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JNCI Journal of the National Cancer Institute 2002 94(16):1238-1246; doi:10.1093/jnci/94.16.1238
© 2002 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 94, No. 16, 1238-1246, August 21, 2002
© 2002 Oxford University Press

ARTICLE

Risk Factors for Breast Cancer at Young Ages in Twins: An International Population-Based Study

Anthony J. Swerdlow, Bianca L. De Stavola, Birgitta Floderus, Niels V. Holm, Jaakko Kaprio, Pia K. Verkasalo, Thomas Mack

Affiliations of authors: A. J. Swerdlow, Section of Epidemiology, Institute of Cancer Research, Sutton, U.K.; B. L. De Stavola, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, U.K.; B. Floderus, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; N. V. Holm, Department of Epidemiology, Institute of Public Health, University of Southern Denmark, and Department of Oncology and Radiotherapy, Odense University Hospital, Odense, Denmark; J. Kaprio, Department of Public Health, University of Helsinki, and Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland; P. K. Verkasalo, Department of Public Health, University of Helsinki; T. Mack, Department of Preventive Medicine, University of Southern California Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles.

Correspondence to: Anthony J. Swerdlow, D.M., Section of Epidemiology, Institute of Cancer Research, Cotswold Rd., Sutton, Surrey SM2 5NG, U.K. (e-mail: a.swerdlow{at}icr.ac.uk).

Background: Breast cancer etiology in women may relate to exposures early in life as well as in adulthood, but it has been difficult to gain information on childhood variables, and evidence on their effects is very limited. Comparison of risk factor levels between affected probands and unaffected twins in twin pairs can provide a unique method to investigate risk factors that act in early life. Methods: We conducted four population-based case–control studies of breast cancer risk in twins in Denmark, England and Wales, Finland, and Sweden and pooled the data from these studies. The case patients were 400 women with incident breast cancer before the age of 50 years, and the control subjects were their twin sisters who had not had breast cancer by that time. Data on risk factors (e.g., demographic and anthropomorphic variables, reproductive history, and family history) were collected by interview and by a mailed questionnaire and were analyzed by calculating matched odds ratios [ORs]. All statistical tests were two-sided. Results: The risk of breast cancer was increased for women who were less obese (OR = 1.44, 95% confidence interval [CI] = 1.08 to 1.91) or taller (OR = 1.27, 95% CI = 0.95 to 1.70) than their co-twin at age 10 years, for women who developed breasts earlier than their co-twin (OR = 1.53, 95% CI = 1.14 to 2.06), and for women who had a smaller waist-to-hip ratio at age 20 years than their co-twin (OR = 1.79, 95% CI = 1.00 to 3.21). Analysis according to family history of breast cancer showed that the associations of childhood height and weight with risk of breast cancer were only apparent in women without a family history of breast cancer. Conclusions: Childhood growth before puberty may affect the risk of premenopausal breast cancer, at least in women without a family history of breast cancer. The distribution of body fat in young adulthood may also be related to breast cancer risk.


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