Amir Almasi-Hashiani1,2, Saharnaz Nedjat3, Reza Ghiasvand4,5, Saeid Safiri6,7, Maryam Nazemipour8,9, Nasrin Mansournia10, Mohammad Ali Mansournia11. 1. Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran. 2. Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran. 3. Department of Epidemiology and Biostatistics, Knowledge Utilization Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran University of Medical Science, Tehran, Iran. 4. Department of Research, Cancer Registry of Norway, Oslo, Norway. 5. Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway. 6. Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. 7. Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 8. Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 9. Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran. 10. Department of Endocrinology, AJA University of Medical Sciences, Tehran, Iran. 11. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, P.O Box: 14155-6446, Tehran, Iran. mansournia_ma@yahoo.com.
Abstract
OBJECTIVES: The relationship between reproductive factors and breast cancer (BC) risk has been investigated in previous studies. Considering the discrepancies in the results, the aim of this study was to estimate the causal effect of reproductive factors on BC risk in a case-control study using the double robust approach of targeted maximum likelihood estimation. METHODS: This is a causal reanalysis of a case-control study done between 2005 and 2008 in Shiraz, Iran, in which 787 confirmed BC cases and 928 controls were enrolled. Targeted maximum likelihood estimation along with super Learner were used to analyze the data, and risk ratio (RR), risk difference (RD), andpopulation attributable fraction (PAF) were reported. RESULTS: Our findings did not support parity and age at the first pregnancy as risk factors for BC. The risk of BC was higher among postmenopausal women (RR = 3.3, 95% confidence interval (CI) = (2.3, 4.6)), women with the age at first marriage ≥20 years (RR = 1.6, 95% CI = (1.3, 2.1)), and the history of oral contraceptive (OC) use (RR = 1.6, 95% CI = (1.3, 2.1)) or breastfeeding duration ≤60 months (RR = 1.8, 95% CI = (1.3, 2.5)). The PAF for menopause status, breastfeeding duration, and OC use were 40.3% (95% CI = 39.5, 40.6), 27.3% (95% CI = 23.1, 30.8) and 24.4% (95% CI = 10.5, 35.5), respectively. CONCLUSIONS: Postmenopausal women, and women with a higher age at first marriage, shorter duration of breastfeeding, and history of OC use are at the higher risk of BC.
OBJECTIVES: The relationship between reproductive factors and breast cancer (BC) risk has been investigated in previous studies. Considering the discrepancies in the results, the aim of this study was to estimate the causal effect of reproductive factors on BC risk in a case-control study using the double robust approach of targeted maximum likelihood estimation. METHODS: This is a causal reanalysis of a case-control study done between 2005 and 2008 in Shiraz, Iran, in which 787 confirmed BC cases and 928 controls were enrolled. Targeted maximum likelihood estimation along with super Learner were used to analyze the data, and risk ratio (RR), risk difference (RD), andpopulation attributable fraction (PAF) were reported. RESULTS: Our findings did not support parity and age at the first pregnancy as risk factors for BC. The risk of BC was higher among postmenopausal women (RR = 3.3, 95% confidence interval (CI) = (2.3, 4.6)), women with the age at first marriage ≥20 years (RR = 1.6, 95% CI = (1.3, 2.1)), and the history of oral contraceptive (OC) use (RR = 1.6, 95% CI = (1.3, 2.1)) or breastfeeding duration ≤60 months (RR = 1.8, 95% CI = (1.3, 2.5)). The PAF for menopause status, breastfeeding duration, and OC use were 40.3% (95% CI = 39.5, 40.6), 27.3% (95% CI = 23.1, 30.8) and 24.4% (95% CI = 10.5, 35.5), respectively. CONCLUSIONS: Postmenopausal women, and women with a higher age at first marriage, shorter duration of breastfeeding, and history of OC use are at the higher risk of BC.
Entities:
Keywords:
Breast neoplasms; Case-control study; Causal analysis; Double robustness; Population attributable fraction; Reproductive history; Super learner; TMLE
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