Education level and risk of breast cancer by tumor subtype in the <scp>EPIC</scp> cohort

Breast cancer (BC) is a heterogeneous disease with subtypes based on receptor status (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]), influencing prognosis and treatment. A higher socioeconomic position (SEP) is associated with an increased BC risk, but its relation to BC subtypes is less clear. This study analyzed 311,631 women from the EPIC cohort, focusing on the incidence of in situ and invasive BC (overall and by receptor status and subtype). Educational attainment was used as a proxy for SEP, and hazard ratios (HRs) were calculated using Cox regression models. Mediation analyses were performed to evaluate the extent to which selected risk factors explained the educational gradient. Over 14 years, 14,432 BC cases were identified, including 12,863 invasive cases. Lower education was associated with a reduced risk of both in situ and invasive BCs. The HRs for primary versus tertiary education were 0.61 (95% CI 0.49-0.73) for in situ and 0.81 (95% CI 0.75-0.87) for invasive BC overall, with similar reductions across ER-positive, PR-positive, HER2-positive, Luminal A, BH-, and BH+. No significant association was found between education and ER-negative, and HER2-enriched BCs. Reproductive and lifestyle factors explained 20-40% of the educational differences in BC risk. While many of the risk factors through which education impacts the development of subtype-specific BC were identified, others remain to be fully elucidated. Differences in screening attendance could partially explain the higher ER-positive BC risk among highly educated; this study further contributes to the understanding of the complex nature of BC in terms of its social gradient and aetiology.

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Publication Details

Journal
International Journal of Cancer
Published
2025-04-01
DOI
https://doi.org/10.1002/ijc.35413
Citations
3
Primary Topic
Breast Cancer Treatment Studies
Type
article
Field-Weighted Citation Impact
2.81
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article

Education level and risk of breast cancer by tumor subtype in the EPIC cohort

Sébastien Lamy, Valeria Pala, Cyrille Delpierre, Pilar Amiano Etxezarreta et al.
3 citations
International Journal of Cancer
Breast Cancer Treatment Studies
2.81
article

Education level and risk of breast cancer by tumor subtype in the EPIC cohort

Sébastien Lamy, Valeria Pala, Cyrille Delpierre, Pilar Amiano Etxezarreta, Alessandra Macciotta, Sabina Rinaldi, Lene Mellemkjær, Pauline Frénoy, Pascal Guénel, Toral Gathani, Matthias Bernd Schulze, A. Fournier, ­Rosario ­Tumino, Fulvio Ricceri, Clara Castro, Margherita Pizzato, Salvatore Vaccarella, Pietro Ferrari, Giovanna Masala, Inger Torhild Gram, Renée T. Fortner, Valerie McCormack, Marcela Guevara, Karina Standahl Olsen, Amaia Aizpurua Atxega, Christian S. Antoniussen, Christina C. Dahm, Umaima Al‐Alem, Anne Marie Tjønneland, José María Huerta, María‐José Sánchez, Tonje Braaten, Rudolf Kaaks, Paolo Vineis, Salvatore Panico, Laure Dossus
article en
3 citations

Abstract

Breast cancer (BC) is a heterogeneous disease with subtypes based on receptor status (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]), influencing prognosis and treatment. A higher socioeconomic position (SEP) is associated with an increased BC risk, but its relation to BC subtypes is less clear. This study analyzed 311,631 women from the EPIC cohort, focusing on the incidence of in situ and invasive BC (overall and by receptor status and subtype). Educational attainment was used as a proxy for SEP, and hazard ratios (HRs) were calculated using Cox regression models. Mediation analyses were performed to evaluate the extent to which selected risk factors explained the educational gradient. Over 14 years, 14,432 BC cases were identified, including 12,863 invasive cases. Lower education was associated with a reduced risk of both in situ and invasive BCs. The HRs for primary versus tertiary education were 0.61 (95% CI 0.49-0.73) for in situ and 0.81 (95% CI 0.75-0.87) for invasive BC overall, with similar reductions across ER-positive, PR-positive, HER2-positive, Luminal A, BH-, and BH+. No significant association was found between education and ER-negative, and HER2-enriched BCs. Reproductive and lifestyle factors explained 20-40% of the educational differences in BC risk. While many of the risk factors through which education impacts the development of subtype-specific BC were identified, others remain to be fully elucidated. Differences in screening attendance could partially explain the higher ER-positive BC risk among highly educated; this study further contributes to the understanding of the complex nature of BC in terms of its social gradient and aetiology.

International Journal of CancerVol. 157(4)
University of Copenhagen (DK), Norwegian Institute of Public Health (NO), Institut Català d'Ornitologia (ES), Université Toulouse III - Paul Sabatier (FR), Inserm (FR), University of Potsdam (DE), German Cancer Research Center (DE), University of Milan (IT), Université de Versailles Saint-Quentin-en-Yvelines (FR), Aarhus University (DK), Heidelberg University (DE), University of Illinois Chicago (US), University of Oxford (GB), Instituto de Salud Pública de Navarra (ES), Biogipuzkoa Health Research Institute (ES), Centre de recherche en Epidémiologie et Santé des Populations (FR), Institut Català d'Oncologia (ES), Navarre Institute of Health Research (ES), Instituto de Investigación Biosanitaria de Granada (ES), Federico II University Hospital (IT), Italian Association for Cancer Research (IT), Institut Claudius Regaud (FR), Cancer Registry of Norway (NO), Oxford University Hospitals NHS Trust (GB), Danish Cancer Society (DK), Piedmont Reference Center for Epidemiology and Cancer Prevention (IT), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), German Institute of Human Nutrition (DE), Centre international de recherche sur le cancer (FR), Imperial College London (GB), University of Turin (IT), Andalusian School of Public Health (ES), UiT The Arctic University of Norway (NO)
Good health and well-being
Openalex Percentile: Top 10%
Breast Cancer Treatment Studies
2.81
DOISourceOpenAlex
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