背景:先前的研究发现各种非遗传因素与乳腺癌(BrCa)风险之间存在关联。这项研究总结并评估了有关非遗传因素与BrCa风险之间关联的现有证据的可信度。
方法:我们对meta分析进行了综述。Medline,Scopus,系统检索Cochrane数据库中的非遗传因素和BrCa发病率或死亡率的meta分析.证据的强度分为四类(即,弱,暗示,高度暗示性,令人信服)。
结果:对来自280篇出版物的781项meta分析进行了评估和分级。我们包括了与人体测量相关的暴露,生物标志物,乳房特征和疾病,饮食和补充剂,环境,外源激素,生活方式和社会因素,病史,药物,生殖史,和怀孕。在饮食和补充剂类别以及阿司匹林使用和主动吸烟等暴露方面,所检查的关联数量最多。统计学意义(P值<0.05)的荟萃分析为382(49%),其中204例(53.4%)报告了与BrCa风险增加相关的因素。大多数具有统计学意义的证据(n=224,58.6%)被分级为弱证据。发现体重指数(BMI)增加与BrCa风险增加有关的有害关联,绝经后妇女的BMI和体重增加,绝经前妇女使用口服避孕药,雄烯二酮增加,雌二醇,estrone,和睾酮浓度,高乳腺影像报告和数据系统(BIRADS)分类,乳腺密度增加.与较低BrCa风险相关的令人信服的保护因素包括高纤维摄入量和高性激素结合球蛋白(SHBG)水平,而高度暗示性保护因素包括高25羟维生素D[25(OH)D]水平,坚持健康的生活方式,和中等强度的体力活动。
结论:我们的研究结果提示了一些高度可改变的保护BrCa的因子。有趣的是,虽然饮食是研究最多的接触类别,相关协会未能达到更高水平的证据,这表明了该领域的方法论局限性。为了提高这些关联的有效性,未来的研究应该利用更稳健的研究设计和更好的暴露评估技术。总的来说,我们的研究提供了支持基于证据的BrCa预防建议和指导的发展的知识,在个人层面和公共卫生举措。
背景:PROSPEROCRD42022370675。
BACKGROUND: Previous research has found associations between various non-genetic factors and breast cancer (BrCa) risk. This study summarises and appraises the credibility of the available evidence on the association between non-genetic factors and BrCa risk.
METHODS: We conducted an umbrella review of meta-analyses. Medline, Scopus, and the Cochrane databases were systematically searched for meta-analyses examining non-genetic factors and BrCa incidence or mortality. The strength of the evidence was graded in four categories (i.e., weak, suggestive, highly suggestive, convincing).
RESULTS: A total of 781 meta-analyses from 280 publications were evaluated and graded. We included exposures related to anthropometric measurements, biomarkers, breast characteristics and diseases, diet and supplements, environment, exogenous hormones, lifestyle and social factors, medical history, medication, reproductive history, and pregnancy. The largest number of examined associations was found for the category of diet and supplements and for exposures such as aspirin use and active smoking. The statistically significant (P-value < 0.05) meta-analyses were 382 (49%), of which 204 (53.4%) reported factors associated with increased BrCa risk. Most of the statistically significant evidence (n = 224, 58.6%) was graded as weak. Convincing harmful associations with heightened BrCa risk were found for increased body mass index (BMI), BMI and weight gain in postmenopausal women, oral contraceptive use in premenopausal women, increased androstenedione, estradiol, estrone, and testosterone concentrations, high Breast Imaging Reporting and Data System (BIRADS) classification, and increased breast density. Convincing protective factors associated with lower BrCa risk included high fiber intake and high sex hormone binding globulin (SHBG) levels while highly suggestive protective factors included high 25 hydroxy vitamin D [25(OH)D] levels, adherence to healthy lifestyle, and moderate-vigorous physical activity.
CONCLUSIONS: Our findings suggest some highly modifiable factors that protect from BrCa. Interestingly, while diet was the most studied exposure category, the related associations failed to reach higher levels of evidence, indicating the methodological limitations in the field. To improve the validity of these associations, future research should utilise more robust study designs and better exposure assessment techniques. Overall, our study provides knowledge that supports the development of evidence-based BrCa prevention recommendations and guidance, both at an individual level and for public health initiatives.
BACKGROUND: PROSPERO CRD42022370675.