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Risk factors for breast cancer of different age groups: Moroccan data?

Risk factors for breast cancer of different age groups: Moroccan data?. Fatima Zahra Laamiri 1 Abdellatif Bouayad 2 Nadia Hasswane 3 Samir Ahid 4 , Mustapha Mrabet 1 , BARKAT Amina 1

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Risk factors for breast cancer of different age groups: Moroccan data?

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  1. Risk factors for breast cancer of different age groups: Moroccan data? Fatima Zahra Laamiri1Abdellatif Bouayad2 Nadia Hasswane3SamirAhid4, Mustapha Mrabet1, BARKAT Amina1 1Faculty of Medicine and Pharmacy/Research Team in Maternal and Child Health and Nutrition, Mohammed V University, Rabat, Morocco ; 2Laboratory of Immunology, Institut Pasteur of Morocco, Casablanca, Morocco ; 3Faculty of Medicine and Pharmacy/ hospital Sidilahsen ,Temara, Morocco; 4the Faculty of Medicine and Pharmacy and the Pharmacy Unit at the National Institute of Oncology, Rabat, Morocco

  2. INTRDUCTION Breast cancer occupies the first place in women because of its high rates of incidence and mortality [1], it is a hormone-related cancer [2] which incidence is increasing. In Morocco, breast cancer is one of the most important public health problems, because the diagnosis is often delayed and the management is difficult and expensive. According to the population register of the Casablanca city, the annual national cancer incidence is estimated at 35000 new cancer cases a year of which only 12000 are supported. Several risk factors are known: age (incidence increased after age 30), family history related to the BRCA1 or BRCA2 genes (5% of all cancers), endogenous hormonal factors (early age at menarche, late menopause), exogenous hormonal factors (oral contraceptives, hormone replacement treatment), reproductive factors (not pregnant or late pregnancies after 30 years, not breastfeeding), family history of breast cancer, exposure to ionizing radiation, oral contraceptives, hormone replacement therapy for menopause, obesity and dietary factors[3]. Among the factors cited above, some are associated with an increased risk of breast cancer, others are considered protective factors. Therefore, the acquisition of basic knowledge on the mechanisms of oncogenesis related to these factors is an essential scientific direction for the improvement of current therapies and the development of new therapeutic approaches. Objective The aim of our study was to analyze the relation ship between risk factors and breast cancer in different age groups of Moroccan women with breast cancer compared to healthy controls. METHODS We conducted a case-control study at the National Institute of Oncology Sidi Mohamed Ben Abdallah, Rabat in which we included a population of Moroccan women(collected between December 2008 and December 2010) . The information collected were: (1) age, (2) menopausal status, (3) age at menopause, (4) Body Mass Index, (5) the age at menarche, (6) age at first full term pregnancy, (7) the number of children, (8) the duration of breastfeeding for each child, (9) oral contraceptives, (10) the hormone replacement therapy,(11) family history and (12) exposure to irradiation. To meet the objective of our study we formed three groups of women according to age: (i) resolve 22-34 years, (ii) resolve 35-44 years, (iii) slice 45 years and over and we tried to study in each of these groups a number of population risk factors implicated in mammary carcinogenesis and having made ​​the subject of a number of epidemiological studies.

  3. Table1 Demographic and epidemiological characteristics of control and breast cancer patientsa RESULTS • Table 2 Hormonal factors in the overall series and in different age groups of control and breast cancer patientsa a Values are expressed as count and percentage.

  4. Table 3 Reproductive factors in the overall series and in different age groups of control and breast cancer patients a Table 4 Family historyand health factors in different age groups of control and breast cancer patientsa • a Values are expressed as count and percentage.

  5. DISCUSSION In the present case-control study, we found several risk factors associated with breast cancer in a population of Moroccan women. Firstly, women with early age of menarche are more prone to develop breast cancer than that of the last age of menarche. This association of the early age of menarche was significantly increased in the age subgroup between 22 and 34 years.These findings are in line with other studies[4].Breast cancer shows a strong linked to the early age of menarche and additional years for age at menarche decreased by 5% risk of developing breast cancer[5].The most convincing explanation for the latter remains the hormonal impregnation that exists during the period of activity of the ovaries [6]. In our population, late age at menopause was also found to bestrongly linked to the presence of breast cancer. This association of late age at menopause is now largely supported by data from 51 epidemiological studies conducted by the collaborative group on hormonal factors in breast cancer [7], which suggested that late menopause increases the risk of breast cancer by prolonged ovarian hormone production. One of the striking findings of the present study is that the risk of breast cancer is increased with oral contraceptives beyond 6 months.Indeed, the extensive use of contraceptives at a late age of reproductive life leads to a significant increase of developing breast cancer [8]. No association was observed between breast cancer and hormone replacement therapy. Conflicting results have been reported regarding this result. Another important finding of the present study is that, early age at first pregnancy, multiparity and lactation were negatively associated with breast cancer suggested a protective effect of these factors for breast cancer. A protective role of the multiparity was consistent with the data in the literature that considers multiparity as a protective factor in breast carcinogenesis. The protective role of parity increases proportionately with the number of children and the early age at first birth. Thus, a first pregnancy before 30 years reduces the risk by 25% compared to a woman who has not had children[9]. In our study population, the frequency of women having their first full term pregnancy at an early age (below 30 years) was significantly decreased in the patient population compared to the control population. This decrease was also observed in a different age of our study population groups. Breastfeeding as a protective factor is still debated[10]. The effect of breastfeeding on the risk of breast cancer has been the subject of several studies and the results are controversial. This inverse association between breastfeeding and the risk of breast cancer can be explained by the following biological mechanisms: • Lactation can suppress the occurrence and development of breast cancer by reducing estrogen levels and increased prolactin production, which are supposed to reduce cumulative exposure to estrogen in women[11]. • - The protective effect of breastfeeding to be due to its role in the shift of restoring ovulation (risk factor). It was reported that a family history of breast cancer is strongly associated with breast cancer with a 2-3 fold increased risk, suggesting a stronger genetic component, and perhaps stronger associations with specific genes. In our work the risk arising from at last one family history of breast cancer among first degree relatives was elevated among all age groups of female patients compared with control women. This finding is in line with previous reports that found an association of family history with breast cancer. Surprisingly, we did not find familial history among second degree relatives of breast cancer or radiation exposure to be a predictor’s risk factor for breast cancer. REFERENCES CONCLISION [1] J Fearly, HR Shin, F Bray, D Forman, C Mathers, DM Parkin: Estimates of worlde wide burden of cancer in 2008:GLOBOCAN 2008. Int J Cancer2010, 127:2893- 2917. [2] TJ Key, MC Pike:The role of oestrogens and progestagens in the epidemiology and prevention of breast cancer. Eur J cancer ClinOncol1988, 24:29 -43. [3] A Nkondjock, P Ghadirian:Facteurs de risque du cancer du sein. M/S 2005,21:175-180. [4] A Richard : Première régles : l’age de survenue en baisse chez les adolescents américains. Journal of pediatrics 2005, 147:753-760. [5] DJ Hunter, D Spiegelman, HO Adami,etal:Non-dietary factors as risk factors for breast cancer and as effect modifiers of the association of fat intake and risk of breast cancer. CancerCauses Control 1997,8: 49-56. [6] F Clavel- Chapelon: Cumulative number of menstrual cycles and breast cancer risk: results from the E3N cohort study of French women. Cancer Causes Control 2002,13:831-838. [7] Collaborative group on hormonal factors in breast cancer: Breast cancer and hormonal replacement therapy: collaborative reanalysis of individual data from 51epidemiological studies of 52.705 women with breast cancer and 108.411 women without breast cancer. Lancet1997, 350: 1047-1059. [8] Collaborative groups on hormonal factors in breast cancer: Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53.297 women with breast cancer and 100.239 women without breast cancer from 54 epidemiological studies. Lancet 1996, 347: 1713-1727. [9] M Ewertz, S W Duffy, HO Adami et al: Age at first birth parity and risk of breast cancer: a meta-analysis of 8 studies from Nordic countries.Int J Cancer1990,46: 597-603. [10] L Lipworth, R Bailey, D Trichopoulos: History of breast-feeding in relation to breast cancer risk: a review of the epidemiologic literature. J Natl cancer Inst2000,92:302-312. [11] TJ Key, MC Pike:The role of oestrogens and progestagens in the epidemiology and prevention of breast cancer. Eur J cancer ClinOncol1988, 24:29 -43. Our study demonstrates a significant positive association between certain risk factors in particular, those related to hyperestrogenism (early age of menarche, age late menopause and use of oral contraceptives) and family history, and breast cancer in Moroccan women. Moreover, we found early age at first full-term pregnancy, multiparity and lactation as the most important protective factors in our population.

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