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Breast cancer risk factors and survival by tumor subtype: Pooled analyses from the breast cancer association consortium

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  • The ABCTB Investigators
  • The NBCS Collaborators
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BACKGROUND: It is not known whether modifiable lifestyle factors that predict survival after invasive breast cancer differ by subtype.

METHODS: We analyzed data for 121,435 women diagnosed with breast cancer from 67 studies in the Breast Cancer Association Consortium with 16,890 deaths (8,554 breast cancer specific) over 10 years. Cox regression was used to estimate associations between risk factors and 10-year all-cause mortality and breast cancer-specific mortality overall, by estrogen receptor (ER) status, and by intrinsic-like subtype.

RESULTS: There was no evidence of heterogeneous associations between risk factors and mortality by subtype ( P adj > 0.30). The strongest associations were between all-cause mortality and BMI ≥30 versus 18.5-25 kg/m 2 [HR (95% confidence interval (CI), 1.19 (1.06-1.34)]; current versus never smoking [1.37 (1.27-1.47)], high versus low physical activity [0.43 (0.21-0.86)], age ≥30 years versus <20 years at first pregnancy [0.79 (0.72-0.86)]; >0-<5 years versus ≥10 years since last full-term birth [1.31 (1.11-1.55)]; ever versus never use of oral contraceptives [0.91 (0.87-0.96)]; ever versus never use of menopausal hormone therapy, including current estrogen-progestin therapy [0.61 (0.54-0.69)]. Similar associations with breast cancer mortality were weaker; for example, 1.11 (1.02-1.21) for current versus never smoking.

CONCLUSIONS: We confirm associations between modifiable lifestyle factors and 10-year all-cause mortality. There was no strong evidence that associations differed by ER status or intrinsic-like subtype.

IMPACT: Given the large dataset and lack of evidence that associations between modifiable risk factors and 10-year mortality differed by subtype, these associations could be cautiously used in prognostication models to inform patient-centered care.

OriginalsprogEngelsk
TidsskriftCancer Epidemiology Biomarkers and Prevention
Vol/bind30
Udgave nummer4
Sider (fra-til)623-642
Antal sider20
ISSN1055-9965
DOI
StatusUdgivet - apr. 2021

Bibliografisk note

Funding Information:
For NHS and NHS2, the study protocol was approved by the institutional review boards of the Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, and those of participating registries as required. We would like to thank the participants and staff of the NHS and NHS2 for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. The NHS (principal investigator: H.A. Eliassen) was supported by NIH grants P01 CA87969, UM1 CA186107, and U19 CA148065. The NHS2 (principal investigator: W. Willett) was supported by NIH grants U01 CA176726 and U19 CA148065.

Funding Information:
We thank all the individuals who took part in these studies and all the researchers, clinicians, technicians, and administrative staff who have enabled this work to be carried out. This work was supported by the following funding agencies: The Breast Cancer Association Consortium (all authors, directly or indirectly through having samples genotyped on the iCOGS and/or OncoArray and/or having their data incorporated in the BCAC database) is funded by Cancer Research UK (C1287/A16563, C1287/A10118), the European Union's Horizon 2020 Research and Innovation Programme (grant numbers 634935 and 633784 for BRIDGES and B-CAST, respectively), and by the European Community's Seventh Framework Programme under grant agreement number 223175 (grant number HEALTH-F2- 2009-223175; COGS). The EU Horizon 2020 Research and Innovation Programme funding source had no role in study design, data collection, data analysis, data interpretation or writing of the report.

Funding Information:
BIGGS thanks Niall McInerney, Gabrielle Colleran, Andrew Rowan, Angela Jones. For BIGGS, E.J. Sawyer is supported by NIHR Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust in partnership with King’s College London, United Kingdom. I. Tomlinson is supported by the Oxford Biomedical Research Centre.

Funding Information:
LAABC thanks all the study participants and the entire data collection team, especially Annie Fung and June Yashiki. LAABC (principal investigator: A.H. Wu) is supported by grants (1RB-0287, 3PB-0102, 5PB-0018, 10PB-0098) from the California Breast Cancer Research Program. Incident breast cancer cases were collected by the USC Cancer Surveillance Program (CSP) which is supported under subcontract by the California Department of Health. The CSP is also part of the National Cancer Institute’s Division of Cancer Prevention and Control Surveillance, Epidemiology, and End Results Program, under contract number N01CN25403.

Funding Information:
The BCEES (principal investigators: J. Stone, L. Fritschi) was funded by the National Health and Medical Research Council, Australia and the Cancer Council Western Australia. BCEES thanks Allyson Thomson, Christobel Saunders, Terry Slevin, BreastScreen Western Australia, Elizabeth Wylie, and Rachel Lloyd.

Funding Information:
We thank all the individuals who took part in these studies and all the researchers, clinicians, technicians, and administrative staff who have enabled this work to be carried out. This work was supported by the following funding agencies: The Breast Cancer Association Consortium (all authors, directly or indirectly through having samples genotyped on the iCOGS and/or OncoArray and/or having their data incorporated in the BCAC database) is funded by Cancer Research UK (C1287/A16563, C1287/A10118), the European Union’s Horizon 2020 Research and Innovation Programme (grant numbers 634935 and 633784 for BRIDGES and B-CAST, respectively), and by the European Community’s Seventh Framework Programme under grant agreement number 223175 (grant number HEALTH-F2– 2009–223175; COGS). The EU Horizon 2020 Research and Innovation Programme funding source had no role in study design, data collection, data analysis, data interpretation or writing of the report.

Funding Information:
BSUCH thanks Peter Bugert, Medical Faculty Mannheim, Germany. The BSUCH study (principal investigator: B. Burwinkel) was supported by the Dietmar-Hopp Foundation, the Helmholtz Society, and the German Cancer Research Center (DKFZ).

Funding Information:
ORIGO thanks E. Krol-Warmerdam, and J. Blom for patient accrual, administering questionnaires, and managing clinical information. The LUMC survival data were retrieved from the Leiden hospital–based cancer registry system (ONCDOC) with the help of Dr. J. Molenaar. The ORIGO study (principal investigator: P. Devilee) was supported by the Dutch Cancer Society (RUL 1997– 1505) and the Biobanking and Biomolecular Resources Research Infrastructure (BBMRI-NL CP16).

Funding Information:
The Australian Breast Cancer Tissue Bank (ABCTB) Investigators: Christine Clarke, Deborah Marsh, Rodney Scott, Robert Baxter, Desmond Yip, Jane Carpenter, Alison Davis, Nirmala Pathmanathan, Peter Simpson, J. Dinny Graham, Mythily Sachchithananthan. Samples are made available to researchers on a nonexclusive basis. The ABCTB (principal investigator: C.L. Clarke) was supported by the National Health and Medical Research Council of Australia, The Cancer Institute NSW, and the National Breast Cancer Foundation.

Funding Information:
LMBC thanks Gilian Peuteman, Thomas Van Brussel, EvyVanderheyden, and Kathleen Corthouts. LMBC (principal investigator: D. Lambrechts) is supported by the “Stichting tegen Kanker.” D. Lambrechts is supported by the FWO.

Funding Information:
CCGP thanks Styliani Apostolaki, Anna Margiolaki, Georgios Nintos, Maria Perraki, Georgia Saloustrou, Georgia Sevastaki, Konstantinos Pompodakis. CCGP (principal investigator: E. Saloustros) is supported by funding from the University of Crete.

Funding Information:
Financial support for KARBAC (principal investigators: A. Lindblom, S. Margo-lin) was provided through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, the Swedish Cancer Society, The Gustav V Jubilee foundation and Bert von Kantzows foundation.

Funding Information:
The following are NBCS Collaborators: Kristine K. Sahlberg (PhD), Lars Ottestad (MD), Rolf Ka°resen (Prof. Em.), Anne-Lise Børresen-Dale (Prof. Em.), Dr. Ellen Schlichting (MD), Marit Muri Holmen (MD), Toril Sauer (MD), Vilde Haakensen (MD), Olav Engebra°ten (MD), Bjørn Naume (MD), Alexander Fossa° (MD), Cecile E. Kiserud (MD), Kristin V. Reinertsen (MD), Åslaug Helland (MD), Margit Riis (MD), Ju€rgen Geisler (MD), OSBREAC and Grethe I. Grenaker Alnæs (MSc). The NBCS (principal investigator: V.N. Kristensen) has received funding from the K.G. Jebsen Centre for Breast Cancer Research; the Research Council of Norway grant 193387/V50 (to A.-L. Børresen-Dale and V.N. Kristensen) and grant 193387/H10 (to A.-L. Børresen-Dale and V.N. Kristensen), South Eastern Norway Health Authority (grant 39346 to A.-L. Børresen-Dale) and the Norwegian Cancer Society (to A.-L. Børresen-Dale and V.N. Kristensen).

Funding Information:
MABCS thanks Snezhana Smichkoska, Emilija Lazarova (University Clinic of Radiotherapy and Oncology), Katerina Kubelka-Sabit, Mitko Karadjozov (Adzibadem-Sistina Hospital), Andrej Arsovski, and Liljana Stojanovska (Re-Medika Hospital) for their contributions and commitment to this study. The MABCS study (to D. Plaseska-Karanfilska, M. Jakimovska) is funded by the Research Centre for Genetic Engineering and Biotechnology “Georgi D. Efremov,” MASA.

Funding Information:
The HERPACC (principal investigator: K. Matsuo) was supported by MEXT Kakenhi (no. 170150181 and 26253041) from the Ministry of Education, Science, Sports, Culture and Technology of Japan, by a Grant-in-Aid for the Third Term Comprehensive 10-Year Strategy for Cancer Control from Ministry Health, Labour and Welfare of Japan, by Health and Labour Sciences Research Grants for Research on Applying Health Technology from Ministry Health, Labour and Welfare of Japan, by National Cancer Center Research and Development Fund, and “Practical Research for Innovative Cancer Control (15ck0106177h0001)” from Japan Agency for Medical Research and development, AMED, and Cancer Bio Bank Aichi.

Funding Information:
MARIE thanks Petra Seibold, Dieter Flesch-Janys, Judith Heinz, Alina Vriel-ing, Ursula Eilber, Muhabbet Celik, Til Olchers, and Stefan Nickels. The MARIE study (principal investigator: J. Chang-Claude) was supported by the Deutsche Krebshilfe e.V. (70–2892-BR I, 106332, 108253, 108419, 110826, 110828), the Hamburg Cancer Society, the German Cancer Research Center (DKFZ) and the Federal Ministry of Education and Research (BMBF) Germany (01KH0402 and 01ER1306).

Funding Information:
HABCS would like to thank Peter Schu€rmann, Natalia Bogdanova, Nikki Adrian Krentel, Regina Meier, Frank Papendorf, Michael Bremer, Johann H. Karstens, Hans Christiansen, and Peter Hillemanns for their contributions to this study. The HABCS (principal investigator: T. Dork) was supported by the Claudia von Schilling Foundation for Breast Cancer Research, by the Lower Saxonian Cancer Society, and by the Rudolf Bartling Foundation. HEBCS would like to thank Heli Nevanlinna, Kristiina Aittom€aki, Karl von Smitten, and Kirsi Aaltonen for their contribution for this study.

Funding Information:
ICICLE thanks Kelly Kohut, Michele Caneppele, Maria Troy. ICICLE (principal investigator: E.J. Sawyer) was supported by Breast Cancer Now, CRUK and Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London.

Funding Information:
The Carolina Breast Cancer Study (NCBCS, principal investigator: M.A. Troester) was funded by Komen Foundation, the NCI (P50 CA058223, U54 CA156733, U01 CA179715), and the North Carolina University Cancer Research Fund.

Funding Information:
The GENICA Network: Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, and University of Tu€bingen, Germany (Hiltrud Brauch, Wing-Yee Lo), Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany (Yon-Dschun Ko, Christian Baisch), Institute of Pathology, University of Bonn, Germany (Hans-Peter Fischer), Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany (UH), Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany (Thomas Bru€ning, Beate Pesch, Sylvia Rabstein, Anne Lotz); and Institute of Occupational Medicine and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Germany (Volker Harth). The GENICA (principal investigator: H. Brauch) was funded by the Federal Ministry of Education and Research (BMBF) Germany grants 01KW9975/5, 01KW9976/8, 01KW9977/0 and 01KW0114, the Robert Bosch Foundation, Stuttgart, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, the Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum,

Funding Information:
The GESBC (principal investigator: J. Chang-Claude) was supported by the Deutsche Krebshilfe e. V. (70492) and the German Cancer Research Center (DKFZ).

Funding Information:
KARMA and SASBAC thank the Swedish Medical Research Counsel. The KARMA study (principal investigators: K. Czene, P. Hall) was supported by M€arit and Hans Rausings Initiative Against Breast Cancer.

Funding Information:
The POSH study (principal investigators: W. Tapper, D.M. Eccles) is funded by Cancer Research UK (grants C1275/A11699, C1275/C22524, C1275/A19187, C1275/ A15956 and Breast Cancer Campaign 2010PR62, 2013PR044. PREFACE thanks Sonja Oeser and Silke Landrith. PROCAS thanks NIHR for funding.

Funding Information:
The HEBCS (principal investigator: H. Nevanlinna) was financially supported by the Helsinki University Hospital Research Fund, the Finnish Cancer Society, and the Sigrid Juselius Foundation.

Funding Information:
The CGPS thanks staff and participants of the Copenhagen General Population Study. For the excellent technical assistance: Dorthe Uldall Andersen, Maria Birna Arnadottir, Anne Bank, Dorthe Kjeldga°rd Hansen. The Danish Cancer Biobank is acknowledged for providing infrastructure for the collection of blood samples for the cases. The CGPS (principal investigator: S.E. Bojesen) was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council, and Herlev and Gentofte Hospital.

Funding Information:
Genotyping for PLCO (principal investigator: M. García-Closas) was supported by the Intramural Research Program of the NIH, NCI, Division of Cancer Epidemiology and Genetics. The PLCO (principal investigator: M. García-Closas) is supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics and supported by contracts from the Division of Cancer Prevention, NCI, NIH.

Funding Information:
The MCBCS (principal investigator: F.J. Couch) was supported by the NIH grants CA192393, CA116167, CA176785 an NIH Specialized Program of Research Excellence (SPORE) in Breast Cancer (CA116201),and theBreastCancerResearchFoundation and a generous gift from the David F. and Margaret T. Grohne Family Foundation.

Funding Information:
The Australian Breast Cancer Family Study (ABCFS; principal investigators: J.L. Hopper, M.C. Southey) was supported by grant UM1 CA164920 from the NCI (Rockville, MD). The content of this manuscript does not necessarily reflect the views or policies of the NCI or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government or the BCFR. The ABCFS was also supported by the National Health and Medical Research Council of Australia, the New South Wales Cancer Council, the Victorian Health Promotion Foundation (Australia), and the Victorian Breast Cancer Research Consortium. J.L. Hopper is a National Health and Medical Research Council (NHMRC) senior principal research fellow. M.C. Southey is a NHMRC Senior Research Fellow. ABCFS thank Maggie Angelakos, Judi Mas-kiell, and Gillian Dite. The ABCS study (principal investigator: M.K. Schmidt) was supported by the Dutch Cancer Society (grants NKI 2007–3839; 2009 4363). ABCS thanks the Blood bank Sanquin, the Netherlands.

Funding Information:
OBCS thanks Katri Pylk€as, Arja Jukkola, Saila Kauppila, Meeri Otsukka, Leena Keskitalo, and Kari Mononen for their contributions to this study. The OBCS (principal investigator: R. Winqvist) was supported by research grants from the Finnish Cancer Foundation, the Academy of Finland (grant number 250083, 122715 and Center of Excellence grant number 251314), the Finnish Cancer Foundation, the Sigrid Juselius Foundation, the University of Oulu, the University of Oulu Support Foundation and the special Governmental EVO funds for Oulu University Hospital-based research activities.

Funding Information:
The Melbourne Collaborative Cohort Study (MCCS) was made possible by the contribution of many people, including the original investigators, the teams that recruited the participants and continue working on follow-up, and the many thousands of Melbourne residents who continue to participate in the study. The MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria (principal investigators: G.G. Giles and R.L. Milne). The MCCS was further augmented by Australian National Health and Medical Research Council grants 209057, 396414, and 1074383 and by infrastructure provided by Cancer Council Victoria (principal investigators: G.G. Giles and R.L. Milne). Cases and their vital status were ascertained through the Victorian Cancer Registry and the Australian Institute of Health and Welfare, including the National Death Index and the Australian Cancer Database.

Funding Information:
SEARCH (principal investigator: P.D.P. Pharoah) is funded by Cancer Research UK [C490/A10124, C490/A16561] and supported by the UK National Institute for Health Research Biomedical Research Centre at the University of Cambridge. The University of Cambridge has received salary support for P.D.P. Pharoah from the NHS in the East of England through the Clinical Academic Reserve.

Funding Information:
The CECILE study (principal investigator: P. Guénel) was supported by Fondation de France, Institut National du Cancer (INCa), Ligue Nationale contre le Cancer, Agence Nationale de SécuritéSanitaire, de l’Alimentation, de l’Environnement et du Travail (ANSES), Agence Nationale de la Recherche (ANR).

Funding Information:
The BCINIS study (principal investigator: G. Rennert) is supported, in part, by the Breast Cancer Research Foundation (BCRF). The BCINIS study would not have been possible without the contributions of Dr. K. Landsman, Dr. N. Gronich, Dr. A. Flugelman, Dr. W. Saliba, Dr. F. Lejbkowicz, Dr. E. Liani, Dr. I. Cohen, Dr. S. Kalet, Dr. V. Friedman, Dr. O. Barnet of the NICCC in Haifa, Israel, and all the contributing family medicine, surgery, pathology, and oncology teams in all medical institutes in Northern Israel.

Funding Information:
PBCS thanks Louise Brinton, Mark Sherman, Neonila Szeszenia-Dabrowska, Beata Peplonska, Witold Zatonski, Pei Chao, Michael Stagner. The PBCS (principal investigator: M. García-Closas) was funded by Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services.

Funding Information:
DIETCOMPLYF thanks the patients, nurses and clinical staff involved in the study. The University of Westminster curates the DietCompLyf database (principal investigator: M. Dwek) funded by Against Breast Cancer Registered Charity no. 1121258 and the NCRN. We thank the participants and the investigators of EPIC (European Prospective Investigation into Cancer and Nutrition). The coordination of EPIC (principal investigator: R. Kaaks) is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by: Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santéet de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF, Germany); the Hellenic Health Foundation, the Stavros Niarchos Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (the Netherlands); Health Research Fund (FIS), PI13/ 00061 to Granada, PI13/01162 to EPIC-Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC (RD06/0020) (Spain); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/ 1 to EPIC-Oxford; United Kingdom).

Funding Information:
The KBCP (principal investigator: A. Mannermaa) was financially supported by the special Government Funding (EVO) of Kuopio University Hospital grants, Cancer Fund of North Savo, the Finnish Cancer Organizations, and by the strategic funding of the University of Eastern Finland.

Funding Information:
The SASBAC study (principal investigators: P. Hall, K. Czene) was supported by funding from the Agency for Science, Technology and Research of Singapore (A*STAR), the US NIH, and the Susan G. Komen Breast Cancer Foundation. The SBCGS (principal investigators: W. Zheng, X.-O. Shu) was supported primarily by NIH grants R01CA64277, R01CA148667, UMCA182910, and R37CA70867. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The scientific development and funding of this project were, in part, supported by the Genetic Associations and Mechanisms in Oncology (GAME-ON) Network U19 CA148065.

Funding Information:
D. Torres was, in part, supported by a postdoctoral fellowship from the Alexander von Humboldt Foundation. Investigators from the CPS-II cohort thank the participants and Study Management Group for their invaluable contributions to this research. They also acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention National Program of Cancer Registries, as well as cancer registries supported by the National Cancer Institute Surveillance Epidemiology and End Results program. The American Cancer Society funds the creation, maintenance, and updating of the CPS-II cohort (principal investigators: S.M. Gapstur, M.M. Gaudet). The authors would like to thank the California Teachers Study Steering Committee that is responsible for the formation and maintenance of the Study within which this research was conducted. A full list of California Teachers Study team members is available at https://www.calteachersstudy.org/team. The California Teachers Study (principal investigator: J.V. Lacey) and the research reported in this publication were supported by the NCI of the NIH under award numbers U01-CA199277; P30-CA033572; P30-CA023100; UM1-CA164917; and R01-CA077398. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI or the NIH. The collection of cancer incidence data used in the California Teachers Study (principal investigator: J.V. Lacey) was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; NCI’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco; contract HHSN261201800015I awarded to the University of Southern California; and contract HHSN261201800009I awarded to the Public Health Institute. The opinions, findings, and conclusions expressed herein are those of the author(s) and do not necessarily reflect the official views of the State of California, Department of Public Health, the NCI, the NIH, the Centers for Disease Control and Prevention or their Contractors and Subcontractors, or the Regents of the University of California, or any of its programs.

Funding Information:
The SBCS (principal investigator: A. Cox) was supported by Sheffield Experimental Cancer Medicine Centre and Breast Cancer Now Tissue Bank. We thank the SEARCH and EPIC teams.

Funding Information:
PROCAS (principal investigator: D.G. Evans) is funded by NIHR grant PGfAR 0707–10031. D.G. Evans is supported by the all Manchester NIHR Biomedical Research Centre (IS-BRC-1215–20007).

Funding Information:
The BREast Oncology GAlician Network (BREOGAN) study would not have been possible without the contributions of the following: Manuela Gago-Dominguez, Jose Esteban Castelao, Angel Carracedo, Victor Muñoz Garzón, Alejandro Novo Dom-ínguez, Maria Elena Martinez, Sara Miranda Ponte, Carmen Redondo Marey, Maite Peña Fernández, Manuel Enguix Castelo, Maria Torres, Manuel Calaza (BREOGAN), JoséAntúnez, Máximo Fraga, and the staff of the Department of Pathology and Biobank of the University Hospital Complex of Santiago-CHUS, Instituto de Investigación Sanitaria de Santiago, IDIS, Xerencia de Xestion Integrada de Santiago-SERGAS; Joaquín González-Carreró and the staff of the Department of Pathology and Biobank of University Hospital Complex of Vigo, Instituto de Investigacion Biomedica Galicia Sur, SERGAS, Vigo, Spain. The BREOGAN (principal investigators: J.E. Castelao, M. Gago-Dominguez) is funded by Acción Estratégica de Salud del Instituto de Salud Carlos III FIS PI12/02125/Cofinanciado FEDER, PI17/00918/Cofinanciado FEDER; Acción Estratégica de Salud del Instituto de Salud Carlos III FIS Intrasalud (PI13/01136); Programa Grupos Emergentes, Cancer Genetics Unit, Instituto de Investigacion Biomedica Galicia Sur. Xerencia de Xestion Integrada de Vigo-SERGAS, Instituto de Salud Carlos III, Spain; Grant 10CSA012E, Consellería de Industria Programa Sectorial de Investigación Aplicada, PEME I + DeI + D Suma del Plan Gallego de Investigación, Desarrollo e Innovación Tecnológica de la Consellería de Industria de la Xunta de Galicia, Spain (grant EC11– 192); Fomento de la Investigación Clínica Independiente, Ministerio de Sanidad, Servicios Sociales e Igualdad, Spain; and Grant FEDER-Innterconecta. Ministerio de Economia y Competitividad, Xunta de Galicia, Spain.

Funding Information:
We thank the coordinators, the research staff and especially the MMHS participants for their continued collaboration on research studies in breast cancer. The MMHS study (principal investigator: C.M. Vachon) was supported by NIH grants CA97396, CA128931, CA116201, CA140286 and CA177150.

Funding Information:
The MEC (principal investigator: C.A. Haiman) was supported by NIH grants CA63464, CA54281, CA098758, CA132839 and CA164973. The MISS study (principal investigator: H. Olsson) is supported by funding from ERC-2011–294576 Advanced grant, Swedish Cancer Society, Swedish Research Council, Local hospital funds, Berta Kamprad Foundation, Gunnar Nilsson.

Funding Information:
The ESTHER study thanks Hartwig Ziegler, Sonja Wolf, Volker Hermann, Christa Stegmaier, Katja Butterbach. The ESTHER study (principal investigator: H. Brenner) was supported by a grant from the Baden Wu€rttemberg Ministry of Science, Research and Arts. Additional cases were recruited in the context of the VERDI study, which was supported by a grant from the German Cancer Aid (Deutsche Krebshilfe).

Funding Information:
MYBRCA thanks study participants and research staff (particularly Patsy Ng, Nurhidayu Hassan, Yoon Sook-Yee, Daphne Lee, Lee Sheau Yee, Phuah Sze Yee and Norhashimah Hassan) for their contributions and commitment to this study. MYBRCA (principal investigator: S.H. Teo) is funded by research grants from the Malaysian Ministry of Higher Education (UM.C/HlR/MOHE/06) and Cancer Research Malaysia.

Funding Information:
The AHS study (principal investigator: S. Koutros) is supported by the intramural research program of the NIH, NCI (grant number Z01-CP010119), and the National Institute of Environmental Health Sciences (grant number Z01-ES049030).

Funding Information:
The work of the BBCC (principal investigator: P.A. Fasching) was partly funded by ELAN-Fond of the University Hospital of Erlangen.

Publisher Copyright:
© 2021 American Association for Cancer Research.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

ID: 66208379