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      Association of Estrogen-Related Polygenetic Risk Scores with Breast Cancer and Interactions with Alcohol Intake, Early Menarche, and Nulligravida

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          Abstract

          Backgrounds:

          Early menstruation, late menopause, no pregnancy, and genetic factors are known risk factors of the disease, but their effects may differ in Asian and Caucasian women. The purpose of this study was to identify genetic variants of genes related to estrogen signaling in a large city hospital-based cohort and to determine their interactions with lifestyles.

          Methods:

          This is a case-control study. Three hundred ninety participants diagnosed with breast cancer were compared with 36,290 controls(no cancer)to explore the genetic variants to influence breast cancer risk. Based on GWAS results, the selected genetic variants were subjected to their interactions by generalized multifactor dimensionality reduction (GMDR) analysis.

          Results:

          Early menstruation(OR=1.55), early menopause (OR=1.70), and no experience of pregnancy(OR=2.86) had a positive association with breast cancer risk(P<0.05). The selected polygenetic risk score(PRS) models included four SNPs and seven SNPs: The four-SNP PRS model included CDH13_rs12600325, SMYD3_rs3753686, FGF12_rs2134635, and ESRRB_rs10873289, and in the seven-SNP PRS model, ESR1_ rs2046210, estrogen-related receptor gamma(ESRRG)_rs17043393, and EGFR_ rs6958497 were added into the four-SNP PRS model. Early menstruation, early menopause, and no pregnancy experience interacted with four-SNP PRS. For the participants who had early menstruation and early menopause, high-PRS had an association with a much higher breast cancer risk than the low-PRS in the four-SNP model. However, metabolic parameters, nutrient intakes, and different dietary patterns did not interact with PRS for breast cancer risk. However, alcohol intake interacted with PRS for breast cancer risk (OR=2.33 and 8.07 for mild and moderate alcohol consumption, respectively; P=0.0004).

          Conclusion:

          Consideration of age at menarche and menopause, pregnancy experience, and alcohol intake may be required to reduce breast cancer risk in women with a high-PRS of genes related to the estrogen signaling pathway.

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          Most cited references49

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          Breast cancer

          Breast cancer is the most frequent malignancy in women worldwide and is curable in ~70-80% of patients with early-stage, non-metastatic disease. Advanced breast cancer with distant organ metastases is considered incurable with currently available therapies. On the molecular level, breast cancer is a heterogeneous disease; molecular features include activation of human epidermal growth factor receptor 2 (HER2, encoded by ERBB2), activation of hormone receptors (oestrogen receptor and progesterone receptor) and/or BRCA mutations. Treatment strategies differ according to molecular subtype. Management of breast cancer is multidisciplinary; it includes locoregional (surgery and radiation therapy) and systemic therapy approaches. Systemic therapies include endocrine therapy for hormone receptor-positive disease, chemotherapy, anti-HER2 therapy for HER2-positive disease, bone stabilizing agents, poly(ADP-ribose) polymerase inhibitors for BRCA mutation carriers and, quite recently, immunotherapy. Future therapeutic concepts in breast cancer aim at individualization of therapy as well as at treatment de-escalation and escalation based on tumour biology and early therapy response. Next to further treatment innovations, equal worldwide access to therapeutic advances remains the global challenge in breast cancer care for the future.
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            Breast cancer

            Breast cancer is one of the three most common cancers worldwide. Early breast cancer is considered potentially curable. Therapy has progressed substantially over the past years with a reduction in therapy intensity, both for locoregional and systemic therapy; avoiding overtreatment but also undertreatment has become a major focus. Therapy concepts follow a curative intent and need to be decided in a multidisciplinary setting, taking molecular subtype and locoregional tumour load into account. Primary conventional surgery is not the optimal choice for all patients any more. In triple-negative and HER2-positive early breast cancer, neoadjuvant therapy has become a commonly used option. Depending on clinical tumour subtype, therapeutic backbones include endocrine therapy, anti-HER2 targeting, and chemotherapy. In metastatic breast cancer, therapy goals are prolongation of survival and maintaining quality of life. Advances in endocrine therapies and combinations, as well as targeting of HER2, and the promise of newer targeted therapies make the prospect of long-term disease control in metastatic breast cancer an increasing reality.
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              Polygenic Risk Scores for Prediction of Breast Cancer and Breast Cancer Subtypes

              Stratification of women according to their risk of breast cancer based on polygenic risk scores (PRSs) could improve screening and prevention strategies. Our aim was to develop PRSs, optimized for prediction of estrogen receptor (ER)-specific disease, from the largest available genome-wide association dataset and to empirically validate the PRSs in prospective studies. The development dataset comprised 94,075 case subjects and 75,017 control subjects of European ancestry from 69 studies, divided into training and validation sets. Samples were genotyped using genome-wide arrays, and single-nucleotide polymorphisms (SNPs) were selected by stepwise regression or lasso penalized regression. The best performing PRSs were validated in an independent test set comprising 11,428 case subjects and 18,323 control subjects from 10 prospective studies and 190,040 women from UK Biobank (3,215 incident breast cancers). For the best PRSs (313 SNPs), the odds ratio for overall disease per 1 standard deviation in ten prospective studies was 1.61 (95%CI: 1.57–1.65) with area under receiver-operator curve (AUC) = 0.630 (95%CI: 0.628–0.651). The lifetime risk of overall breast cancer in the top centile of the PRSs was 32.6%. Compared with women in the middle quintile, those in the highest 1% of risk had 4.37- and 2.78-fold risks, and those in the lowest 1% of risk had 0.16- and 0.27-fold risks, of developing ER-positive and ER-negative disease, respectively. Goodness-of-fit tests indicated that this PRS was well calibrated and predicts disease risk accurately in the tails of the distribution. This PRS is a powerful and reliable predictor of breast cancer risk that may improve breast cancer prevention programs.
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                Author and article information

                Journal
                Asian Pac J Cancer Prev
                Asian Pac J Cancer Prev
                APJCP
                Asian Pacific Journal of Cancer Prevention : APJCP
                West Asia Organization for Cancer Prevention (Iran )
                1513-7368
                2476-762X
                January 2022
                : 23
                : 1
                : 13-24
                Affiliations
                [1] Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, Asan, Korea.
                Author notes
                [* ]For Correspondence: smpark@hoseo.edu
                Article
                10.31557/APJCP.2022.23.1.13
                9258656
                35092367
                36c42cb8-87cc-44ec-8bfc-85f2ea144b93

                This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License. https://creativecommons.org/licenses/by-nc/4.0/

                History
                : 1 September 2020
                : 9 January 2022
                Categories
                Original Article

                gene-gene interaction,breast cancer,oestrogen receptor,polygenic risk scores,alcohol

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