Population-Attributable Risk Proportion of Clinical Risk Factors for Breast Cancer.
OBJECTIVE
Many established breast cancer risk factors are used in clinical risk prediction models, although the proportion of breast cancers explained by these factors is unknown.


OBJECTIVE
To determine the population-attributable risk proportion (PARP) for breast cancer associated with clinical breast cancer risk factors among premenopausal and postmenopausal women.


METHODS
Case-control study with 1:10 matching on age, year of risk factor assessment, and Breast Cancer Surveillance Consortium (BCSC) registry. Risk factor data were collected prospectively from January 1, 1996, through October 31, 2012, from BCSC community-based breast imaging facilities. A total of 18 437 women with invasive breast cancer or ductal carcinoma in situ were enrolled as cases and matched to 184 309 women without breast cancer, with a total of 58 146 premenopausal and 144 600 postmenopausal women enrolled in the study.


METHODS
Breast Imaging Reporting and Data System (BI-RADS) breast density (heterogeneously or extremely dense vs scattered fibroglandular densities), first-degree family history of breast cancer, body mass index (>25 vs 18.5-25), history of benign breast biopsy, and nulliparity or age at first birth (≥30 years vs <30 years).


METHODS
Population-attributable risk proportion of breast cancer.


RESULTS
Of the 18 437 women with breast cancer, the mean (SD) age was 46.3 (3.7) years among premenopausal women and 61.7 (7.2) years among the postmenopausal women. Overall, 4747 (89.8%) premenopausal and 12 502 (95.1%) postmenopausal women with breast cancer had at least 1 breast cancer risk factor. The combined PARP of all risk factors was 52.7% (95% CI, 49.1%-56.3%) among premenopausal women and 54.7% (95% CI, 46.5%-54.7%) among postmenopausal women. Breast density was the most prevalent risk factor for both premenopausal and postmenopausal women and had the largest effect on the PARP; 39.3% (95% CI, 36.6%-42.0%) of premenopausal and 26.2% (95% CI, 24.4%-28.0%) of postmenopausal breast cancers could potentially be averted if all women with heterogeneously or extremely dense breasts shifted to scattered fibroglandular breast density. Among postmenopausal women, 22.8% (95% CI, 18.3%-27.3%) of breast cancers could potentially be averted if all overweight and obese women attained a body mass index of less than 25.


CONCLUSIONS
Most women with breast cancer have at least 1 breast cancer risk factor routinely documented at the time of mammography, and more than half of premenopausal and postmenopausal breast cancers are explained by these factors. These easily assessed risk factors should be incorporated into risk prediction models to stratify breast cancer risk and promote risk-based screening and targeted prevention efforts.
Department of Epidemiology and Biostatistics, University of California, San Francisco.
Natalie J
NJ
Engmann
Department of Public Health Sciences, University of California, Davis.
Marzieh K
MK
Golmakani
Department of Public Health Sciences, University of California, Davis.|Group Health Research Institute, Group Health Cooperative, Seattle, Washington.
Diana L
DL
Miglioretti
Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington.
Brian L
BL
Sprague
Department of Epidemiology and Biostatistics, University of California, San Francisco.|Department of Medicine, University of California, San Francisco.
Karla
K
Kerlikowske
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001940:Breast / Q000000981:diagnostic imaging; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016022:Case-Control Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017698:Postmenopause; D017697:Premenopause; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors