title: Quantifying the Role of Circulating Unconjugated Estradiol in Mediating the Body Mass Index-Breast Cancer Association.
abstract: BACKGROUND
  Higher body mass index (BMI) and circulating estrogen levels each increase postmenopausal breast cancer risk, particularly estrogen receptor-positive (ER(+)) tumors. Higher BMI also increases estrogen production.
  
  
  METHODS
  We estimated the proportion of the BMI-ER(+) breast cancer association mediated through estrogen in a case-control study nested within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Participants included 143 women with invasive ER(+) breast cancer and 268 matched controls, all postmenopausal and never having used hormone therapy at baseline. We used liquid chromatography-tandem mass spectrometry to measure 15 estrogens and estrogen metabolites in baseline serum. We calculated BMI from self-reported height and weight at baseline. We estimated the mediating effect of unconjugated estradiol on the BMI-ER(+) breast cancer association using Aalen additive hazards and Cox regression models.
  
  
  RESULTS
  All estrogens and estrogen metabolites were statistically significantly correlated with BMI, with unconjugated estradiol most strongly correlated [Pearson correlation (r) = 0.45]. Approximately 7% to 10% of the effect of overweight, 12% to 15% of the effect of obesity, and 19% to 20% of the effect of a 5 kg/m(2) BMI increase on ER(+) breast cancer risk was mediated through unconjugated estradiol. The BMI-breast cancer association, once adjusted for unconjugated estradiol, was not modified by further adjustment for two metabolic ratios statistically significantly associated with both breast cancer and BMI.
  
  
  CONCLUSIONS
  Circulating unconjugated estradiol levels partially mediate the BMI-breast cancer association, but other potentially important estrogen mediators (e.g., bioavailable estradiol) were not evaluated.
  
  
  CONCLUSIONS
  Further research is required to identify mechanisms underlying the BMI-breast cancer association.
authors.affiliation: Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland. schairec@exchange.nih.gov.
authors.forename: Catherine
authors.initials: C
authors.lastname: Schairer
authors.affiliation: Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Fuhrman
authors.affiliation: Information Management Services, Inc., Silver Spring, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Boyd-Morin
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York.
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Genkinger
authors.affiliation: Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Gail
authors.affiliation: Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hoover
authors.affiliation: Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
authors.forename: Regina G
authors.initials: RG
authors.lastname: Ziegler
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D016022:Case-Control Studies; D004958:Estradiol / Q000097:blood*; D004967:Estrogens / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications*; D017698:Postmenopause; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D004967:Estrogens; D004958:Estradiol