials: AC
authors.lastname: Klassen
authors.forename: Frank C
authors.initials: FC
authors.lastname: Curriero
authors.forename: Benjamin
authors.initials: B
authors.lastname: Caballero
authors.forename: Kathy
authors.initials: K
authors.lastname: Helzlsouer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data*