The causal effect and impact of reproductive factors on breast cancer using super learner and targeted maximum likelihood estimation: a case-control study in Fars Province, Iran

BMC Public Health

卷:21

Saeid Safiri¹  Nasrin Mansournia²  Saharnaz Nedjat³  Mohammad Ali Mansournia⁴  Amir Almasi-Hashiani⁵  Reza Ghiasvand⁶  Maryam Nazemipour⁷ 

[1] Aging Research Institute, Tabriz University of Medical Sciences;

[2] Department of Endocrinology, AJA University of Medical Sciences;

[3] Department of Epidemiology and Biostatistics, Knowledge Utilization Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran University of Medical Science;

[4] Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences;

[5] Department of Epidemiology, School of Health, Arak University of Medical Sciences;

[6] Department of Research, Cancer Registry of Norway;

[7] Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences;

关键词: Breast neoplasms;    Reproductive history;    Case-control study;    Population attributable fraction;    Causal analysis;    Double robustness;   

DOI  :  10.1186/s12889-021-11307-5

来源: DOAJ

【 摘 要 】

Abstract Objectives The relationship between reproductive factors and breast cancer (BC) risk has been investigated in previous studies. Considering the discrepancies in the results, the aim of this study was to estimate the causal effect of reproductive factors on BC risk in a case-control study using the double robust approach of targeted maximum likelihood estimation. Methods This is a causal reanalysis of a case-control study done between 2005 and 2008 in Shiraz, Iran, in which 787 confirmed BC cases and 928 controls were enrolled. Targeted maximum likelihood estimation along with super Learner were used to analyze the data, and risk ratio (RR), risk difference (RD), andpopulation attributable fraction (PAF) were reported. Results Our findings did not support parity and age at the first pregnancy as risk factors for BC. The risk of BC was higher among postmenopausal women (RR = 3.3, 95% confidence interval (CI) = (2.3, 4.6)), women with the age at first marriage ≥20 years (RR = 1.6, 95% CI = (1.3, 2.1)), and the history of oral contraceptive (OC) use (RR = 1.6, 95% CI = (1.3, 2.1)) or breastfeeding duration ≤60 months (RR = 1.8, 95% CI = (1.3, 2.5)). The PAF for menopause status, breastfeeding duration, and OC use were 40.3% (95% CI = 39.5, 40.6), 27.3% (95% CI = 23.1, 30.8) and 24.4% (95% CI = 10.5, 35.5), respectively. Conclusions Postmenopausal women, and women with a higher age at first marriage, shorter duration of breastfeeding, and history of OC use are at the higher risk of BC.

【 授权许可】

Unknown