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Breast cancer risk factor associations differ for pure versus invasive carcinoma with an in situ component in case–control and case–case analyses

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Abstract

Purpose

Invasive ductal carcinoma (IDC) is diagnosed with or without a ductal carcinoma in situ (DCIS) component. Previous analyses have found significant differences in tumor characteristics between pure IDC lacking DCIS and mixed IDC with DCIS. We will test our hypothesis that pure IDC represents a form of breast cancer with etiology and risk factors distinct from mixed IDC/DCIS.

Methods

We compared reproductive risk factors for breast cancer risk, as well as family and smoking history between 831 women with mixed IDC/DCIS (n = 650) or pure IDC (n = 181), and 1,620 controls, in the context of the Women’s Circle of Health Study (WCHS), a case–control study of breast cancer in African-American and European-American women. Data on reproductive and lifestyle factors were collected during interviews, and tumor characteristics were abstracted from pathology reports. Case–control and case–case analyses were conducted using unconditional logistic regression.

Results

Most risk factors were similarly associated with pure IDC and mixed IDC/DCIS. However, among postmenopausal women, risk of pure IDC was lower in women with body mass index (BMI) 25 to <30 [odds ratio (OR) 0.66; 95 % confidence interval (CI) 0.35–1.23] and BMI ≥ 30 (OR 0.33; 95 % CI 0.18–0.67) compared to women with BMI < 25, with no associations with mixed IDC/DCIS. In case–case analyses, women who breastfed up to 12 months (OR 0.55; 95 % CI 0.32–0.94) or longer (OR 0.47; 95 % CI 0.26–0.87) showed decreased odds of pure IDC than mixed IDC/DCIS compared to those who did not breastfeed.

Conclusions

Associations with some breast cancer risk factors differed between mixed IDC/DCIS and pure IDC, potentially suggesting differential developmental pathways. These findings, if confirmed in a larger study, will provide a better understanding of the developmental patterns of breast cancer and the influence of modifiable risk factors, which in turn could lead to better preventive measures for pure IDC, which have worse disease prognosis compared to mixed IDC/DCIS.

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Abbreviations

IDC:

Invasive ductal carcinoma

DCIS:

Ductal carcinoma in situ

AA:

African-American

WCHS:

Women’s Circle of Health Study

EA:

European-American

BMI:

Body mass index

OR:

Odds ratio

CI:

Confidence interval

ER:

Estrogen receptor

HER2:

Human epidermal growth factor 2

LN:

Lymph node

RPCI:

Roswell Park Cancer Institute

CINJ:

Rutgers Cancer Institute of New Jersey

ISMMSS:

Icahn School of Medicine at Mount Sinai School

OC:

Oral contraceptive

MHT:

Menopausal hormone therapy

HAMLET:

Human milk complex of alpha-lactalbumin and oleic acid

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Acknowledgments

This work was supported by grants from the US Army Medical Research and Material Command (DAMD-17-01-1-0334) (to D.H. Bovbjerg and C.B. Ambrosone), the National Cancer Institute (R03 CA17106 to C.B. Ambrosone; R01 CA100598 to C.B. Ambrosone; P01 CA151135 to C.B. Ambrosone, J.R. Palmer, and A.F. Olshan; K22 CA138563 to E.V. Bandera; P30 CA072720 to Roswell Park Cancer Institute; P30 CA016056 to Rutgers Cancer Institute of NJ), the Breast Cancer Research Foundation (to C.B. Ambrosone), and a gift from the Philip L. Hubbell family (to C.B. Ambrosone). The New Jersey State Cancer Registry (NJSCR) is a participant in the Centers for Disease Control and Prevention’s National Program of Cancer Registries and is a National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Expansion Registry. The NJSCR is supported by the Centers for Disease Control and Prevention under cooperative agreement 5U58DP003931-02 awarded to the New Jersey Department of Health. The collection of New Jersey cancer incidence data is also supported by the National Cancer Institute’s SEER Program under contract N01PC-2013-00021 and the State of New Jersey. The funding agents played no role in the study design, data collection, analysis, and interpretation of data or in the writing of the manuscript for publication.

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Authors and Affiliations

  1. Department of Biotechnical and Clinical Laboratory Sciences, University at Buffalo, 12 Capen Hall, Buffalo, NY, 14214, USA

    Melanie Ruszczyk & Patricia Masso-Welch

  2. Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Sts., Buffalo, NY, 14263, USA

    Gary Zirpoli, Gregory Ciupak, Christine B. Ambrosone & Chi-Chen Hong

  3. Department of Surgical Oncology, Roswell Park Cancer Institute, Elm & Carlton Sts., Buffalo, NY, 14263, USA

    Shicha Kumar

  4. Population Science/Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., New Brunswick, NJ, 08903, USA

    Elisa V. Bandera

  5. Department of Epidemiology, Rutgers School of Public Health, 683 Hoes Ln W, Piscataway, NJ, 08854, USA

    Elisa V. Bandera

  6. Department of Psychiatry, University of Pittsburgh Cancer Institute, 5150 Centre Ave., Pittsburgh, PA, 15232, USA

    Dana H. Bovbjerg

  7. Department of Oncology Sciences, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave., New York, NY, 10029, USA

    Lina Jandorf

  8. Department of Pathology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA

    Thaer Khoury

  9. Department of Pathology, University of Texas, Southwestern Medical Center, 5325 Harry Hines Blvd., Dallas, TX, 75390, USA

    Helena Hwang

  10. New Jersey State Cancer Registry, New Jersey Department of Health, 140 East Front Street, Trenton, NJ, 08625, USA

    Karen Pawlish

  11. Department of Cell, Development and Cancer Biology, Oregon Health Sciences University, 3181 SW Sam Jackson Pkwy, Portland, OR, 97239, USA

    Pepper Schedin

Authors
  1. Melanie Ruszczyk
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  2. Gary Zirpoli
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  3. Shicha Kumar
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  4. Elisa V. Bandera
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  5. Dana H. Bovbjerg
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  6. Lina Jandorf
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  7. Thaer Khoury
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  8. Helena Hwang
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  9. Gregory Ciupak
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  10. Karen Pawlish
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  11. Pepper Schedin
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  12. Patricia Masso-Welch
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  13. Christine B. Ambrosone
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  14. Chi-Chen Hong
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Corresponding author

Correspondence to Chi-Chen Hong.

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Compliance with ethical standards

WCHS protocols for agreement to participate and informed consent were approved by the institutional review boards at Roswell Park Cancer Institute (RPCI), Rutgers Cancer Institute of New Jersey (CINJ), Icahn School of Medicine at Mount Sinai School (ISMMSS, formerly the Mount Sinai School of Medicine), and the participating hospitals in NYC in compliance with the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Ruszczyk, M., Zirpoli, G., Kumar, S. et al. Breast cancer risk factor associations differ for pure versus invasive carcinoma with an in situ component in case–control and case–case analyses. Cancer Causes Control 27, 183–198 (2016). https://doi.org/10.1007/s10552-015-0696-z

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  • DOI: https://doi.org/10.1007/s10552-015-0696-z

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