American Journal of Epidemiology Vol. 147, No. 9: 826-833
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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Population Attributable Fraction Estimation for Established Breast Cancer Risk Factors: Considering the Issues of High Prevalence and Unmodifiability
1Channing Laboratory, Brigham and Women's Hospital Boston, MA
2National Institute of Environmental Health Sciences Research Triangle Park, NC
3Department of Epidemiology, University of North Carolina at Chapel Hill Chapel Hill, NC
Reprint requests to Dr. Beverly Rockhill, channing Laboratory, 181 Longwood Avenue, Boston, MA 02115.
Established breast cancer risk factors, in addition to being relatively unmodifiable, are highly prevalent among US women. Previous reports of population attributable fraction for the established risk factors have used definitions that resulted in 75-100% of women in the source population labeled exposed. The practical value of such estimates has not been discussed; further, the estimates have frequently been misinterpreted. In the context of examining the interpretation and public health value of such estimates, the authors demonstrate the sensitivity of the population attributable fraction to changes in exposure outpoints. They use data from the Carolina Breast Cancer Study, a case-control study of breast cancer conducted in North Carolina between 1993 and 1996. For the four established risk factors (menarche before age 14 years, first birth at age 20 years or later/nulliparity, family history of breast cancer, and history of benign breast biopsy), the estimated population attributable fraction was 0.25 (95% confidence interval 0.06-0.48). Over 98% of the source population was exposed to at least one of these risk factors. The population attributable fraction estimate was reduced to 0.15 when more restrictive definitions of early menarche (less than age 12 years) and late age at first full-term pregnancy (30 years or more) were used (proportion exposed, 0.62). Population attributable fractions for established breast cancer risk factors probably have little public health value because of both the high proportions exposed and the relative unmodifiability of the risk factor distributions. Am J Epidemiol 1998; 147:826-33.
breast neoplasm; risk factors
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