Birth Weight and Breast Cancer
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《新英格兰医药杂志》
To the Editor: Ahlgren et al. (Oct. 14 issue)1 report the importance of both birth weight and childhood growth on the risk of breast cancer. Although the authors do not provide information about early growth (from the postnatal period to the age of eight years) or birth length, the size of their study permits additional analyses to enhance our understanding of how growth patterns relate to disease.2 For example, were there any interactions between birth weight and childhood body size? Underweight babies who are well nourished in early childhood may have a greater risk of chronic disease later in life because of the hormonal changes that accompany rapid catch-up growth.3,4,5 If so, persons with a low birth weight and peak height at an early age may have a greater increase in the risk of breast cancer than persons with a higher birth weight whose peak height occurs later. Babies who have "catch-down" growth may also have a different risk profile. Since the effect of menarche on breast cancer was mediated by other growth variables, models showing how measures of growth in infancy and early childhood are associated with markers of intermediate growth, including age at peak height, would provide crucial insight into the underlying pathways.
Mary Beth Terry, Ph.D.
Mailman School of Public Health
New York, NY 10032
mt146@columbia.edu
References
Ahlgren M, Melbye M, Wohlfahrt J, Sorensen TI. Growth patterns and the risk of breast cancer in women. N Engl J Med 2004;351:1619-1626.
Terry MB, Susser E. The impact of fetal and infant exposures along the life course. Int J Epidemiol 2001;30:95-96.
Stoll BA. Western diet, early puberty, and breast cancer risk. Breast Cancer Res Treat 1998;49:187-193.
Johnston LB, Dahlgren J, Leger J, et al. Association between insulin-like growth factor I (IGF-I) polymorphisms, circulating IGF-I, and pre- and postnatal growth in two European small for gestational age populations. J Clin Endocrinol Metab 2003;88:4805-4810.
Ben-Shlomo Y, Holly J, McCarthy A, et al. An investigation of fetal, postnatal and childhood growth with insulin-like growth factor I and binding protein 3 in adulthood. Clin Endocrinol (Oxf) 2003;59:366-373.
To the Editor: Ahlgren et al. report that birth weight and childhood growth influence the risk of breast cancer. We recently analyzed these relationships in a British cohort followed from birth to the age of 53 years.1,2 A higher risk of breast cancer at the age of 53 years was associated, in multivariable models, with the gain in height between 4 and 7 years and between 11 and 15 years and with the decrease in the body-mass index between 2 and 4 years. These effects were stronger the earlier the age at menarche, reflecting a similar pattern in the relationship between adult height and the risk of breast cancer (Table 1). Thus, it appears that women who grew faster in early childhood, had an earlier menarche, and continued to grow during the postpubertal period, reaching an adult height that was above average for their age at menarche, were at greatest risk. Our findings, although based on a limited number of cancers in relatively young women, may help elucidate the complex relations among childhood growth, the onset of menarche, and the risk of breast cancer that are described — but not explained — in the report by Ahlgren et al.
Table 1. Relative Risks of Breast Cancer Associated with 1-SD Increases in Anthropometric Measures at Certain Ages, According to the Age at Menarche.
Bianca L. De Stavola, Ph.D.
Isabel dos Santos Silva, M.D., Ph.D.
London School of Hygiene and Tropical Medicine
London WC1E 7HT, United Kingdom
bianca.destavola@lshtm.ac.uk
Michael J. Wadsworth, Ph.D.
Royal Free and University College Medical School
London WC1E 6BT, United Kingdom
References
De Stavola BL, dos Santos Silva I, McCormack V, Hardy RJ, Kuh DJ, Wadsworth ME. Childhood growth and breast cancer. Am J Epidemiol 2004;159:671-682.
dos Santos Silva I, De Stavola BL, Hardy RJ, Kuh DJ, McCormack VA, Wadsworth ME. Is the association of birth weight with premenopausal breast cancer risk mediated through childhood growth? Br J Cancer 2004;91;519-24.
Dr. Ahlgren replies: Inspired by Dr. Terry's comments and those of Dr. De Stavola and colleagues, we investigated whether birth weight modified the main results. As shown in Table 1, we found no significant effect modification.
Table 1. Association between Growth Variables and Breast Cancer, According to Birth Weight.
Martin Ahlgren, M.D., Ph.D.
Statens Serum Institut
DK-2300 Copenhagen, Denmark
abk@ssi.dk
Mary Beth Terry, Ph.D.
Mailman School of Public Health
New York, NY 10032
mt146@columbia.edu
References
Ahlgren M, Melbye M, Wohlfahrt J, Sorensen TI. Growth patterns and the risk of breast cancer in women. N Engl J Med 2004;351:1619-1626.
Terry MB, Susser E. The impact of fetal and infant exposures along the life course. Int J Epidemiol 2001;30:95-96.
Stoll BA. Western diet, early puberty, and breast cancer risk. Breast Cancer Res Treat 1998;49:187-193.
Johnston LB, Dahlgren J, Leger J, et al. Association between insulin-like growth factor I (IGF-I) polymorphisms, circulating IGF-I, and pre- and postnatal growth in two European small for gestational age populations. J Clin Endocrinol Metab 2003;88:4805-4810.
Ben-Shlomo Y, Holly J, McCarthy A, et al. An investigation of fetal, postnatal and childhood growth with insulin-like growth factor I and binding protein 3 in adulthood. Clin Endocrinol (Oxf) 2003;59:366-373.
To the Editor: Ahlgren et al. report that birth weight and childhood growth influence the risk of breast cancer. We recently analyzed these relationships in a British cohort followed from birth to the age of 53 years.1,2 A higher risk of breast cancer at the age of 53 years was associated, in multivariable models, with the gain in height between 4 and 7 years and between 11 and 15 years and with the decrease in the body-mass index between 2 and 4 years. These effects were stronger the earlier the age at menarche, reflecting a similar pattern in the relationship between adult height and the risk of breast cancer (Table 1). Thus, it appears that women who grew faster in early childhood, had an earlier menarche, and continued to grow during the postpubertal period, reaching an adult height that was above average for their age at menarche, were at greatest risk. Our findings, although based on a limited number of cancers in relatively young women, may help elucidate the complex relations among childhood growth, the onset of menarche, and the risk of breast cancer that are described — but not explained — in the report by Ahlgren et al.
Table 1. Relative Risks of Breast Cancer Associated with 1-SD Increases in Anthropometric Measures at Certain Ages, According to the Age at Menarche.
Bianca L. De Stavola, Ph.D.
Isabel dos Santos Silva, M.D., Ph.D.
London School of Hygiene and Tropical Medicine
London WC1E 7HT, United Kingdom
bianca.destavola@lshtm.ac.uk
Michael J. Wadsworth, Ph.D.
Royal Free and University College Medical School
London WC1E 6BT, United Kingdom
References
De Stavola BL, dos Santos Silva I, McCormack V, Hardy RJ, Kuh DJ, Wadsworth ME. Childhood growth and breast cancer. Am J Epidemiol 2004;159:671-682.
dos Santos Silva I, De Stavola BL, Hardy RJ, Kuh DJ, McCormack VA, Wadsworth ME. Is the association of birth weight with premenopausal breast cancer risk mediated through childhood growth? Br J Cancer 2004;91;519-24.
Dr. Ahlgren replies: Inspired by Dr. Terry's comments and those of Dr. De Stavola and colleagues, we investigated whether birth weight modified the main results. As shown in Table 1, we found no significant effect modification.
Table 1. Association between Growth Variables and Breast Cancer, According to Birth Weight.
Martin Ahlgren, M.D., Ph.D.
Statens Serum Institut
DK-2300 Copenhagen, Denmark
abk@ssi.dk