Contributors: Department of Public Health; Erasmus University Medical Center Rotterdam (Erasmus MC); Centre de recherche en épidémiologie et santé des populations (CESP); Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM); National Institute for Public Health and the Environment Bilthoven (RIVM); University of Amsterdam Amsterdam = Universiteit van Amsterdam (UvA); Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Dept of Epidemiology and Public Health; Imperial College London; Department of Cardiology and Department of Clinical Epidemiology; Aarhus University Hospital; Cancer Epidemiology Institute; Danish Cancer Society; Division of Cancer Epidemiology; German Cancer Research Center - Deutsches Krebsforschungszentrum Heidelberg (DKFZ); Dept of Epidemiology; German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE); Dept of Hygiene, Epidemiology and Medical Statistics; University of Athens Medical School Athens; Department of Epidemiology; Havard School of Public Health; Hellenic Health Foundation; Molecular and Nutritional Epidemiology Unit; Cancer Research and Prevention Institute – ISPO; Department of Preventive & Predictive Medicine; Fondazione IRCCS-IRCCS Istituto Nazionale dei Tumori Milano; Department of Clinical and Experimental Medicine; University of Naples Federico II = Università degli studi di Napoli Federico II; Cancer Registry and Histopathology Unit; Civile - M.P.Arezzo Hospital; Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte = Center for Cancer Prevention-Piemonte (CPO Piemonte ); Institute of Community Medicine; University of Tromsø (UiT); Public Health and Health Planning Directorate; Unit of Nutrition, Environment, and Cancer; Catalan Institute of Oncology = Instituto Catalán de Oncología (ICO); Andalusian School of Public Health Granada; CIBERESP; CIBER Epidemiologia y Salud Pública; Epidemiology Department; Murcia Health Council; Public Health Institute of Navarra; Department of Oncology; Skane University Hospital Lund; Department of surgery; Malmö University Hospital-Skane University Hospital Lund; Dept of Public Health and Primary Care; University of Cambridge UK (CAM)-Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte = Center for Cancer Prevention-Piemonte (CPO Piemonte ); Cancer Epidemiology Unit; University of Oxford-Cancer Epidemiology Unit; International Agency for Cancer Research (IACR); ISI Foundation Institute for Scientific Interchange; G Menvielle received a funding from the Fondation pour la Recherche Médicale for this analysis. The project was in part funded by the European Commission, through the Eurocadet project (from the commission of the European communities research directorate-general, grant No EUROCADET:SP23-CT-2005-006528). EPIC was supported by the European Commission: Public Health and Consumer Protection Directorate 1993-2004 and the Research Directorate-General 2005-2008. European Commission FP5 project (QLG1-CT-2001-01049). The EPIC study was funded by "Europe Against Cancer" Programme of the European Commission (SANCO); Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l'Education Nationale; Institut National de la Santé et de la Recherche Médicale; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Red Temática de Investigación Cooperativa de Centros de Cáncer (C03/10); the participating regional governments and institutions of Murcia, Navarra, Asturias, Pais Vasco y Andalucia, Spain; Cancer Research UK; Medical Research Council, United Kingdom; Stroke Association, United Kingdom; British Heart Foundation; Department of Health, United Kingdom; Food Standards Agency, United Kingdom; The Wellcome Trust, United Kingdom; Greek Ministry of Health; Stavros Niarchos Foundation; Italian Association for Research on Cancer; Dutch Ministry of Public Health, Welfare and Sports; Dutch Ministry of Health; Dutch Prevention Funds; LK Research Funds; Dutch Zorg Onderzoek Nederland; World Cancer Research Fund; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Vasterbotten and Skane, Sweden; Norwegian Cancer Society; and Foundation to Promote Research into Functional Vitamin B12 Deficiency, Norway. Some authors are partners of Environmental Cancer Risk, Nutrition and Individual Susceptibility, a network of excellence of the European Commission (6FP contract 513943). Antonio Agudo and Paolo Vineis were supported by ECNIS.
نبذة مختصرة : International audience ; The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association was not observed among nulliparous women (RII = 1.13, 95% CI: 0.84, 1.52). Inequalities in breast cancer incidence decreased substantially after adjusting for reproductive history (RII = 1.11, 95% CI: 0.98, 1.25), with most of the association being explained by age at first full-term pregnancy. Each other risk factor explained a small additional part of the inequalities in breast cancer incidence. Height accounted for most of the remaining differences in incidence. After adjusting for all known risk factors, the authors found no association between education level and risk of invasive breast cancer. Inequalities in incidence were more pronounced for in situ breast cancer, and those inequalities remained after adjustment for all known risk factors (RII = 1.61, 95% CI: 1.07, 2.41), especially among nulliparous women.
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