Risk Factors of Breast Cancer

A Systematic Review and Meta-Analysis

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Thunyarat Anothaisintawee, MD, Cholatip Wiratkapun, MD, Panuwat Lerdsitthichai, MD, MSc, , ,
Vijj Kasamesup, MD, PhD, Sansanee Wongwaisayawan, MD, Jiraporn Srinakarin, MD, Siriporn
Hirunpat, MD, Piyanoot Woodtichartpreecha, MD, Sarawan Boonlikit, MD, Yot Teerawattananon, MD,
PhD, Ammarin Thakkinstian, PhD, Thunyarat Anothaisintawee, MD, Cholatip Wiratkapun, MD, Panuwat
Lerdsitthichai, MD, MSc, Vijj Kasamesup, MD, PhD, Sansanee Wongwaisayawan, MD, Jiraporn
Srinakarin, MD, Siriporn Hirunpat, MD, Piyanoot Woodtichartpreecha, MD, Sarawan Boonlikit, MD, Yot
Teerawattananon, MD, PhD, Ammarin Thakkinstian, PhD

Article Information
Volume: 25 issue: 5, page(s): 368-387
Article first published online: May 23, 2013; Issue published: September 1, 2013
https://doi.org/10.1177/1010539513488795
Thunyarat Anothaisintawee, MD1, Cholatip Wiratkapun, MD1, Panuwat Lerdsitthichai, MD, MSc1, Vijj
Kasamesup, MD, PhD1, Sansanee Wongwaisayawan, MD1, Jiraporn Srinakarin, MD2, Siriporn
Hirunpat, MD3, Piyanoot Woodtichartpreecha, MD3, Sarawan Boonlikit, MD4, Yot
Teerawattananon, MD, PhD5, Ammarin Thakkinstian, PhD1
1Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
3Prince of Songkla University, Songkla, Thailand
4National Cancer Institute, Bangkok, Thailand
5Ministry of Public Health, Nontaburi, Thailand

Corresponding Author: Ammarin Thakkinstian, Section for Clinical Epidemiology and Biostatistics,
Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand.
Email: ammarin.tha@mahidol.ac.th
Abstract

The etiology of breast cancer might be explained by 2 mechanisms, namely,

differentiation and proliferation of breast epithelial cells mediated by hormonal factors.
We performed a systematic review and meta-analysis to update effects of risk factors
for both mechanisms. MEDLINE and EMBASE were searched up to January 2011.
Studies that assessed association between oral contraceptives (OC), hormonal
replacement therapy (HRT), diabetes mellitus (DM), or breastfeeding and breast cancer
were eligible. Relative risks with their confidence intervals (CIs) were extracted. A
random-effects method was applied for pooling the effect size. The pooled odds ratios
of OC, HRT, and DM were 1.10 (95% CI = 1.03-1.18), 1.23 (95% CI = 1.21-1.25), and
1.14 (95% CI = 1.09-1.19), respectively, whereas the pooled odds ratio of ever-
breastfeeding was 0.72 (95% CI = 0.58-0.89). Our study suggests that OC, HRT, and
DM might increase risks, whereas breastfeeding might lower risks of breast cancer.
Keywords breast cancer, meta-analysis, risk factor, systematic review

http://journals.sagepub.com/doi/abs/10.1177/1010539513488795?journalCode=apha