| Background Breast cancer is one of the most common malignanttumors in women.Although we have made some achievements in recentyears in the incidence and treatment of breast cancer,the overallincidence and mortality of breast cancer are on the rise.The prevention andtreatment of breast cancer is still facing enormous challenges.However,Studyof risk factors in breast cancer are mainly concentrated in economicallydeveloped and more developed regions,and due to different ethnicgroups,customs,and living environments in different regions,there are differences in the results of various studies and they cannot be promoted and applied.At the sametime,even in the same area,in the same group of people,at different times,the factors of breast cancer may also evolve due to the evolution of their environment,lifestyle,etc.On the other side,the study of minority nationalities with special human geography and customs is almost blank.The results of breast cancer risk factors are rarely used for population screening and intervention,and lack of application and efficacy evaluation of the results.So,It is necessary to study the factors of breast cancer in Tibet alone,in order to effectively carry out preventive interventions,so as to reduce the incidence ofbreast cancer in the Tibetan population,and improvethe treatment effect of breast cancer.Objective 1.To identify the factors of breast cancer among Tibetan women and supporting the prevention of breast cancer later.2.To construct and evaluate risk scoring model of breast cancer in Tibetan women.Improve the efficiency of breast cancer screening in the region and achieve early diagnosis and early treatment.3.To provide ideas for follow-up research.Methods In this study,a hospital-based case-control study was conducted to obtain information on breast cancer patients and their paired healthy women who were first diagnosed from September 2013 to December 2017 in the Oncology Department of the People's Hospital of the Tibet Autonomous Region through questionnaires.The single factor Logistic regression analysis and multiple factor Logistic regression analysis were used to evaluate the relationship between each factor and the onset of breast cancer.Then,based on the regression coefficient(B),the risk scoring model of breast cancer was established after analyzing the interaction and the common linear test of the factors that were included in the model.At last,the area under ROC curve of risk scoring model was calculated,the Cut-off Value was selected by using the Youden index(YI),and the predictive efficiency of the scoring model was evaluated by using the in-group substitution method.Results 1.Single factor Logistic regression analysis: Risk factors for breast cancer included religious personnel,Number of last school years(years),BMI,age of menarche ? 18 years,dysmenorrhea(infrequently or hardly),sleep time(? 10 hours per day),and drinking ghee tea(3-5 days per week).Protective factors for the breast cancer included the number of last school years1(3 to 7 years or 7 to 10 years),education(Primary education or Junior education),annual income(10,000 to 30,000 RMB per year),age of menarche age(years),married,fertility history,age of first birth,number of births(1 to 3 times or ? 3times),number of abortions 1(1 to 3 times).Multi-factor Logistic regression analysis: education(Primary education)(OR = 0.054,95%CI:0.017 to 0.175),education(Junior education)(OR = 0.033,95%CI: 0.004 to 0.251),annual income(10,000 to 30,000 RMB per year)(OR = 0.139,95%CI: 0.046 to 0.415),age of menarche age(12 to 15 years old)(OR =0.099,95%CI: 0.014 ~ 0.722)were protective factors for breast cancer.Occupation(religious personnel)(OR = 77.246,95%CI: 10.258 to581.665),dysmenorrhea(infrequently)(OR = 4.294,95%CI: 1.039 to17.737),dysmenorrhea(hardly)(OR = 10.563,95%CI: 2.329 ~ 47.906)were the risk factor for breast cancer.2.The breast cancer risk scoring model for Tibetan women in Tibet was: y = 30 × occupation(religious personnel)+ 10 × dysmenorrhea(infrequently)or 16 × dysmenorrhea(hardly)-20 × education(Primary education)or 23 × highest education(Junior education)-16 ×age of menarche age(12 to 15 years old)-14 ×annual income(10,000 to 30,000 RMB per year).3.The area under ROCcurve(AUC)was 0.816(P = 0.000,95%CI: 0.762 to 0.869).The Cut-off Value calculated by the Youden Index was-6.5 points.Greater than-6.5 points was divided into high-risk groups with a sensitivity of70.7 % and a specificity of 78.4 %.All the subjects were predicted,with a Positive Predictive Value(PPV)of 76.6% and a Negative Predictive Value(NPV)of 72.8%.Conclusion 1.The highest level of education(Primary education or Junior education),annual income(10,000 to 30,000 RMB per year),and initial-tide age(12 to 15 years old)were protective factors for the incidence of breast cancer among Tibetan women in Tibet.Occupation(religious personnel)and dysmenorrhea(infrequently or hardly)were the risk factors for breast cancer among Tibetan women in Tibet.2.The Tibetan women's breast cancer risk scoring model obtained in this study was: y = 30 × occupation(religious personnel)+ 10 × dysmenorrhea(infrequently)or 16 × dysmenorrhea(hardly)-20 × education(Primary education)or 23 × highest education(Junior education)-16 ×age of menarche age(12 to 15 years old)-14 × annual income(10,000 to 30,000 RMB per year).According to the evaluation results,the model has a good predictive ability. |
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