Associations between Medical Conditions and Breast Cancer Risk in Asians: A Nationwide Population-Based Study in Taiwan

BACKGROUND The breast cancer incidence in Asia is rising. To explore whether the etiology of breast cancer is different from the known risk factors from studies in Western countries, we conducted a nested case-control study using data from the Taiwan National Health Insurance Research Database (NHIRD). METHODS All medical conditions based on the first three digits of the ICD-9 and a list of medical conditions based on literature review were retrieved for each case and control. The odds ratios (OR) and 95% confidence intervals (CI) of the associations between medical conditions and breast cancer risks were estimated using conditional logistic regression and adjusted for occupation, number of breast cancer screening, and the average number of outpatient visits prior the diagnosis. The associations were also estimated for younger (<50 years old) and older subjects separately. RESULTS The analyses included 4,884 breast cancer cases and 19,536 age-matched controls. Prior breast diseases (OR, 95% CI: 2.47, 2.26-2.71), obesity (1.43, 1.04-1.96), endometriosis (1.44, 1.15-1.80), uterine leiomyoma (1.20, 1.03-1.40), hypertensive diseases (1.14, 1.05-1.25), and disorders in lipid metabolism (1.13, 1.04-1.24) were associated with increased breast cancer risk. No heterogeneity was observed between age groups (<50 and ≥50 years old). CONCLUSIONS In addition to benign breast diseases, obesity, endometriosis, uterine leiomyoma, hypertensive diseases, and disorders of lipid metabolism were associated with a subsequent breast cancer risk. IMPACTS Our results suggest that estrogen related factors may play an important role in breast cancer risks in the Taiwanese female population.