Marius Wunderle1, Jutta Pretscher1, Sara Y Brucker2, Bernhard Volz1, Arndt Hartmann3, Cornelia Fiessler4, Alexander Hein1, Lothar Häberle1, Sebastian M Jud1, Michael P Lux1, Wolfgang Janni5, Christian R Loehberg1, Andreas D Hartkopf2, Christina B Walter2, Gerold Baake6, Alexander Fridman7,8, Wolfram Malter7, Rachel Wuerstlein9, Nadia Harbeck9, Oliver Hoffmann10, Sherko Kümmel11, Bernhard Martin12, Christoph Thomssen13, Heiko Graf14, Christopher Wolf15, Christian M Bayer1, Carolin C Hack1, Katrin Almstedt16, Paul Gass1, Felix Heindl1, Tobias F Brodkorb1, Naiba Nabieva1, Christoph Lindner17, Hans-Christian Kolberg18, Petra Krabisch19, Michael Weigel20, Dieter Steinfeld-Birg21, Andreas Kohls22, Cosima Brucker23, Volker Schulz24, Gunnar Fischer25, Volker Pelzer26, Diethelm Wallwiener2, Brigitte Rack5, Tanja Fehm27, Achim Rody28, Nicolai Maass29, Matthias W Beckmann1, Peter A Fasching30, Claudia Rauh1. 1. Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany. 2. Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany. 3. Institute of Pathology, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany. 4. Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany. 5. Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany. 6. Oncological Medical Practice Pinneberg, Pinneberg, Germany. 7. Breast Center, Department of Gynecology and Obstetrics, University Hospital of Cologne, Cologne, Germany. 8. Department of Gynecology and Obstetrics, Evangelic Hospital Kalk, Cologne, Germany. 9. Breast Center and Comprehensive Cancer Center, Department of Gynecology and Obstetrics, University of Munich (LMU), Munich, Germany. 10. Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. 11. Breast Unit, Kliniken Essen-Mitte, Essen, Germany. 12. Department of Gynecology and Obstetrics, Tuttlingen Clinic, Tuttlingen, Germany. 13. Department of Gynecology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. 14. Breast Center, Helios Clinic Meiningen, Meiningen, Germany. 15. Ulm Medical Center, Ulm, Germany. 16. Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany. 17. Department of Gynecology and Obstetrics, Agaplesion Diakonie Clinic Hamburg, Hamburg, Germany. 18. Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany. 19. Department of Gynecology and Obstetrics, Klinikum Chemnitz, Chemnitz, Germany. 20. Department of Gynecology and Obstetrics, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany. 21. Gynecological Oncological Practice Augsburg, Augsburg, Germany. 22. Department of Gynecology and Obstetrics, Evangelic County Hospital Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany. 23. Department of Gynecology and Obstetrics, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany. 24. Gynecological Practice abts+partner Kiel, Kiel, Germany. 25. Department of Gynecology and Obstetrics, Mittweida Hospital, Mittweida, Germany. 26. Department of Gynecology and Obstetrics, St. Marien Hospital Bonn, Bonn, Germany. 27. Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany. 28. Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. 29. Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany. 30. Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany. peter.fasching@uk-erlangen.de.
Abstract
PURPOSE: Evidence shows that genetic and non-genetic risk factors for breast cancer (BC) differ relative to the molecular subtype. This analysis aimed to investigate associations between epidemiological risk factors and immunohistochemical subtypes in a cohort of postmenopausal, hormone receptor-positive BC patients. METHODS: The prospective, single-arm, multicenter phase IV PreFace study (Evaluation of Predictive Factors Regarding the Effectivity of Aromatase Inhibitor Therapy) included 3529 postmenopausal patients with hormone receptor-positive early BC. Data on their epidemiological risk factors were obtained from patients' diaries and their medical histories. Data on estrogen receptor, progesterone receptor, and HER2 receptor status were obtained from pathology reports. Patients with incomplete information were excluded. Data were analyzed using conditional inference regression analysis, analysis of variance, and the chi-squared test. RESULTS: In a cohort of 3392 patients, the strongest association with the molecular subtypes of BC was found for hormone replacement therapy (HRT) before diagnosis of early BC. The analysis showed that patients who took HRT at diagnosis had luminal A-like BC more often (83.7%) than those who had never taken HRT or had stopped taking it (75.5%). Luminal B-like BC and HER2-positive BC were diagnosed more often in women who had never taken HRT or had stopped taking it (13.3% and 11.2%, respectively) than in women who were taking HRT at diagnosis of BC (8.3% and 8.0%, respectively). CONCLUSIONS: This analysis shows an association between HRT and the distribution of molecular subtypes of BC. However, no associations between other factors (e.g., age at diagnosis, body mass index, smoking status, age at menopause, number of deliveries, age at first delivery, breastfeeding history, or family history) were noted.
PURPOSE: Evidence shows that genetic and non-genetic risk factors for breast cancer (BC) differ relative to the molecular subtype. This analysis aimed to investigate associations between epidemiological risk factors and immunohistochemical subtypes in a cohort of postmenopausal, hormone receptor-positive BC patients. METHODS: The prospective, single-arm, multicenter phase IV PreFace study (Evaluation of Predictive Factors Regarding the Effectivity of Aromatase Inhibitor Therapy) included 3529 postmenopausal patients with hormone receptor-positive early BC. Data on their epidemiological risk factors were obtained from patients' diaries and their medical histories. Data on estrogen receptor, progesterone receptor, and HER2 receptor status were obtained from pathology reports. Patients with incomplete information were excluded. Data were analyzed using conditional inference regression analysis, analysis of variance, and the chi-squared test. RESULTS: In a cohort of 3392 patients, the strongest association with the molecular subtypes of BC was found for hormone replacement therapy (HRT) before diagnosis of early BC. The analysis showed that patients who took HRT at diagnosis had luminal A-like BC more often (83.7%) than those who had never taken HRT or had stopped taking it (75.5%). Luminal B-like BC and HER2-positive BC were diagnosed more often in women who had never taken HRT or had stopped taking it (13.3% and 11.2%, respectively) than in women who were taking HRT at diagnosis of BC (8.3% and 8.0%, respectively). CONCLUSIONS: This analysis shows an association between HRT and the distribution of molecular subtypes of BC. However, no associations between other factors (e.g., age at diagnosis, body mass index, smoking status, age at menopause, number of deliveries, age at first delivery, breastfeeding history, or family history) were noted.