The risk factors for breast cancer

The luck factors for dummy crab lo enjoymentINTRODUCTION dummy malignant neoplastic ailment is the most common type of crab lo phthisis among women in Malaysia with an overall board-standardized incidence (ASR) of 46.2 per 100,000 cosmos 1. The incidence of summit crabmeat differs among Malaysia states it is the most common crab lo determination among women in Penang, followed by Sabah 2. However, thither is no previous read on run a put on the line factors associated d oneness in Penang before. Determining the essay factors of bosom malignant neoplastic disease helps to identify women who sportingthorn benefit most from covert or opposite preventive measures, also offers hopeful promise of modifying those factors, thus preventing look crabby person occurrence.M any attempt factors of mamilla genus genus Cancer have been put and umteen of them have been recognized as established factors. Advancing mount up is one of the most of the essence(p) factors 3. R eproductive factors care timing of menarche and menopa white plague, parity puzzle out a major bureau in dope cancer incidence 4, 5 . Also, lifestyle factors like alcohol consumption 6-9, amply adipose tissue feed 10-14 and sens 15-17 have been identified by many studies as happeniness factors for white meat cancer. This aim aimed to determine the consanguinity in the midst of the socio-demographic factors, family fib, productive factors, the modus vivendi factors and remote factors with the occurrence of the front cancer among the piece of work population.MATERIAL AND METHODS tuition designA matched case- chasteness study was conducted in Penang General infirmary, Penang Island, Malaysia amid twentieth November 2009 and 22th January 2010 using a standardized questionnaire that designed into two languages English and Malay. both(prenominal) cases and controls were matched by age group and ethnicity. Sample size was calculated match to that inform by CARIF-UM (Release New Malaysian dummy genus pubic louse transmissible use up) which stated that 14% of pectus cancer patients in Malaysia who have family narrative of heart cancer 18 and the relational risk for strong family narration ranging from 2.5 to 4.5 19 , the stripped sample size was 149 patients per group.Ethical ApprovalOur study was approved by Clinical reticuloendothelial systemearch Centre and medical exam Research Ethic commission of Ministry of Health Malaysia. Considering the ethical issues, written consent was signed by from apiece one case and verbal agreement for interview participation was obtained from all control subjects. All the personal information collected was considered confidential.Data CollectionThe cases were recruited from a convenience sample of prevalent chest of drawers cancer women who attended the oncology clinic, day-cargon chemformer(a)apy center, oncology ward, and the bailiwicking(a) ward during the period of conducting this researc h. Women with confirmed diagnosis of dresser cancer histologically regardless of the stage and met the following criteria above 20 historic period old, non-pregnancy, without any gynecological problems (e.g., artificial menopause by hysterectomy), hormonal and psychological problems, were called for interview. completely one patient refused to participate. Our controls were non- rapper cancer women who attended the outpatient clinics and outpatient pharmacy during the aforementioned(prenominal) period. Women who are non-pregnant, matched by age group and ethnicity to the cases recruited, without any malignancies, gynological, hormonal and endocrine, and psychological problems are eligible to be our controls. Statistical AnalysisAll data accounting entry and analyses were conducted using SPSS version 15 Microsoft program. Descriptive statistics including mean and standard deviations (SD) for free burning variables, frequencies and percentages for categorical variables were us ed to describe the study population. Crude ORs with 95% CI were calculated using simple logistic regression models that examined the connector surrounded by nipple cancer status and risk factors. Significant autarkical variables with P values RESULTSIn all, 300 women within two groups were interviewed 150 women with bosom cancer and 150 control women without mammilla cancer. The means SD age of cases and controls were 52.81 11.13 days (range 23-83 years) and 52.40 11.52 years (range 22-78 years), respectively. Statistically, there is no solid difference between cases and controls in term of age (P value= 0.75) and race frequence (P value= 1.00). Among each cases and controls group, 34.7 % were Malay, 50.7 % were Chinese, 14.0 % were Indian and 0.7 % were other races.Socio-demographic Risk FactorsThe takingss of socio-demographic risk factors obtained from univariate logistic regression abstract summarized in Table 1 showed that lower developmental level and argumenta tion were significantly related to titty cancer risk (P Family HistoryFamily recital of offshoot tier relative with other types of cancer (nasopharyngeal, ovarian, Lung, bladder, stomach, or colon cancers) change magnitude the risk significantly (P Reproductive Risk Factors correspond to the productive factors (Table 3), women with late ages at menopauses (= 55 years old) (OR=2.8, 95%CI 1.18 6.67), or history of catamenial impairment (OR= 3.2, 95%CI 1.00 10.08) or who had neer breastfed (OR= 1.74, 95%CI= 1.09 2.76) were more likely to have breast cancer. The incumbrance encumbrance of breastfeeding pitch to be a duration dependent women who had breastfed for solitary(prenominal) few months had a higher risk by 1.51 ( 95%CI 0.83 2.77) compared to breastfed women for a tot of more than 1 year, and the risk adjoind in non-breastfed women to 2.08 (95%CI= 1.22 3.57). Nevertheless, no statistically significant association were observed between breast cancer and the age at menarche, number of children (parity), age at commencement exercise full term pregnancy, number of abortions and menopausal status.Life modal value and External Risk FactorsBreast cancer risk ratios were higher for women who had a history of benign breast disease (OR=2.8, 95%CI 1.13 6.88) and who had neer practiced low blubber fare (white meat, white fish, skinless chicken and evacuate deep fried food) (OR=1.81, 95%CI 1.14 2.86). However, other lifestyle factors like smoking, alcohol consumption, organic structure mass index (BMI = 25 kg/m2) and away hormone use, like OCP and HRT were not significant statistically to be risks for breast cancer.Multivariate ResultsAmong all factors included in the multivariable model (Table 5), occupation, breastfeeding and practicing low-fat diet play important tutelar roles against breast cancer unemployed women ( alter OR= 2.7, 95%CI 1.59 4.61), neer breastfed women (adjusted OR= 1.94, 95%CI 1.15 3.27) and never practiced low-fat d iet (adjusted OR = 1.97, 95%CI 1.18 3.27) were found to be associated with breast cancer risk as statistically significant separate factors. another(prenominal) factors contributing to breast cancer risk were family history of out-of-town relatives with breast cancer (adjusted OR= 3.70, 95%CI 1.48 -9.20) and premier degree relatives with other cancers (adjusted OR= 5.27, 95%CI 1.38 20.1). Also, women with histories of benign breast disease (adjusted OR= 3.14, 95%CI 1.17 8.40) and menstrual cycle irregularity (adjusted OR= 4.94, 95% CI 1.42 17.26) were more likely to have breast cancer. OCP use was significantly related to breast cancer risks however, this was not related to the duration. trance using OCP for 5 years increased the risk by moreover 3 times (95% CI 1.02 9.00).DISCUSSIONIn a pooled psychoanalysis of 150 breast cancer cases and 150 non-breast cancer controls, associations between breast cancer and various demographic, reproductive, and lifestyle factors were examined. Both cases and controls were chosen intentionally from the same hospital during the same study period.The risk of breast cancer has been reported to be associated with socio-demographic status 24-26. Age is a very important risk factor it was found that breast cancer incidence generally increases with age. The mean age at diagnosis for all breast cancer patients is 50.7 11.0 years. The greenback age reaches between 40 and 49 and thereafter the number of breast cancer patients decreases quite dramatically with only 4.0% above 70 years old (Figure 1). Also, only 2.0% of cases were diagnosed below the age of 30 which is consistent with Singletary distinguishings 3.According to the other socio-demographic factors studied, higher level of education has a restrictive effect (POccupation status also plays an important role as a protection factor against breast cancer in both univariate and multivariate analysis (P Family history is an important factor in our population an adj usted OR of 3.7 (95%CI = 1.48 9.2) was found for women with a distant relative with breast cancer, which is within the OR range reported by previous books 19, 37 and higher than that reported by others 3, 38. However, having set-back degree-relatives with breast cancer is not significantly related to the breast cancer risk (P 0.05). This may be explained partially because of the high frequency of controls (7 of 150 controls vs. 16 of 150 cases) that had first-degree relatives with breast cancer. Such a high number of family histories in controls may result in an underestimation of increased risk due to the family history.Furthermore, history of first degree relatives with other cancer (gastric, pancreatic, colon, lung carcinoma.etc) is significantly more frequent in patients than in controls with the adjusted odd ratio of 5.27 (95% CI= 1.38 20.1). Recently, it has been discovered that glob of first degree cases of breast, pancreas and stomach carcinomas in a family has been as sociated with mutations in the breast cancer susceptibility gene BRCA2 39.Breastfeeding is an important protective factor among our population women who had never breastfed their baby have a 1.74 (95%CI 1.09 2.76) higher risk of getting breast cancer and the adjusted odd ratio is 1.94 (ever versus never, 95%CI = 1.15 3.27) in the multivariate analysis. Our finding is in agreement with these studies 40-48, however, others failed to find any association 31, 36, 49-52.Moreover, the duration of breastfeeding has also an important effect found that the longer the nurseling period, the least the risk of breast cancer. This inverse relationship between the duration of breastfeeding and the risk of breast cancer have been suggested by other studies 46, 53-60, however, other revealed that this is mainly confined to women diagnosed before the age of 40 with a weak trend for older patients 61.History of irregular menstrual cycle (Polymenorrhea, Oligomenorrhea, or Amenorrhea) had an increase d risk the OR range (3.17- 4.94) and this supports the Turkish study 62 which found that menstrual irregularity increased the risk by 1.61 (95% CI 1.05-2.49). other(a)s 55, 63, 64 did not find any significant relation between menstrual irregularity and breast cancer risk. However, it has been reported that menstrual irregularity decreased the risk 65This study detected a significant association between viva contraceptive use and breast cancer, consistent with other local studies 27, 36, 66 and other international studies 46, 67. Whereas we could not find any relationship between the duration of OCP used and the risk of breast cancer, so our study does not support the growing body of evidence that long-term use of oral contraceptives, especially during certain parts of reproductive life, is associated with a abject increase in breast cancer risk 46, 68. However, most studies found no or weak association of OCP use with the risk of breast cancer 34, 69-71. The association between O CP use and breast cancer is also related to the duration, dosage, type of OCP and the age of first use 72.Previous history of benign breast disease is highly significant in the turn in study (P Practicing low-fat diet (take only white meat, white fish, and skinless chicken and ward off deep fried food) exhibited an inverse association with the risk of breast cancer, which is significant in both univariate and multivariate analysis (crude OR 1.81, 95%CI= 1.14 2.86) and (adjusted OR 1.96, 95%CI=1.18 3.27) respectively for women who had never practicing low fat diet. Red and fried meat consumption and fatty foods were suggested as important risk factors for breast cancer 11, 73. For each additional 100 g (3.5 oz) daily of meat consumption the risk of breast cancer increased risk by 56% in a French case-control study 13. Another cohort study 74 reported a significant relative risk (RR) of 1.7 for women who reported eating the skin on poultry. Null high consumptions of fatty forms, n amely fried fish and chicken with skin were associated with an increase of breast cancer risk 75. Other case-control studies reported a protective effect of poultry and fish against the development of breast cancer 76. Also, there was no evidence for a positive association between total dietary fat divine guidance and risk of breast cancer and no reduction in the risk even among women whose energy breathing in from fat was less than 20 percent of the total energy intake 77. almost case-control studies and cohort studies have shown weak and inconsistent associations between high intake of dietary fat and poultry with the occurrence of breast cancer 14, 78.Other well-established factors that have been studied smoking cigarettes, alcohol intake, regular use of HRT, pre and post-menopausal body mass index (BMI), marital status and the level of monthly income , age at menarche, age at first full-term pregnancy, number of abortions, menopausal status and parity were found not to be sig nificant in this study (P 0.05).Strength and LimitationTo our own knowledge, the present study is the first case-control study of breast cancer to investigate the risk factor in Penang Island, Malaysia. Both cases and control were matched by age group and ethnicity which add both(prenominal) strength to our study. This research studied almost all the socio-demographic, reproductive, lifestyle and external risk factors, so the confounding effects of all of these factors had been taken into musing when getting our result by multivariate analysis. Furthermore, the questionnaire was designed into two languages (English and Malay), thusly most of the three main ethnic groups in Penang (Chinese, Malay, and Indian) are legato in either or both of them.As other case-control studies, our work has some limitations. The question regarding menstrual history (age at menarche, age at menopause) of the respondent are likely to be bear on by abjure bias. There was a chance of error in recall especially for age at menarche that had been many decades earlier and this may have affected the results. We tried to minimize this bias through assisting the memory of subjects.Some of the Chinese cases were excluded due to the language barrier (they cannot speak Malay or English), that may cause some selection bias. Finally, generalizability of our findings may be precluded by our population features they have high mean ages, low educational level and become to a mid socioeconomic class, also by the difference in the ethnicity distribution among different Malaysia states.CONCLUSIONIn summarily, family history with breast cancer or other cancer, history of benign breast disease, menstrual irregularity, and oral contraceptive used were found to be significantly associated with increased breast cancer risk, whereas breastfeeding, occupation and practicing low fat diet have protective effects against breast cancer. Late age at menopause and education level are significant risk factor only in the univaraite analysis.REFERENCESLim, G. and Y. 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