Breast Cancer Symposium:
Reproductive risk factors associated with breast carcinoma in a tertiary care hospital of north India: A case‑control study
Original Article
Babita R, Kumar N, Karwasra RK1, Singh M1, Malik JS, Kaur A Departments of Community Medicine and 1General Surgery, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India Correspondence to: Dr. Babita, E‑mail: [email protected]
Abstract
CONTEXT: Worldwide, breast cancer is the most common cancer among women. In India and other developing countries, breast carcinoma ranks
second only to cervical carcinoma among women. But the incidence of breast cancer is on the rise and may become number one cancer in females in near future. AIMS: (1) To find out the magnitude of reproductive risk factors of carcinoma breast among the study subjects; and (2) to find out the association of reproductive risk factors with breast carcinoma. MATERIALS AND METHODS: The study was done in the wards of General Surgery and Oncosurgery from August 2009‑July 2010 in a tertiary care institute. A total of 128 histopathologically confirmed cases of breast cancer those came in this duration were considered. Equal controls were selected by simple random sampling by lottery method. The controls were matched for age with a range of ± 2 years. The subjects were interviewed using a pre‑tested questionnaire. Written informed consent was taken from study subjects before starting the interview. STATISTICAL ANALYSIS USED: Chi‑square test, odds ratio with 95% confidence interval, and t test. RESULTS: The age group of the cases was 25‑78 years, whereas that of the controls was 24‑79 years. The difference among cases and controls regarding age at marriage, age at menarche, age at menopause, age at first pregnancy, and number of children was statistically significant. Continuous variables of the study population were analyzed by independent t tests, in which age at menarche and age at first pregnancy were found statistically significant. CONCLUSIONS: Information, education, and communication activities regarding risk factors and breast self‑examination should be imparted to the women to create awareness about this fatal disease. Key Words: Breast cancer, case control, risk factors
Introduction Worldwide, breast cancer is the most common cancer among women. Globally, every 3 min a woman is diagnosed with breast cancer, amounting to one million cases annually. According to World Cancer Report the incidence could go up to 1.5 million by 2020.[1] It is reported that 1 in 22 women in India is likely to suffer from breast cancer during her lifetime, while the figure is definitely more in America with 1 in 8 being a victim of this deadly cancer.[2] In India and other developing countries, breast carcinoma ranks second only to cervical carcinoma among women. But the incidence of breast cancer is on the rise and may become number one cancer in females in the near future. The age‑adjusted incidence rates varied between 16 and 25/100,000 populations. At present, India reports around 100,000 new cases annually. According to a study by the International Agency for Research on Cancer (IARC), there will be approximately 250,000 new cases of breast cancer in India by 2015.[1] Under the National Cancer Registry Programme (NCRP), the Indian Council of Medical Research commenced a network of cancer registries across the country in December 1981. The consolidated report of population‑based cancer registries (PBCRs) was published in 2005. It consisted of 2 years data (1999‑2000) of the 5 urban (Bangalore, Bhopal, Chennai, Delhi, and Mumbai) and 1 rural (Barshi) PBCR. The report released in December 2006 covers (a) the data of the 6 registries—Bangalore, Bhopal, Chennai, Delhi, Mumbai, and Barshi for the years 2001‑2003, (b) the 6 PBCRs (Aizawl District, Dibrugarh District, Kamrup Urban District, Silchar Town, Imphal West District, and Sikkim State) in the North East for the year 2003‑2004, Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146759 PMID: *******
Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
and (c) that of the Ahmedabad PBCR covering Ahmedabad District (other than Ahmedabad Urban) for the year 2004. In the PBCR report, among females, breast cancer was the leading site of cancer in all registries, except in Barshi. This was followed by cancer cervix as the second leading site of cancer. In Barshi, the leading site of cancer was cervix uteri constituting 36.8% of all cancers followed by breast. Hospital‑ based cancer registries reported more cases of breast cancer than cervical cancer in Mumbai, Dibrugarh, and Thiruvananthapuram and more cases of cervical cancer than breast cancer in Bangalore and Chennai. The increase in the breast cancer cases is mainly being documented in the metropolitan cities; but this data is not totally reliable as many cases in the rural areas go unnoticed.[3] Reproductive and hormonal factors contribute most to the development of breast cancer. Among these, the high‑risk reproductive factors are Early menarche, late menopause, late first full‑term pregnancy and nulliparity[4] Nulliparity, more age at first live birth and no breastfeeding are major reproductive risk factors for breast cancer in the developed countries. The role of reproductive factors in the development of breast cancer in Indian population is different as compared with that seen in the western population. This is because parity, younger age at first live birth, and lactation practices are part of our culture, whereas these factors are far less prevalent in western women. Geographic variation in the incidence of breast cancer can be attributed to exposure to various risk factors. Risk of breast cancer increases in successive generations of people moving from low‑risk areas to high‑risk regions proving that changes in reproductive behavior and lifestyle are more important than hereditary factors in the development of breast cancer.[5] These factors are mainly responsible for the variation in breast cancer incidence seen in different regions of the world by virtue of their different prevalence in these regions. The following study was undertaken to find the magnitude of reproductive risk factors and the association of these factors with carcinoma breast among the study subjects in a tertiary care hospital of north India. 251
Babita, et al.: Reproductive risk factors
Aims
Results
• To find out the magnitude of reproductive risk factors of carcinoma breast among study subjects. • To find out the association of reproductive risk factors with breast carcinoma.
All the data were coded and entered into computer. Cases and controls were matched for age with the range of ±2 years. Age group of the cases was 25‑78 years, whereas that of the controls was 24‑79 years. Maximum number of the cases (93.8%) and controls (97.7%) belonged to the Hindu community; rest of the study population comprised Muslims and Sikhs. No Christians could be included in the study. The proportion of cases (56.3%) and controls (63.3%) living in rural areas were more than those living in the urban areas.
Materials and Methods An interview based case‑control study was carried out in the wards of Oncosurgery and General Surgery in a tertiary care institute of north India. About 125‑150 new patients of breast carcinoma are admitted annually for treatment in the Department of Oncosurgery in this institute. All the newly diagnosed women with breast cancer admitted in the Oncosurgery ward during 1‑year period were taken as study subjects. The study was conducted from August 2009 to July 2010. A written informed consent was taken from study subjects before starting the interview. A total of 128 women, with histopathologically confirmed breast cancer, who consented were included in the study The study subjects were interviewed once only and their registration number were recorded to prevent double counting of the same subject. Wards were visited twice weekly and any new cases were included in the study, after explaining the objectives of the study to the subject. Controls were selected from the indoor female patients admitted for a wide spectrum of general surgical procedures in the General Surgery ward of the same institute without having any type of cancer. Controls were also selected twice a week by simple random sampling using lottery method. Controls were matched for age with range of ±2 years. Case to control ratio was 1:1. Study subjects were interviewed personally and the information was recorded in the semi‑structured pretested proforma. Women were labeled as menopausal if they have not menstruated during the previous 6 months before the date of data collection. The primary concern was on quality of data collection. An attempt to minimize recall bias, associated with timing of a particular event, was made by asking questions about the related important events in the respondent’s life; for example, information about age of menarche was not remembered correctly by some of the respondents, in these respondents information was deduced by correlating age of menarche with the age of marriage. Exclusion criteria for cases
• Women with hysterectomy and artificial menopause • Women aged 80 years. Exclusion criteria for controls
• Women with hysterectomy and artificial menopause • Women aged 80 years • Women with breast or any other carcinoma. Statistical methods
The categorical data were analyzed statistically using Chi‑square test and odds ratio (OR) with 95% confidence interval (CI). Continuous variables were analyzed using independent t test. All the analyses were performed with Statistical Package for Social Sciences (SPSS) version 17. 252
In maximum cases (54.7%), the age at marriage was between 15 and 20 years, followed by
Reproductive risk factors associated with breast carcinoma in a tertiary care hospital of north India: A case‑control study
Original Article
Babita R, Kumar N, Karwasra RK1, Singh M1, Malik JS, Kaur A Departments of Community Medicine and 1General Surgery, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India Correspondence to: Dr. Babita, E‑mail: [email protected]
Abstract
CONTEXT: Worldwide, breast cancer is the most common cancer among women. In India and other developing countries, breast carcinoma ranks
second only to cervical carcinoma among women. But the incidence of breast cancer is on the rise and may become number one cancer in females in near future. AIMS: (1) To find out the magnitude of reproductive risk factors of carcinoma breast among the study subjects; and (2) to find out the association of reproductive risk factors with breast carcinoma. MATERIALS AND METHODS: The study was done in the wards of General Surgery and Oncosurgery from August 2009‑July 2010 in a tertiary care institute. A total of 128 histopathologically confirmed cases of breast cancer those came in this duration were considered. Equal controls were selected by simple random sampling by lottery method. The controls were matched for age with a range of ± 2 years. The subjects were interviewed using a pre‑tested questionnaire. Written informed consent was taken from study subjects before starting the interview. STATISTICAL ANALYSIS USED: Chi‑square test, odds ratio with 95% confidence interval, and t test. RESULTS: The age group of the cases was 25‑78 years, whereas that of the controls was 24‑79 years. The difference among cases and controls regarding age at marriage, age at menarche, age at menopause, age at first pregnancy, and number of children was statistically significant. Continuous variables of the study population were analyzed by independent t tests, in which age at menarche and age at first pregnancy were found statistically significant. CONCLUSIONS: Information, education, and communication activities regarding risk factors and breast self‑examination should be imparted to the women to create awareness about this fatal disease. Key Words: Breast cancer, case control, risk factors
Introduction Worldwide, breast cancer is the most common cancer among women. Globally, every 3 min a woman is diagnosed with breast cancer, amounting to one million cases annually. According to World Cancer Report the incidence could go up to 1.5 million by 2020.[1] It is reported that 1 in 22 women in India is likely to suffer from breast cancer during her lifetime, while the figure is definitely more in America with 1 in 8 being a victim of this deadly cancer.[2] In India and other developing countries, breast carcinoma ranks second only to cervical carcinoma among women. But the incidence of breast cancer is on the rise and may become number one cancer in females in the near future. The age‑adjusted incidence rates varied between 16 and 25/100,000 populations. At present, India reports around 100,000 new cases annually. According to a study by the International Agency for Research on Cancer (IARC), there will be approximately 250,000 new cases of breast cancer in India by 2015.[1] Under the National Cancer Registry Programme (NCRP), the Indian Council of Medical Research commenced a network of cancer registries across the country in December 1981. The consolidated report of population‑based cancer registries (PBCRs) was published in 2005. It consisted of 2 years data (1999‑2000) of the 5 urban (Bangalore, Bhopal, Chennai, Delhi, and Mumbai) and 1 rural (Barshi) PBCR. The report released in December 2006 covers (a) the data of the 6 registries—Bangalore, Bhopal, Chennai, Delhi, Mumbai, and Barshi for the years 2001‑2003, (b) the 6 PBCRs (Aizawl District, Dibrugarh District, Kamrup Urban District, Silchar Town, Imphal West District, and Sikkim State) in the North East for the year 2003‑2004, Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146759 PMID: *******
Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
and (c) that of the Ahmedabad PBCR covering Ahmedabad District (other than Ahmedabad Urban) for the year 2004. In the PBCR report, among females, breast cancer was the leading site of cancer in all registries, except in Barshi. This was followed by cancer cervix as the second leading site of cancer. In Barshi, the leading site of cancer was cervix uteri constituting 36.8% of all cancers followed by breast. Hospital‑ based cancer registries reported more cases of breast cancer than cervical cancer in Mumbai, Dibrugarh, and Thiruvananthapuram and more cases of cervical cancer than breast cancer in Bangalore and Chennai. The increase in the breast cancer cases is mainly being documented in the metropolitan cities; but this data is not totally reliable as many cases in the rural areas go unnoticed.[3] Reproductive and hormonal factors contribute most to the development of breast cancer. Among these, the high‑risk reproductive factors are Early menarche, late menopause, late first full‑term pregnancy and nulliparity[4] Nulliparity, more age at first live birth and no breastfeeding are major reproductive risk factors for breast cancer in the developed countries. The role of reproductive factors in the development of breast cancer in Indian population is different as compared with that seen in the western population. This is because parity, younger age at first live birth, and lactation practices are part of our culture, whereas these factors are far less prevalent in western women. Geographic variation in the incidence of breast cancer can be attributed to exposure to various risk factors. Risk of breast cancer increases in successive generations of people moving from low‑risk areas to high‑risk regions proving that changes in reproductive behavior and lifestyle are more important than hereditary factors in the development of breast cancer.[5] These factors are mainly responsible for the variation in breast cancer incidence seen in different regions of the world by virtue of their different prevalence in these regions. The following study was undertaken to find the magnitude of reproductive risk factors and the association of these factors with carcinoma breast among the study subjects in a tertiary care hospital of north India. 251
Babita, et al.: Reproductive risk factors
Aims
Results
• To find out the magnitude of reproductive risk factors of carcinoma breast among study subjects. • To find out the association of reproductive risk factors with breast carcinoma.
All the data were coded and entered into computer. Cases and controls were matched for age with the range of ±2 years. Age group of the cases was 25‑78 years, whereas that of the controls was 24‑79 years. Maximum number of the cases (93.8%) and controls (97.7%) belonged to the Hindu community; rest of the study population comprised Muslims and Sikhs. No Christians could be included in the study. The proportion of cases (56.3%) and controls (63.3%) living in rural areas were more than those living in the urban areas.
Materials and Methods An interview based case‑control study was carried out in the wards of Oncosurgery and General Surgery in a tertiary care institute of north India. About 125‑150 new patients of breast carcinoma are admitted annually for treatment in the Department of Oncosurgery in this institute. All the newly diagnosed women with breast cancer admitted in the Oncosurgery ward during 1‑year period were taken as study subjects. The study was conducted from August 2009 to July 2010. A written informed consent was taken from study subjects before starting the interview. A total of 128 women, with histopathologically confirmed breast cancer, who consented were included in the study The study subjects were interviewed once only and their registration number were recorded to prevent double counting of the same subject. Wards were visited twice weekly and any new cases were included in the study, after explaining the objectives of the study to the subject. Controls were selected from the indoor female patients admitted for a wide spectrum of general surgical procedures in the General Surgery ward of the same institute without having any type of cancer. Controls were also selected twice a week by simple random sampling using lottery method. Controls were matched for age with range of ±2 years. Case to control ratio was 1:1. Study subjects were interviewed personally and the information was recorded in the semi‑structured pretested proforma. Women were labeled as menopausal if they have not menstruated during the previous 6 months before the date of data collection. The primary concern was on quality of data collection. An attempt to minimize recall bias, associated with timing of a particular event, was made by asking questions about the related important events in the respondent’s life; for example, information about age of menarche was not remembered correctly by some of the respondents, in these respondents information was deduced by correlating age of menarche with the age of marriage. Exclusion criteria for cases
• Women with hysterectomy and artificial menopause • Women aged 80 years. Exclusion criteria for controls
• Women with hysterectomy and artificial menopause • Women aged 80 years • Women with breast or any other carcinoma. Statistical methods
The categorical data were analyzed statistically using Chi‑square test and odds ratio (OR) with 95% confidence interval (CI). Continuous variables were analyzed using independent t test. All the analyses were performed with Statistical Package for Social Sciences (SPSS) version 17. 252
In maximum cases (54.7%), the age at marriage was between 15 and 20 years, followed by
