title: A multi-ethnic breast cancer case-control study in New Zealand: evidence of differential risk patterns.
abstract: OBJECTIVE
  To investigate whether the relationships between established risk factors and breast cancer risk differ between three ethnic groups in New Zealand, namely Māori, Pacific, and non-Māori/non-Pacific women.
  
  
  METHODS
  The study is a multi-ethnic, age-, and ethnicity-matched population-based case-control study of breast cancer in women. Women with a primary, invasive breast cancer registered on the New Zealand Cancer Registry between 1 April 2005 and 30 April 2006, and Māori or Pacific women diagnosed to 30 April 2007 were eligible. Control women were identified from the New Zealand Electoral Roll, stratified by ethnicity, then frequency matched on age to the cases. Logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) between exposures and breast cancer risk in three ethnic groups separately. Likelihood ratio tests were used to test for modification of the effects by ethnicity. Post-stratification weighting of the controls was used to account for differential non-response by deprivation category.
  
  
  RESULTS
  The study comprised 1,799 cases (302 Māori, 70 Pacific, 1,427 non-Māori/non-Pacific) and 2,543 controls (746 Māori, 194 Pacific, 1,603 non-Māori/non-Pacific), based on self-identified ethnicity. Māori women were more likely to have ER and PR positive breast cancer compared to other ethnicities. There were marked differences in exposure prevalence between ethnicities and some differing patterns of risk factors for breast cancer between the three main ethnic groups. Of interest was the strong relationship between number of children and lower breast cancer risk in Pacific women (OR for 4 or more vs. 1 child OR 0.13, 95 % CI 0.05-0.35) and a higher risk of breast cancer associated with smoking (OR 1.76, 95 % CI 1.25-2.48) and binge drinking (5 or more vs. 1-2 drinks per occasion, OR 1.55, 95 % CI 1.07-2.26) in Māori women. Some of the documented results were attenuated following post-stratification weighting.
  
  
  CONCLUSIONS
  The findings of this study need to be interpreted with caution, given the possibility of selection bias due to low response rates among some groups of women. Reducing the burden of breast cancer in New Zealand is likely to require different approaches for different ethnic groups.
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, UK. mona.jeffreys@bristol.ac.uk
authors.forename: Mona
authors.initials: M
authors.lastname: Jeffreys
authors.forename: Fiona
authors.initials: F
authors.lastname: McKenzie
authors.forename: Ridvan
authors.initials: R
authors.lastname: Firestone
authors.forename: Michelle
authors.initials: M
authors.lastname: Gray
authors.forename: Soo
authors.initials: S
authors.lastname: Cheng
authors.forename: Ate
authors.initials: A
authors.lastname: Moala
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.forename: Lis
authors.initials: L
authors.lastname: Ellison-Loschmann
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology*; D002277:Carcinoma / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology*; D016022:Case-Control Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010865:Pilot Projects; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors