Reproductive factors and breast cancer risk: A meta-analysis of case–control studies in Indian women

Gayatri Vishwakarma; Harrison Ndetan; Durgesh Nandini Das; Garima Gupta; Moushumi Suryavanshi; Anurag Mehta; Karan P. Singh

doi:10.4103/sajc.sajc_317_18

South Asian Journal of Cancer, Table of Contents

CC BY-NC-ND 4.0 · South Asian J Cancer 2019; 08(02): 080-084
DOI: 10.4103/sajc.sajc_317_18

ORIGINAL ARTICLE: Breast Cancers

Reproductive factors and breast cancer risk: A meta-analysis of case–control studies in Indian women

Gayatri Vishwakarma

Rajiv Gandhi Cancer Institute and Research Centre, New Delhi

,

Harrison Ndetan

The University of Texas Health Science Center at Tyler, Texas

,

Durgesh Nandini Das

The University of Texas Health Science Center at Tyler, Texas

,

Garima Gupta

Rajiv Gandhi Cancer Institute and Research Centre, New Delhi

,

Moushumi Suryavanshi

Rajiv Gandhi Cancer Institute and Research Centre, New Delhi

,

Anurag Mehta

Rajiv Gandhi Cancer Institute and Research Centre, New Delhi

,

Karan P. Singh

The University of Texas Health Science Center at Tyler, Texas

› Author Affiliations

Abstract

PDF Download

Abstract

Background/Objective: India is the world's most biodiverse region and is undergoing a period of dramatic social and economic change. Due to population's explosion, climate change and lax implementation of environmental policies, the incidence of breast cancer is increasing. From population-based cancer registry data, breast cancer is the most common cancer in women in urban registries where it constitutes more than 30% of all cancers in females. We conducted a meta-analysis of all breast cancer case–control studies conducted in India during 1991–2018 to find pooled estimates of odds ratio (OR). Materials and Methods: Eligible studies were identified through a comprehensive literature search of PubMed, EMBASE, and HINARI databases from 1991 to January 2018. This analysis included 24 observational studies out of 34 that reported the case–control distribution of reproductive factors, body mass index (BMI) and type of residence. The analysis was performed using RevMan 5.3 (Review Manager, 2017) applying the random-effects model. Results: A total of 21,511 patients (9889 cases and 11,622 controls) were analyzed, resulting in statistically significant association between breast cancer and the following reproductive factors: never breastfeed (OR: 3.69; 95% confidence interval [CI]: 1.70, 8.01), menopausal age >50 years (OR: 2.88; 95% CI: 1.85, 3.85), menarche age <13 years (OR: 1.83; 95% CI: 1.34, 2.51), null parity (OR: 1.58; 95% CI: 1.21, 2.06), postmenopause (OR: 1.35; 95% CI: 1.13, 1.62), and age at the 1^st pregnancy >25 years (OR: 1.57; 95% CI: 1.37, 1.80). Family history (FH) of breast cancer (OR: 5.33; 95% CI: 2.89, 9.82), obesity (OR: 1.19; 95% CI: 1.00, 1.42), and urban residence (OR: 1.22; 95% CI: 1.03, 1.44) were also found to be significant risk factors. Conclusion: The results of this meta-analysis are indicative of significant associations between reproductive factors and breast cancer risk, profoundly so among women experiencing menopause after the age of 50, women who never breastfeed and FH of breast cancer.

Key words

Breast cancer - India - meta-analysis - reproductive risk factors

PDF (2195 kb)

References

References
1 Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 1975-2014. National Cancer Institute, Bethesda, MD. 2017. Available from: https://seer.cancer.gov/csr/1975_2014. [Last assessed on 2018 Feb 13].
2 Cardoso F, Spence D, Mertz S, Corneliussen-James D, Sabelko K, Gralow J, et al. Global analysis of advanced/metastatic breast cancer: Decade report (2005-2015). Breast 2018;39:131-8.
3 Kurian AW, Clarke CA, Carlson RW. The decline in breast cancer incidence: Real or imaginary? Curr Oncol Rep 2009;11:21-8.
4 Emens LA, Davidson NE. Adjuvant hormonal therapy for premenopausal women with breast cancer. Clin Cancer Res 2003;9:486S-94S.
5 Jiwa M, Long A, Shaw T, Pagey G, Halkett G, Pillai V, et al. The management of acute adverse effects of breast cancer treatment in general practice: A video-vignette study. J Med Internet Res 2014;16:e204.
6 Breast Cancer in Developing Countries. Lancet 2009;374:1567.
7 Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
8 Mohite AP, Mohite RV. Dietary factors and breast cancer: A case control study from rural India. Asian J Med Sci 2014;6:55-60.
9 Mohite AP, Mohite RV. Reproductive risk factors and breast cancer: A case control study from rural India. Bangladesh J Med Sci 2015;14:258-64.
10 Datta K, Biswas J. Influence of dietary habits, physical activity and affluence factors on breast cancer in East India: A case-control study. Asian Pac J Cancer Prev 2009;10:219-22.
11 Asegaonkar S, Chaudhari SC, Bardapurkar JS. Lipid profile in breast cancer patients from rural India. J Indian Med Assoc 2012;110:831-2, 837.
12 Devi KR, Chenkual S, Majumdar G, Ahmed J, Kaur T, Zonunmawia JC, et al. TLR2Δ22 (196174) significantly increases the risk of breast cancer in females carrying proline allele at codon 72 of TP53 gene: A casecontrol study from four ethnic groups of north eastern region of India. Tumour Biol 2015;36:999510002.
13 Moorman PG, Terry PD. Consumption of dairy products and the risk of breast cancer: A review of the literature. Am J Clin Nutr 2004;80:514.
14 Pharoah PD, Day NE, Duffy S, Easton DF, Ponder BA. Family history and the risk of breast cancer: A systematic review and metaanalysis. Int J Cancer 1997;71:8009.
15 Bhadoria AS, Kapil U, Sareen N, Singh P. Reproductive factors and breast cancer: A case-control study in tertiary care hospital of North India. Indian J Cancer 2013;50:316-21.
16 Mathew A, Gajalakshmi V, Rajan B, Kanimozhi VC, Brennan P, BinukumarBP, et al. Physical activity levels among urban and rural women in south India and the risk of breast cancer: A case-control study. Eur J Cancer Prev. 2009;18:368-76. doi: 10.1097/CEJ.0b013e32832e1c46.
17 Sloan FA and Gelband H. Cancer Control Opportunities in Low-and Middle-Income Countries: Washington (DC): National Academies Press (US); 2007. doi: 10.17226/11797.
18 Das S, Sen S, Mukherjee A, Chakraborty D, Mondal PK. Risk factors of breast cancer among women in Eastern India: A tertiary hospital based case control study. Asian Pac J Cancer Prev 2012;13:4979-81.
19 Dey S, Boffetta P, Mathews A, Brennan P, Soliman A, Mathew A, et al. Risk factors according to estrogen receptor status of breast cancer patients in Trivandrum, South India. Int J Cancer 2009;125:1663-70.
20 Gathani T, Barnes I, Ali R, Arumugham R, Chacko R, Digumarti R, et al. Lifelong vegetarianism and breast cancer risk: A large multicentre case control study in India. BMC Womens Health 2017;17:6.
21 Mathew A, Gajalakshmi V, Rajan B, Kanimozhi V, Brennan P, Mathew BS, et al. Anthropometric factors and breast cancer risk among urban and rural women in South India: A multicentric case-control study. Br J Cancer 2008;99:207-13.
22 Singh M, Jangra B. Association between body mass index and risk of breast cancer among females of north india. South Asian J Cancer 2013;2:121-5.
23 Jayalekshmi P, Varughese SC, Kalavathi, Nair MK, Jayaprakash V, Gangadharan P, et al. A nested case-control study of female breast cancer in karunagappally cohort in Kerala, India. Asian Pac J Cancer Prev 2009;10:241-6.
24 Kapahi R, Guleria K, Sambyal V, Manjari M, Sudan M, Uppal MS, et al. Vascular endothelial growth factor (VEGF) gene polymorphisms and breast cancer risk in Punjabi population from North West India. Tumour Biol 2014;35:11171-81.
25 Rao DN, Ganesh B, Desai PB. Role of reproductive factors in breast cancer in a low-risk area: A case-control study. Br J Cancer 1994;70:129-32.
26 Sambyal V, Guleria K, Kapahi R, Manjari M, Sudan M, Uppal MS, et al. Association of the -2518 A/G polymorphism of MCP-1 with breast cancer in Punjab, North-West India. Asian Pac J Cancer Prev 2015;16:7243-8.
27 Meshram HP, Kulkarni PN. Reproductive risk factors for breast cancer: A case control study. Online J Health Allied Sci 2009;8:1-4.
28 Wirth MD, Burch JB, Hébert JR, Kowtal P, Mehrotra-Kapoor A, Steck SE, et al. Case-control study of breast cancer in India: Role of PERIOD3 clock gene length polymorphism and chronotype. Cancer Invest 2014;32:321-9.
29 Babita R, Kumar N, Karwasra RK, Singh M, Malik JS, Kaur A, et al. Reproductive risk factors associated with breast carcinoma in a tertiary care hospital of North India: A case-control study. Indian J Cancer 2014;51:251-5.
30 Parameshwari P, Muthukumar K, Jennifer HG. A population based case control study on breast cancer and the associated risk factors in a rural setting in Kerala, Southern India. J Clin Diagn Res 2013;7:1913-6.
31 Samson M, Swaminathan R, Rama R, Sridevi V, Nancy KN, Rajkumar T, et al. Role of GSTM1 (Null/Present), GSTP1 (Ile105Val) and P53 (Arg72Pro) genetic polymorphisms and the risk of breast cancer: A case control study from South India. Asian Pac J Cancer Prev 2007;8:253-7.
32 Saxena A, Dhillon VS, Raish M, Asim M, Rehman S, Shukla NK, et al. Detection and relevance of germline genetic polymorphisms in glutathione S-transferases (GSTs) in breast cancer patients from Northern Indian population. Breast Cancer Res Treat 2009;115:537-43.
33 Gajalakshmi CK, Shanta V. Risk factors for female breast cancer. A hospital-based case-control study in Madras, India. Acta Oncol 1991;30:569-74.
34 Gajalakshmi V, Mathew A, Brennan P, Rajan B, Kanimozhi VC, Mathews A, et al. Breastfeeding and breast cancer risk in India: A multicenter case-control study. Int J Cancer 2009;125:662-5.
35 Lodha R, Joshi A, Paul D, Lodha KM, Nahar N, Shrivastava A, et al. Association between reproductive factors and breast cancer in an urban set up at Central India: Acasecontrol study. Indian J Cancer 2011;48:3037.
36 Mathew A, Gajalakshmi V, Rajan B, Kanimozhi VC, Brennan P, Binukumar BP, et al. Physical activity levels among urban and rural women in south India and the risk of breast cancer: A case-control study. Eur J Cancer Prev. 2009;18:368-76. doi: 10.1097/CEJ.0b013e32832e1c46.