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1.  Low penetrance breast cancer susceptibility loci are associated with specific breast tumor subtypes: findings from the Breast Cancer Association Consortium 
Broeks, Annegien | Schmidt, Marjanka K. | Sherman, Mark E. | Couch, Fergus J. | Hopper, John L. | Dite, Gillian S. | Apicella, Carmel | Smith, Letitia D. | Hammet, Fleur | Southey, Melissa C. | Van ’t Veer, Laura J. | de Groot, Renate | Smit, Vincent T.H.B.M. | Fasching, Peter A. | Beckmann, Matthias W. | Jud, Sebastian | Ekici, Arif B. | Hartmann, Arndt | Hein, Alexander | Schulz-Wendtland, Ruediger | Burwinkel, Barbara | Marme, Frederik | Schneeweiss, Andreas | Sinn, Hans-Peter | Sohn, Christof | Tchatchou, Sandrine | Bojesen, Stig E. | Nordestgaard, Børge G. | Flyger, Henrik | Ørsted, David D. | Kaur-Knudsen, Diljit | Milne, Roger L. | Pérez, Jose I. Arias | Zamora, Pilar | Rodríguez, Primitiva Menéndez | Benítez, Javier | Brauch, Hiltrud | Justenhoven, Christina | Ko, Yon-Dschun | Hamann, Ute | Fischer, Hans-Peter | Brüning, Thomas | Pesch, Beate | Chang-Claude, Jenny | Wang-Gohrke, Shan | Bremer, Michael | Karstens, Johann H. | Hillemanns, Peter | Dörk, Thilo | Nevanlinna, Heli A. | Heikkinen, Tuomas | Heikkilä, Päivi | Blomqvist, Carl | Aittomäki, Kristiina | Aaltonen, Kirsimari | Lindblom, Annika | Margolin, Sara | Mannermaa, Arto | Kosma, Veli-Matti | Kauppinen, Jaana M. | Kataja, Vesa | Auvinen, Päivi | Eskelinen, Matti | Soini, Ylermi | Chenevix-Trench, Georgia | Spurdle, Amanda B. | Beesley, Jonathan | Chen, Xiaoqing | Holland, Helene | Lambrechts, Diether | Claes, Bart | Vandorpe, Thijs | Neven, Patrick | Wildiers, Hans | Flesch-Janys, Dieter | Hein, Rebecca | Löning, Thomas | Kosel, Matthew | Fredericksen, Zachary S. | Wang, Xianshu | Giles, Graham G. | Baglietto, Laura | Severi, Gianluca | McLean, Catriona | Haiman, Christopher A. | Henderson, Brian E. | Le Marchand, Loic | Kolonel, Laurence N. | Grenaker Alnæs, Grethe | Kristensen, Vessela | Børresen-Dale, Anne-Lise | Hunter, David J. | Hankinson, Susan E. | Andrulis, Irene L. | Marie Mulligan, Anna | O'Malley, Frances P. | Devilee, Peter | Huijts, Petra E.A. | Tollenaar, Rob A.E.M. | Van Asperen, Christi J. | Seynaeve, Caroline S. | Chanock, Stephen J. | Lissowska, Jolanta | Brinton, Louise | Peplonska, Beata | Figueroa, Jonine | Yang, Xiaohong R. | Hooning, Maartje J. | Hollestelle, Antoinette | Oldenburg, Rogier A. | Jager, Agnes | Kriege, Mieke | Ozturk, Bahar | van Leenders, Geert J.L.H. | Hall, Per | Czene, Kamila | Humphreys, Keith | Liu, Jianjun | Cox, Angela | Connley, Daniel | Cramp, Helen E. | Cross, Simon S. | Balasubramanian, Sabapathy P. | Reed, Malcolm W.R. | Dunning, Alison M. | Easton, Douglas F. | Humphreys, Manjeet K. | Caldas, Carlos | Blows, Fiona | Driver, Kristy | Provenzano, Elena | Lubinski, Jan | Jakubowska, Anna | Huzarski, Tomasz | Byrski, Tomasz | Cybulski, Cezary | Gorski, Bohdan | Gronwald, Jacek | Brennan, Paul | Sangrajrang, Suleeporn | Gaborieau, Valerie | Shen, Chen-Yang | Hsiung, Chia-Ni | Yu, Jyh-Cherng | Chen, Shou-Tung | Hsu, Giu-Cheng | Hou, Ming-Feng | Huang, Chiun-Sheng | Anton-Culver, Hoda | Ziogas, Argyrios | Pharoah, Paul D.P. | Garcia-Closas, Montserrat
Human Molecular Genetics  2011;20(16):3289-3303.
Breast cancers demonstrate substantial biological, clinical and etiological heterogeneity. We investigated breast cancer risk associations of eight susceptibility loci identified in GWAS and two putative susceptibility loci in candidate genes in relation to specific breast tumor subtypes. Subtypes were defined by five markers (ER, PR, HER2, CK5/6, EGFR) and other pathological and clinical features. Analyses included up to 30 040 invasive breast cancer cases and 53 692 controls from 31 studies within the Breast Cancer Association Consortium. We confirmed previous reports of stronger associations with ER+ than ER− tumors for six of the eight loci identified in GWAS: rs2981582 (10q26) (P-heterogeneity = 6.1 × 10−18), rs3803662 (16q12) (P = 3.7 × 10−5), rs13281615 (8q24) (P = 0.002), rs13387042 (2q35) (P = 0.006), rs4973768 (3p24) (P = 0.003) and rs6504950 (17q23) (P = 0.002). The two candidate loci, CASP8 (rs1045485, rs17468277) and TGFB1 (rs1982073), were most strongly related with the risk of PR negative tumors (P = 5.1 × 10−6 and P = 4.1 × 10−4, respectively), as previously suggested. Four of the eight loci identified in GWAS were associated with triple negative tumors (P ≤ 0.016): rs3803662 (16q12), rs889312 (5q11), rs3817198 (11p15) and rs13387042 (2q35); however, only two of them (16q12 and 2q35) were associated with tumors with the core basal phenotype (P ≤ 0.002). These analyses are consistent with different biological origins of breast cancers, and indicate that tumor stratification might help in the identification and characterization of novel risk factors for breast cancer subtypes. This may eventually result in further improvements in prevention, early detection and treatment.
doi:10.1093/hmg/ddr228
PMCID: PMC3140824  PMID: 21596841
2.  Associations of Breast Cancer Risk Factors With Tumor Subtypes: A Pooled Analysis From the Breast Cancer Association Consortium Studies 
Yang, Xiaohong R. | Chang-Claude, Jenny | Goode, Ellen L. | Couch, Fergus J. | Nevanlinna, Heli | Milne, Roger L. | Gaudet, Mia | Schmidt, Marjanka K. | Broeks, Annegien | Cox, Angela | Fasching, Peter A. | Hein, Rebecca | Spurdle, Amanda B. | Blows, Fiona | Driver, Kristy | Flesch-Janys, Dieter | Heinz, Judith | Sinn, Peter | Vrieling, Alina | Heikkinen, Tuomas | Aittomäki, Kristiina | Heikkilä, Päivi | Blomqvist, Carl | Lissowska, Jolanta | Peplonska, Beata | Chanock, Stephen | Figueroa, Jonine | Brinton, Louise | Hall, Per | Czene, Kamila | Humphreys, Keith | Darabi, Hatef | Liu, Jianjun | Van ‘t Veer, Laura J. | van Leeuwen, Flora E. | Andrulis, Irene L. | Glendon, Gord | Knight, Julia A. | Mulligan, Anna Marie | O’Malley, Frances P. | Weerasooriya, Nayana | John, Esther M. | Beckmann, Matthias W. | Hartmann, Arndt | Weihbrecht, Sebastian B. | Wachter, David L. | Jud, Sebastian M. | Loehberg, Christian R. | Baglietto, Laura | English, Dallas R. | Giles, Graham G. | McLean, Catriona A. | Severi, Gianluca | Lambrechts, Diether | Vandorpe, Thijs | Weltens, Caroline | Paridaens, Robert | Smeets, Ann | Neven, Patrick | Wildiers, Hans | Wang, Xianshu | Olson, Janet E. | Cafourek, Victoria | Fredericksen, Zachary | Kosel, Matthew | Vachon, Celine | Cramp, Helen E. | Connley, Daniel | Cross, Simon S. | Balasubramanian, Sabapathy P. | Reed, Malcolm W. R. | Dörk, Thilo | Bremer, Michael | Meyer, Andreas | Karstens, Johann H. | Ay, Aysun | Park-Simon, Tjoung-Won | Hillemanns, Peter | Arias Pérez, Jose Ignacio | Rodríguez, Primitiva Menéndez | Zamora, Pilar | Benítez, Javier | Ko, Yon-Dschun | Fischer, Hans-Peter | Hamann, Ute | Pesch, Beate | Brüning, Thomas | Justenhoven, Christina | Brauch, Hiltrud | Eccles, Diana M. | Tapper, William J. | Gerty, Sue M. | Sawyer, Elinor J. | Tomlinson, Ian P. | Jones, Angela | Kerin, Michael | Miller, Nicola | McInerney, Niall | Anton-Culver, Hoda | Ziogas, Argyrios | Shen, Chen-Yang | Hsiung, Chia-Ni | Wu, Pei-Ei | Yang, Show-Lin | Yu, Jyh-Cherng | Chen, Shou-Tung | Hsu, Giu-Cheng | Haiman, Christopher A. | Henderson, Brian E. | Le Marchand, Loic | Kolonel, Laurence N. | Lindblom, Annika | Margolin, Sara | Jakubowska, Anna | Lubiński, Jan | Huzarski, Tomasz | Byrski, Tomasz | Górski, Bohdan | Gronwald, Jacek | Hooning, Maartje J. | Hollestelle, Antoinette | van den Ouweland, Ans M. W. | Jager, Agnes | Kriege, Mieke | Tilanus-Linthorst, Madeleine M. A. | Collée, Margriet | Wang-Gohrke, Shan | Pylkäs, Katri | Jukkola-Vuorinen, Arja | Mononen, Kari | Grip, Mervi | Hirvikoski, Pasi | Winqvist, Robert | Mannermaa, Arto | Kosma, Veli-Matti | Kauppinen, Jaana | Kataja, Vesa | Auvinen, Päivi | Soini, Ylermi | Sironen, Reijo | Bojesen, Stig E. | Dynnes Ørsted, David | Kaur-Knudsen, Diljit | Flyger, Henrik | Nordestgaard, Børge G. | Holland, Helene | Chenevix-Trench, Georgia | Manoukian, Siranoush | Barile, Monica | Radice, Paolo | Hankinson, Susan E. | Hunter, David J. | Tamimi, Rulla | Sangrajrang, Suleeporn | Brennan, Paul | McKay, James | Odefrey, Fabrice | Gaborieau, Valerie | Devilee, Peter | Huijts, P.E.A. | Tollenaar, RAEM. | Seynaeve, C. | Dite, Gillian S. | Apicella, Carmel | Hopper, John L. | Hammet, Fleur | Tsimiklis, Helen | Smith, Letitia D. | Southey, Melissa C. | Humphreys, Manjeet K. | Easton, Douglas | Pharoah, Paul | Sherman, Mark E. | Garcia-Closas, Montserrat
Background
Previous studies have suggested that breast cancer risk factors are associated with estrogen receptor (ER) and progesterone receptor (PR) expression status of the tumors.
Methods
We pooled tumor marker and epidemiological risk factor data from 35 568 invasive breast cancer case patients from 34 studies participating in the Breast Cancer Association Consortium. Logistic regression models were used in case–case analyses to estimate associations between epidemiological risk factors and tumor subtypes, and case–control analyses to estimate associations between epidemiological risk factors and the risk of developing specific tumor subtypes in 12 population-based studies. All statistical tests were two-sided.
Results
In case–case analyses, of the epidemiological risk factors examined, early age at menarche (≤12 years) was less frequent in case patients with PR− than PR+ tumors (P = .001). Nulliparity (P = 3 × 10−6) and increasing age at first birth (P = 2 × 10−9) were less frequent in ER− than in ER+ tumors. Obesity (body mass index [BMI] ≥ 30 kg/m2) in younger women (≤50 years) was more frequent in ER−/PR− than in ER+/PR+ tumors (P = 1 × 10−7), whereas obesity in older women (>50 years) was less frequent in PR− than in PR+ tumors (P = 6 × 10−4). The triple-negative (ER−/PR−/HER2−) or core basal phenotype (CBP; triple-negative and cytokeratins [CK]5/6+ and/or epidermal growth factor receptor [EGFR]+) accounted for much of the heterogeneity in parity-related variables and BMI in younger women. Case–control analyses showed that nulliparity, increasing age at first birth, and obesity in younger women showed the expected associations with the risk of ER+ or PR+ tumors but not triple-negative (nulliparity vs parity, odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.75 to 1.19, P = .61; 5-year increase in age at first full-term birth, OR = 0.95, 95% CI = 0.86 to 1.05, P = .34; obesity in younger women, OR = 1.36, 95% CI = 0.95 to 1.94, P = .09) or CBP tumors.
Conclusions
This study shows that reproductive factors and BMI are most clearly associated with hormone receptor–positive tumors and suggest that triple-negative or CBP tumors may have distinct etiology.
doi:10.1093/jnci/djq526
PMCID: PMC3107570  PMID: 21191117
3.  Transcription factors zeb1, twist and snai1 in breast carcinoma 
BMC Cancer  2011;11:73.
Background
Epitheliomesenchymal transition (EMT) is the process where cancer cells attain fibroblastic features and are thus able to invade neighboring tissues. Transcriptional factors zeb1, snai1 and twist regulate EMT.
Methods
We used immunohistochemistry to investigate the expression of zeb1, twist and snai1 in tumor and stromal compartments by in a large set of breast carcinomas. The results were compared with estrogen and progesterone receptor status, HER2 amplification, grade, histology, TNM status and survival of the patients.
Results
Nuclear expression for twist was seen in the epithelial tumor cell compartment in 3.6% and for snai1 in 3.1% of the cases while zeb1 was not detected at all in these areas. In contrast, the tumor stromal compartment showed nuclear zeb1 and twist expression in 75% and 52.4% of the cases, respectively. Although rare, nuclear expression of twist in the epithelial tumor cell compartment was associated with a poor outcome of the patients (p = 0.054 log rank, p = 0.013, Breslow, p = 0.025 Tarone-Ware). Expression of snai1, or expression of zeb1 or twist in the stromal compartment did not have any prognostic significance. Furthermore, none of these factors associated with the size of the tumors, nor with the presence of axillary or distant metastases. Expression of zeb1 and twist in the stromal compartment was positively associated with a positive estrogen or progesterone receptor status of the tumors. Stromal zeb1 expression was significantly lower in ductal in situ carcinomas than in invasive carcinomas (p = 0.020). Medullary carcinomas (p = 0.017) and mucinous carcinomas (p = 0.009) had a lower stromal expression of zeb1 than ductal carcinomas. Stromal twist expression was also lower in mucinous (p = 0.017) than in ductal carcinomas.
Conclusions
Expression of transcriptional factors zeb1 and twist mainly occur in the stromal compartment of breast carcinomas, possibly representing two populations of cells; EMT transformed neoplastic cells and stromal fibroblastic cells undergoing activation of zeb1 and twist due to growth factors produced by the tumor. However, epithelial expression of twist was associated with a poor prognosis, hinting at its importance in the spread of breast carcinoma.
doi:10.1186/1471-2407-11-73
PMCID: PMC3055233  PMID: 21324165
4.  Assessing interactions between the associations of common genetic susceptibility variants, reproductive history and body mass index with breast cancer risk in the breast cancer association consortium: a combined case-control study 
Milne, Roger L | Gaudet, Mia M | Spurdle, Amanda B | Fasching, Peter A | Couch, Fergus J | Benítez, Javier | Arias Pérez, José Ignacio | Zamora, M Pilar | Malats, Núria | dos Santos Silva, Isabel | Gibson, Lorna J | Fletcher, Olivia | Johnson, Nichola | Anton-Culver, Hoda | Ziogas, Argyrios | Figueroa, Jonine | Brinton, Louise | Sherman, Mark E | Lissowska, Jolanta | Hopper, John L | Dite, Gillian S | Apicella, Carmel | Southey, Melissa C | Sigurdson, Alice J | Linet, Martha S | Schonfeld, Sara J | Freedman, D Michal | Mannermaa, Arto | Kosma, Veli-Matti | Kataja, Vesa | Auvinen, Päivi | Andrulis, Irene L | Glendon, Gord | Knight, Julia A | Weerasooriya, Nayana | Cox, Angela | Reed, Malcolm WR | Cross, Simon S | Dunning, Alison M | Ahmed, Shahana | Shah, Mitul | Brauch, Hiltrud | Ko, Yon-Dschun | Brüning, Thomas | Lambrechts, Diether | Reumers, Joke | Smeets, Ann | Wang-Gohrke, Shan | Hall, Per | Czene, Kamila | Liu, Jianjun | Irwanto, Astrid K | Chenevix-Trench, Georgia | Holland, Helene | Giles, Graham G | Baglietto, Laura | Severi, Gianluca | Bojensen, Stig E | Nordestgaard, Børge G | Flyger, Henrik | John, Esther M | West, Dee W | Whittemore, Alice S | Vachon, Celine | Olson, Janet E | Fredericksen, Zachary | Kosel, Matthew | Hein, Rebecca | Vrieling, Alina | Flesch-Janys, Dieter | Heinz, Judith | Beckmann, Matthias W | Heusinger, Katharina | Ekici, Arif B | Haeberle, Lothar | Humphreys, Manjeet K | Morrison, Jonathan | Easton, Doug F | Pharoah, Paul D | García-Closas, Montserrat | Goode, Ellen L | Chang-Claude, Jenny
Breast Cancer Research : BCR  2010;12(6):R110.
Introduction
Several common breast cancer genetic susceptibility variants have recently been identified. We aimed to determine how these variants combine with a subset of other known risk factors to influence breast cancer risk in white women of European ancestry using case-control studies participating in the Breast Cancer Association Consortium.
Methods
We evaluated two-way interactions between each of age at menarche, ever having had a live birth, number of live births, age at first birth and body mass index (BMI) and each of 12 single nucleotide polymorphisms (SNPs) (10q26-rs2981582 (FGFR2), 8q24-rs13281615, 11p15-rs3817198 (LSP1), 5q11-rs889312 (MAP3K1), 16q12-rs3803662 (TOX3), 2q35-rs13387042, 5p12-rs10941679 (MRPS30), 17q23-rs6504950 (COX11), 3p24-rs4973768 (SLC4A7), CASP8-rs17468277, TGFB1-rs1982073 and ESR1-rs3020314). Interactions were tested for by fitting logistic regression models including per-allele and linear trend main effects for SNPs and risk factors, respectively, and single-parameter interaction terms for linear departure from independent multiplicative effects.
Results
These analyses were applied to data for up to 26,349 invasive breast cancer cases and up to 32,208 controls from 21 case-control studies. No statistical evidence of interaction was observed beyond that expected by chance. Analyses were repeated using data from 11 population-based studies, and results were very similar.
Conclusions
The relative risks for breast cancer associated with the common susceptibility variants identified to date do not appear to vary across women with different reproductive histories or body mass index (BMI). The assumption of multiplicative combined effects for these established genetic and other risk factors in risk prediction models appears justified.
doi:10.1186/bcr2797
PMCID: PMC3046455  PMID: 21194473
5.  Outcome of patients with HER2-positive breast cancer treated with or without adjuvant trastuzumab in the Finland Capecitabine Trial (FinXX) 
Background.
Little information is available about survival outcomes of patients with HER2-positive early breast cancer treated with adjuvant capecitabine-containing chemotherapy with or without trastuzumab.
Patients and methods.
One thousand and five hundred patients with early breast cancer were entered to the Finland Capecitabine trial (FinXX) between January 2004 and May 2007, and were randomly assigned to receive either three cycles of adjuvant TX (docetaxel, capecitabine) followed by three cycles of CEX (cyclophosphamide, epirubicin, capecitabine; TX-CEX) or three cycles of docetaxel followed by three cycles of CEF (cyclophosphamide, epirubicin, fluorouracil; T-CEF). The primary endpoint was recurrence-free survival (RFS). The study protocol was amended in May 2005 while study accrual was ongoing to allow adjuvant trastuzumab for patients with HER2-positive cancer. Of the 284 patients with HER2-positive cancer accrued to FinXX, 176 (62.0%) received trastuzumab after amending the study protocol, 131 for 12 months and 45 for nine weeks. The median follow-up time was 6.7 years.
Results.
Patients with HER2-positive cancer who received trastuzumab had better RFS than those who did not (five-year RFS 89.2% vs. 75.9%; HR 0.41, 95% CI 0.23–0.72; p = 0.001). Patients treated with trastuzumab for 12 months or nine weeks had similar RFS. There was no significant interaction between trastuzumab administration and the type of chemotherapy. Four (2.3%) patients treated with trastuzumab had heart failure or left ventricular dysfunction, three of these received capecitabine.
Conclusion.
Adjuvant trastuzumab improves RFS of patients treated with TX-CEX or T-CEF. Few patients had cardiac failure.
doi:10.3109/0284186X.2013.820840
PMCID: PMC3894716  PMID: 23957715

Results 1-5 (5)