The association between China's Great famine and risk of breast cancer according to hormone receptor status: a hospital-based study.
The Great Chinese Famine afflicted almost all Chinese people between 1959 and 1961. No study has explicitly assessed the association between an exposure to Chinese Famine and risk of overall breast cancer and tumor subtype. We evaluated the unique historical environmental influences of famine exposure on breast cancer subtypes.



16,469 Chinese women who were diagnosed with invasive breast cancer in the Fudan University Shanghai Cancer Center (FUSCC) from 1999 to 2014 were analyzed. Four tumor subtypes were defined by both estrogen-receptor (ER) and progesterone-receptor (PR) status. Multinomial logistic regression models were used to estimate the odds ratios (ORs) of ER-PR-, ER+PR-, and ER-PR+ relative to ER+PR+ breast cancer for exposure to famine and age at the exposure.



Compared with cases not exposed to the Famine, exposed cases were more likely to be diagnosed with ER-PR- (OR 1.60, 95 % CI 1.43-1.81), ER-PR+ (OR 4.85, 95 % CI 3.80-6.19), and ER+PR- (OR 1.99, 95 % CI 1.67-2.37) than ER+PR+ breast cancer after controlling for established breast cancer risk factors. Women exposed to Famine after first birth had a higher risk of EP-PR- (OR 1.66, 95 % CI 1.28-2.15), ER-PR+ (OR 9.75, 95 % CI 5.85-16.25), and ER+PR- (OR 2.35, 95 % CI 1.69-3.26) compared to those with ER+PR+ breast cancer.



Women exposed to the Famine, particularly those exposed after first birth, were more likely to be diagnosed with ER-PR-, ER-PR+, and ER+PR- breast cancer. This retrospective analysis suggests that famine, malnutrition, or the associated lack of fruit and vegetable consumption in adulthood may be related to epidemiological heterogeneity within breast cancer subtypes.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Siteman Cancer Center, 660 South Euclid Ave, Campus Box 8100, St Louis, MO, 63110, USA.
Aliya
A
Alimujiang
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.|Clinical Statistics Center, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Miao
M
Mo
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Siteman Cancer Center, 660 South Euclid Ave, Campus Box 8100, St Louis, MO, 63110, USA.
Ying
Y
Liu
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Nai-Si
NS
Huang
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Guangyu
G
Liu
Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.|Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China.
Wanghong
W
Xu
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Jiong
J
Wu
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Zhen-Zhou
ZZ
Shen
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. zhimingshao@yahoo.com.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. zhimingshao@yahoo.com.
Zhimin
0000-0002-7307-0291
Z
Shao
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Siteman Cancer Center, 660 South Euclid Ave, Campus Box 8100, St Louis, MO, 63110, USA. colditzg@wustl.edu.
Graham A
GA
Colditz
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D012931:Social Environment
D014408:Biomarkers, Tumor; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
Breast cancer; Estrogen-receptor; Famine; Hormone receptors; Progesterone-receptor; Subtype