泸州市乳腺癌危险因素病例对照研究

A case-control study of the risk factors for breast cancer in Luzhou,China

目的:通过病例对照研究探讨泸州地区乳腺癌危险因素,为当地制定乳腺癌预防策略提供依据。方法:采用1∶1匹配的病例对照研究,以西南医科大学附属医院首次确诊的乳腺癌手术患者为病例组,按照年龄±3岁、居住地区为匹配条件选择乳腺癌患者所居住的村或街道没有患乳腺癌的邻居为对照组。按居住地区和绝经状态分层分析城市和农村、绝经前后乳腺癌的危险因素。结果:单因素分析结果:初潮年龄、粗粮、豆类、情绪状态(抑郁和易怒)在乳腺癌组和对照组存在差异(P <0.05)。多因素分析结果显示:初潮年龄晚(OR=0.815,95%CI:0.722~0.919),分娩次数多(OR=0.777,95%CI:0.615~0.983),豆类(OR=0.267,95%CI:0.137~0.524)和粗粮(OR=0.272,95%CI:0.132~0.56)的摄入是乳腺癌的保护因素,过去一年有连续两周以上心情抑郁(OR=3.339,95%CI:1.675~6.659),有两年以上大多数时间内心情抑郁(OR=2.3,95%CI:1.047~5.055)是乳腺癌的危险因素。城市农村分层多因素分析结果显示:过去一年有连续两周以上易怒(OR_(农村)=1.769,95%CI:1.058~2.957;OR_(城市)=9.168,95%CI:3.291~25.539)是农村和城市的共同危险因素。在城市妇女中,人流次数(OR=1.477,95%CI:1.123~1.941)是危险因素,新鲜水果(OR=0.124,95%CI:0.025~0.624)的摄入是保护因素。在农村妇女中,初潮年龄晚(OR=0.83,95%CI:0.729~0.945),豆类(OR=0.115,95%CI:0.048~0.277)和粗粮(OR=0.114,95%CI:0.039~0.337)的摄入是保护因素,过去一年有连续两周以上心情抑郁(OR=3.304,95%CI:1.58~6.909),有两年以上大多数时间内心情抑郁(OR=2.481,95%CI:1.093~5.631)是危险因素。未绝经与已绝经分层多因素分析结果显示:过去一年有连续两周以上心情抑郁(OR_(未绝经)=4.947,95%CI:1.802~13.582;OR_(已绝经)=4.497,95%CI:2.224~9.092)是危险因素。在已绝经妇女中,初潮年龄晚(OR=0.792,95%CI:0.675~0.929)和豆类的摄入(OR=0.115,95%CI:0.045~0.296)是保护因素,有两年以上大多数时间易怒(OR=1.927,95%CI:1.007~3.687)是危险因素。在未绝经妇女中,过去一年有连续两周以上易怒(OR=3.178,95%CI:1.31~7.709)是危险因素。结论:人流次数、情绪状态(心情抑郁和易怒)是乳腺癌的危险因素,初潮年龄晚、分娩次数多、豆类和粗粮摄入是乳腺癌的保护因素,而且存在明显的城乡差异。因此在制定乳腺癌预防措施时要注意城乡差别。

Objective:To investigate the risk factors for breast cancer in Luzhou,China through a case-control study,and to provide a basis for developing prevention strategies for breast cancer.Methods:A case-control study matched at a ratio of 1:1 was performed.The patients with breast cancer who were diagnosed for the first time in The Affiliated Hospital of Southwest Medical University were enrolled as case group,and with an age of ±3 years and place of residence as matching conditions,the neighbors without breast cancer who lived in the same village or subdistrict as the breast cancer patients were enrolled as control group.A stratified analysis based on place of residence and menopause was performed to investigate the risk factors for breast cancer in urban or rural areas and before or after menopause.Results:The univariate analysis showed that there were significant differences between the case group and the control group in age of menarche,intake of coarse grains,intake of beans,and emotional state(depression and irritability)(P <0.05).The multivariate analysis showed that late age of menarche(odds ratio [OR]=0.815,95% confidence interval [CI]:0.722~0.919),high number of childbirths(OR=0.777,95% CI:0.615~0.983),intake of beans(OR=0.267,95% CI:0.137~0.524),and intake of coarse grains(OR=0.272,95% CI:0.132~0.56) were protective factors against breast cancer,while depression for more than two consecutive weeks in the past year(OR=3.339,95% CI:1.675~6.659) and depression for most of the times in more than two years(OR=2.3,95% CI:1.047~5.055) were risk factors for breast cancer.The multivariate stratified analysis for urban and rural areas showed that getting irritable for more than two consecutive weeks in the past year(ORrural=1.769,95% CI:1.058~2.957;ORurban=9.168,95% CI:3.291~25.539) was a common risk factor for breast cancer in both rural and urban areas.For women in the urban area,number of abortions(OR=1.477,95% CI:1.123~1.941) was a risk factor,while intake of fresh fruits(OR=0.124,95% CI:0.025~0.624) was a protective factor against breast cancer.For women in the rural area,late age of menarche(OR=0.83,95% CI:0.729~0.945),intake of beans(OR=0.115,95% CI:0.048~0.277),and intake of coarse grains(OR=0.114,95% CI:0.039~0.337) were protective factors against breast cancer,and depression for more than two consecutive weeks in the past year(OR=3.304,95% CI:1.58~6.909) and depression for most of the times in more than two years(OR=2.481,95% CI:1.093~5.631)were risk factors for breast cancer.The multivariate stratified analysis for pre-menopausal and post-menopausal women showed that depression for more than two consecutive weeks in the past year(ORpre-menopausal=4.947,95% CI:1.802~13.582;ORpost-menopausal=4.497,95% CI:2.224~9.092) was a risk factor for breast cancer.For post-menopausal women,late age of menarche(OR=0.792,95% CI:0.675~0.929) and intake of beans(OR=0.115,95%CI:0.045~0.296) were protective factors against breast cancer,while getting irritable for most of the times in more than two years(OR=1.927,95% CI:1.007~3.687) was a risk factor for breast cancer.For pre-menopausal women,getting irritable for more than two consecutive weeks in the past year(OR=3.178,95% CI:1.31~7.709) was a risk factor for breast cancer.Conclusion:Number of abortions and emotional state(depression and irritation) are risk factors for breast cancer,and late age of menarche,high number of childbirths,and intake of beans and coarse grains are protective factors against breast cancer,with significant differences between the urban and rural areas,which should be taken seriously in developing prevention strategies for breast cancer.