PO.PS01.12 · 人群科学
利用Healthy Oregon Project（HOP）评估关键生殖期的环境暴露与年轻发病乳腺癌风险
Leveraging the Healthy Oregon Project (HOP) to evaluate environmental exposures during critical reproductive periods and young-onset breast cancer risk
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摘要 Abstract
中文摘要
背景：年轻发病乳腺癌（YOBC），即50岁前确诊的乳腺癌，其死亡率是≥50岁确诊病例的两倍。在美国，2012-2021年间YOBC诊断每年增加1.4%，西部各州非都市区的增幅高于都市区。地理差异可能受环境因素影响，如社区社会经济背景、有限的医疗可及性以及环境危害暴露（如农药、全氟和多氟烷基物质[PFAS]污染的水、野火烟雾），这些因素已被证实与乳腺组织炎症和乳腺癌风险增加相关。关键生殖期（如初潮、延迟生育、绝经）的变化以及产次或未生育（这些可能受这些环境因素塑造）也可能影响风险，并可能与环境应激源产生协同交互作用。我们的目的是在一个具有强烈城乡环境暴露对比的美国西部州中，评估关键生殖期的环境暴露以评价YOBC风险。
方法：我们利用Healthy Oregon Project（HOP）——一个覆盖全州、拥有超过50,000名俄勒冈居民的前瞻性队列——评估了入组的18-49岁、确诊YOBC女性居住地址的城乡属性。病例通过HOP基线问卷的自报识别。基线居住地址与美国农业部经济研究局的城乡通勤区（RUCA）代码关联，分类为城市（代码1-3）、乡村（代码4-9）或边远地区（代码10）。一份补充的生殖生命历程问卷（包括关键生殖窗口期间的居住地址）正在开发中，以便我们将空间数据集（如细颗粒物空气污染[PM2.5]、野火烟雾、温度、水中PFAS、土地覆盖、农业农药）与YOBC病例和匹配对照关联。
结果：HOP已获得51,978名俄勒冈居民的知情同意（约占该州340万成年居民的1.5%）。在基线问卷中，37,695人（72.5%）出生时为女性，615人报告了YOBC诊断。总体而言，参与者居住于城市（72.5%）、乡村（13.5%）和边远地区（1.9%），12.1%数据缺失。确诊YOBC者呈现相似分布（分别为79.8%、13.5%和2.3%；4.4%缺失）。
结论：HOP参与者居住地的城乡属性在YOBC患者与整体队列之间相似；该分布代表了俄勒冈州的城乡构成。未来分析将关联生命历程中关键生殖窗口期间的历史居住地址与时空对齐的环境和社会经济暴露数据，以评估累积的、可能协同的环境暴露如何促成YOBC风险。
查看英文原文 English abstract
Background: Young-onset breast cancer (YOBC), diagnosed before age 50, has twice the mortality of cases diagnosed ≥50. In the US, YOBC diagnoses increased by 1.4% annually from 2012-2021, with higher increases in non-metropolitan vs. metropolitan areas in western states. Geographic disparities may be influenced by environmental factors, such as neighborhood socioeconomic context, limited healthcare access, and exposure to environmental hazards (e.g., pesticides, per- and polyfluoroalkyl substances [PFAS]-contaminated water, wildfire smoke), which have been associated with breast tissue inflammation and increased breast cancer risk. Shifts in critical reproductive periods (e.g., menarche, delayed childbirth, menopause) and parity or nulliparity, which may be shaped by these environmental factors, may also affect risk and interact synergistically with environmental stressors. Our objective was to assess environmental exposures during critical reproductive periods to evaluate YOBC risk in a western US state with strong urban-rural environmental exposure contrasts.
Methods: We used the Healthy Oregon Project (HOP) - a statewide prospective cohort of >50,000 Oregonians - to assess rurality of residential addresses of enrolled females, 18-49 years old, diagnosed with YOBC. Cases were identified via self-report on the HOP baseline questionnaire. Baseline residential addresses were linked to the USDA Economic Research Service's Rural Urban Commuting Area (RUCA) codes, and classified as Urban (codes 1-3), Rural (codes 4-9), or Frontier (code 10). A supplementary reproductive lifecourse questionnaire, including residential addresses during critical reproductive windows, is in development to allow us to link spatial datasets (e.g., fine particulate air pollution [PM 2.5 ], wildfire smoke, temperature, PFAS in water, land cover, agricultural pesticides) to YOBC cases and matched controls.
Results: HOP has consented 51,978 Oregonians (~1.5% of the state's 3.4 million adult residents). On baseline questionnaires, 37,695 (72.5%) identified as female at birth, and 615 reported a YOBC diagnosis. Overall, participants resided in Urban (72.5%), Rural (13.5%) and Frontier (1.9%) areas, with 12.1% missing. Those diagnosed with YOBC showed a similar distribution (79.8%, 13.5% and 2.3%, respectively; 4.4% missing).
Conclusion: Rurality of HOP participants' residences was similar across those with YOBC and the overall cohort; this distribution is representative of Oregon's urban-rural composition. Future analyses will link historic residential addresses during critical reproductive windows across the lifecourse to spatiotemporally aligned environmental and socioeconomic exposure data to evaluate how cumulative, and potentially synergistic, environmental exposures contribute to YOBC risk.
利益披露 Disclosure
C. Roscoe, None..
S. I. Chapela Lara, None..
W. Stoller, None..
M. Simmons, None..
H. Brack, None..
J. Shannon, None..
P. J. Schedin, None..
Z. Zhang, None.