Open Access Highly Accessed Open Badges Research article

Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors

Marilyn L Kwan1*, Lawrence H Kushi1, Erin Weltzien1, Benjamin Maring1, Susan E Kutner2, Regan S Fulton3, Marion M Lee4, Christine B Ambrosone5 and Bette J Caan1

Author Affiliations

1 Kaiser Permanente, Division of Research, 2000 Broadway, First Floor, Oakland, CA 94612, USA

2 Kaiser Permanente, San Jose, 280 Hospital Parkway, San Jose, CA 95119, USA

3 Kaiser Permanente, Regional Immunohistochemistry Laboratory, 350 St. Joseph's Street, San Francisco, CA 94115, USA

4 Department of Epidemiology and Biostatistics, Box 0981, 185 Berry Street 6600, University of California, San Francisco, CA 94143-0981, USA

5 Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA

For all author emails, please log on.

Breast Cancer Research 2009, 11:R31  doi:10.1186/bcr2261

See related editorial by Troester and Swift-Scanlan,

Published: 22 May 2009



The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospective breast cancer studies within a large health maintenance organization.


Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (Her2) status were obtained (1868 luminal A tumors, 294 luminal B tumors, 288 triple-negative tumors and 94 Her2-overexpressing tumors). Demographic, reproductive and lifestyle information was collected either in person or by mailed questionnaires. Case-only odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusting for age at diagnosis, race/ethnicity, and study origin.


Compared with luminal A cases, luminal B cases were more likely to be younger at diagnosis (P = 0.0001) and were less likely to consume alcohol (OR = 0.74, 95% CI = 0.56 to 0.98), use hormone replacement therapy (HRT) (OR = 0.66, 95% CI = 0.46 to 0.94), and oral contraceptives (OR = 0.73, 95% CI = 0.55 to 0.96). Compared with luminal A cases, triple-negative cases tended to be younger at diagnosis (P ≤ 0.0001) and African American (OR = 3.14, 95% CI = 2.12 to 4.16), were more likely to have not breastfed if they had parity greater than or equal to three (OR = 1.68, 95% CI = 1.00 to 2.81), and were more likely to be overweight (OR = 1.82, 95% CI = 1.03 to 3.24) or obese (OR = 1.97, 95% CI = 1.03 to 3.77) if premenopausal. Her2-overexpressing cases were more likely to be younger at diagnosis (P = 0.03) and Hispanic (OR = 2.19, 95% CI = 1.16 to 4.13) or Asian (OR = 2.02, 95% CI = 1.05 to 3.88), and less likely to use HRT (OR = 0.45, 95% CI = 0.26 to 0.79).


These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors. Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype, but not all subtypes, include obesity, breastfeeding, and alcohol consumption. Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to elucidate these associations further.