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American Journal of Epidemiology Advance Access originally published online on March 24, 2009
American Journal of Epidemiology 2009 169(10):1251-1259; doi:10.1093/aje/kwp036
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Breast Cancer Risk Factors Defined by Estrogen and Progesterone Receptor Status

The Multiethnic Cohort Study

Veronica Wendy Setiawan, Kristine R. Monroe, Lynne R. Wilkens, Laurence N. Kolonel, Malcolm C. Pike and Brian E. Henderson

Correspondence to Dr. Veronica Wendy Setiawan, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1450 Biggy Street, Room 1517G, Los Angeles, CA 90033 (e-mail: vsetiawa{at}usc.edu).

Received for publication July 29, 2008. Accepted for publication January 26, 2009.

Prospective data on ethnic differences in hormone receptor-defined subtypes of breast cancer and their risk factor profiles are scarce. The authors examined the joint distributions of estrogen receptor (ER) and progesterone receptor (PR) status across 5 ethnic groups and the associations of established risk factors with ER/PR status in the Multiethnic Cohort Study (Hawaii and Los Angeles, California). During an average of 10.4 years of follow-up of 84,427 women between 1993–1996 and 2004/2005, 2,543 breast cancer cases with data on ER/PR status were identified: 1,672 estrogen receptor-positive (ER+)/progesterone receptor-positive (PR+); 303 ER+/progesterone receptor-negative (PR–); 77 estrogen receptor-negative (ER–)/PR+; and 491 ER–/PR–. ER/PR status varied significantly across racial/ethnic groups even within the same tumor stage (for localized tumors, P < 0.0001; for advanced tumors, P = 0.01). The highest fraction of ER–/PR– tumors was observed in African Americans (31%), followed by Latinas (25%), Whites (18%), Japanese (14%), and Native Hawaiians (14%). Associations differed between ER+/PR+ and ER–/PR– cases for postmenopausal obesity (P = 0.02), age at menarche (P = 0.05), age at first birth (P = 0.04), and postmenopausal hormone use (P < 0.0001). African Americans are more likely to be diagnosed with ER–/PR– tumors independently of stage at diagnosis, and there are disparate risk factor profiles across the ER/PR subtypes of breast cancer.

breast neoplasms; cohort studies; receptors, estrogen; receptors, progesterone; risk factors

Abbreviations: CI, confidence interval; ER, estrogen receptor; ER–, estrogen receptor-negative; ER+, estrogen receptor-positive; HR, hazard ratio; PR, progesterone receptor; PR–, progesterone receptor-negative; PR+, progesterone receptor-positive; SEER, Surveillance, Epidemiology, and End Results


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