Premenopausal Breast Cancer Risk Factors and Associations with Molecular Subtypes: A Case-Control Study
Bibliographic record
Abstract
Background. Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women’s cancer-related deaths and morbidity worldwide. In Rwanda, BC incidence is increasing with an unacceptably high mortality rate in premenopausal women. Objectives. The purpose was to identify modifiable BC risk factors and assess associations between common breast cancer risks factors and molecular subtypes in premenopausal women in Rwanda. Methods. This was a case-control study. Premenopausal women with histological confirmation of BC and frequency-matched for age controls were recruited. A preestablished questionnaire was administered to both cases and controls for sociodemographics, BC probable risk factors, and clinical and pathological characteristics. BC was classified into luminal A, luminal B, HER2-type, basal-like (triple negative), and unclassified molecular subtypes by immunohistochemistry (IHC). Odds ratio (OR) and 95% confidence interval (CI) were estimated using multivariate logistic regression analysis. Results. 340 participants were recruited into the study (170 cases vs. 170 controls). The median age was 39 years. The majority of cases presented at advanced stages of the disease (51.2% in stages III and IV) and had invasive ductal carcinoma (98.2%). 60.6% had subtypes of poor prognosis (HER2 enriched 14.7%, triple negative 12.9%, and unclassified 32.9%). Alcohol intake <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mfenced open="(" close=")"> <a:mrow> <a:mtext>AOR</a:mtext> <a:mo>=</a:mo> <a:mn>3.73</a:mn> <a:mo>,</a:mo> <a:mn>95</a:mn> <a:mi>%</a:mi> <a:mi>C</a:mi> <a:mi>I</a:mi> <a:mtext> </a:mtext> <a:mn>2.19</a:mn> <a:mo>−</a:mo> <a:mn>6.32</a:mn> <a:mo>,</a:mo> <a:mi>p</a:mi> <a:mo><</a:mo> <a:mn>0.001</a:mn> </a:mrow> </a:mfenced> </a:math> , obesity/overweight in adolescence or early adulthood <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M2"> <e:mfenced open="(" close=")"> <e:mrow> <e:mtext>AOR</e:mtext> <e:mo>=</e:mo> <e:mn>10.86</e:mn> <e:mo>,</e:mo> <e:mn>95</e:mn> <e:mi>%</e:mi> <e:mi>C</e:mi> <e:mi>I</e:mi> <e:mtext> </e:mtext> <e:mn>4.82</e:mn> <e:mo>−</e:mo> <e:mn>24.4</e:mn> <e:mo>,</e:mo> <e:mi>p</e:mi> <e:mo><</e:mo> <e:mn>0.001</e:mn> </e:mrow> </e:mfenced> </e:math> , history of primary infertility <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M3"> <i:mfenced open="(" close=")"> <i:mrow> <i:mtext>AOR</i:mtext> <i:mo>=</i:mo> <i:mn>33.8</i:mn> <i:mo>,</i:mo> <i:mn>95</i:mn> <i:mi>%</i:mi> <i:mi>C</i:mi> <i:mi>I</i:mi> <i:mtext> </i:mtext> <i:mn>3.5</i:mn> <i:mo>−</i:mo> <i:mn>321.5</i:mn> <i:mo>,</i:mo> <i:mi>p</i:mi> <i:mo>=</i:mo> <i:mn>0.002</i:mn> </i:mrow> </i:mfenced> </i:math> , nulliparity <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M4"> <m:mfenced open="(" close=")"> <m:mrow> <m:mtext>AOR</m:mtext> <m:mo>=</m:mo> <m:mn>3.75</m:mn> <m:mo>,</m:mo> <m:mn>95</m:mn> <m:mi>%</m:mi> <m:mi>C</m:mi> <m:mi>I</m:mi> <m:mtext> </m:mtext> <m:mn>1.61</m:mn> <m:mo>−</m:mo> <m:mn>8.75</m:mn> <m:mo>,</m:mo> <m:mi>p</m:mi> <m:mo>=</m:mo> <m:mn>0.002</m:mn> </m:mrow> </m:mfenced> </m:math> , and a history of benign breast disease <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M5"> <q:mfenced open="(" close=")"> <q:mrow> <q:mtext>AOR</q:mtext> <q:mo>=</q:mo> <q:mn>6.06</q:mn> <q:mo>,</q:mo> <q:mn>95</q:mn> <q:mi>%</q:mi> <q:mi>C</q:mi> <q:mi>I</q:mi> <q:mtext> </q:mtext> <q:mn>1.19</q:mn> <q:mo>−</q:mo> <q:mn>30.73</q:mn> <q:mo>,</q:mo> <q:mi>p</q:mi> <q:mo>=</q:mo> <q:mn>0.03</q:mn> </q:mrow> </q:mfenced> </q:math> were associated with the occurrence of premenopausal breast cancer. There was no significant difference between risk factor stratification per molecular subtype. Conclusion. Several reproductive, environmental, and lifestyle risk factors have been identified to be associated with premenopausal BC. Among them, alcohol intake and obesity/overweight during adolescence/early adulthood can be modified. Interventions targeting alcohol consumption and obesity/overweight in adolescents and young adults may decrease the incidence of premenopausal breast cancer.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".