A Meta-analysis And Survey Of Risk Factors Of Breast Cancer And Evaluation Of Quality Of Life

ObjectiveThis study was designed to survey breast cancer risk factors in Wuhan City, by means of Meta analysis and Epidemiological Study. It assesses the influence of social life events, behavior and social support on breast cancer by Life Events Scale (LES), Trait Coping Style Questionnaire (TCSQ) and the Social Support Rating Scale (SSRS), and evaluates the Quality of Life (QoL) for patients with breast cancer by the questionnaire of Functional Assessment of Cancer Therapy-B (FACT-B) with the purpose of investigating long-term QoL and prognosis. The study provides guidance of prevention of breast cancer with regards of biology, life, social psychology to prevent breast cancer, and it attempts to search a reasonable theory of breast cancer prevention strategy so as to enhance the medical management of high-risk individuals.MethodsWe performed a meta-analysis of case-control studies that addressed whether reproductive factors, oral contraceptive use, family history of breast cancer in first-degree relative, personal history of benign breast disease and family history of other cancers are associated with breast cancer by searching the MEDLINE, PubMed, Proquest Embase, ScienceDirect, African Healthline, BMJ Health Intelligence and Chinese Periodical net databases for all English-language and Chinese-language papers published from January 1, 1997 to December 31,2007.1:1 case-control matched study. Case group selected 500 female breast cancer patients between the ages of 23-80 years old, diagnosed with the first, pathologically confirmed breast cancer between June 2008 and May 2009, were identified in three hospitals, including Tongji Hospital, Xiehe Hospital and Wuhan Central Hospital in Wuhan City, Hubei Province of China. The patients with early breast cancer (Ⅰ-Ⅱstage) are excluded other physical diseases, genetic diseases and mental diseases. Control Samples were women who were never diagnosed with breast cancer, they were also from Wuhan city. Control Samples were frequency-matched to the breast cancer group with regards to their age and area.Interviewers combined in two ways, including household survey and interviewed in hospitals. All participants were interviewed with LES, TCSQ, and SSRS. Case group were interviewed a week prior to the surgery with FACT-B V 4.0.All data was recorded by Epidate3.0, and carried out by SAS 9.0 software.ResultA total of 9 studies in China calculated pool ORs indicated that irregular menstruation (odds ratio [OR],2.89*; 95% confidence interval [CI],1.14-7.36); age at first full-term pregnancy≥30 years(OR,1.75*; 95%CI,1.18-2.59) and abortion>2 parities(OR,4.05*,95% CI,2.31-7.09) were associated with increase in breast cancer risk while the summary OR based on breastfed (OR,0.59; 95% CI,0.46-0.76) indicated no association with breast cancer risk.A total of 16 studies in China calculated pool ORs indicated that family history of breast cancer in first-degree relative (odds ratio [OR],3.61; 95% confidence interval [CI],1.75-7.44), personal history of benign breast disease (OR,3.17,95% CI,2.83-3.55) and family history of other cancers (OR,2.18*, "*":summary OR was adjusted; 95% CI,1.64-2.90) were associated with increase in breast cancer risk.A total of 11 studies outside China identified number of full-term pregnancy≥1 (OR,0.63*; 95% CI,0.60-0.68) and postmenopausal>50years (OR,1.39; 95% CI.1.22-1.57), and oral contraceptive use (OR,1.29*; 95% CI,1.08-1.54) were associated with increase in breast cancer risk while the summary OR based on breastfed (OR,0.79; 95% CI, 0.66-0.95) indicated no association with breast cancer risk. The association was statistically significant among women both in China and outside China.A total of 15 studies outside of China calculated pool ORs indicated family history of breast cancer in first-degree relative (OR,1.53*,95% CI,1.26-1.64) and personal history of benign breast disease (OR,1.44,95% CI,1.26-1.64) were associated with increase in breast cancer risk.There are not statistically significant in age, degree, career and working properties between case and control group (P>0.05).There are statistically significant in the proportion of body mass index (BMI), reproduction, personal history of benign breast disease, history of reproductive disease, family history of breast cancer in first-degree relative, personal history of benign breast disease, cigarette smoking, alcohol consumption, sleep, night shift (years), working and living environment (P＜0.05).Statistically significant differences were found in level of negative events, total scale, family problem, work and study problem in the life event scale (LES) (P＜0.0001 respectively).Conditional logistic regression shows that larger BMI, working properties, younger at menarche, more days in menses, history of dysmenorrheal, more times of induced abortion, a family history of breast cancer, living environment with high-risk factors, negative coping, more negative life events, family problems, and higher total score of social life events are associated with increase in breast cancer risk (P<0.05), while positive coping, and higher score of subjective support degree and utility degree of social support are associated with decrease in breast cancer risk (P<0.05)Step conditional logistic regression shows that larger BMI, working properties, more days in menses, more parity, more times of induced abortion, a family history of breast cancer, more years in night shift, living environment with high-risk factors, more family problems, and higher total score of social life events are associated with increase in breast cancer risk (P<0.05), while sleep well, positive coping, and higher score of subjective support degree and utility degree of social support are associated with decrease in breast cancer risk (P＜0.05).There was statistical significance for the model of CCA (P＜.0001). The standardized linear combination of the first pair of standardized canonical coefficients for the VAR variables and standardized canonical coefficients for the WITH variables are as following: (x1:Positive coping, x2:Negative coping, x3:The scale of social support, x4:Subjective support, x5:Objective support; x6:Utility degree of social support; y1:Physical well-being, y2:Social/family well-being, y3:Emotional well-being, y4:Functional well-being, y5: Additional concern, y6:Total score of FACT-B)Conclusions:The incidence of breast cancer is a common result of multiple factors. BMI, occupation, reproductive status, and breastfeeding, family history of breast cancer, past medical history, life style and environment, psychosocial factors are associated with breast cancer. Traits coping styles and social support were associated with QOL of breast cancer patients after surgery.