% IMPORTANT: The following is UTF-8 encoded.  This means that in the presence
% of non-ASCII characters, it will not work with BibTeX 0.99 or older.
% Instead, you should use an up-to-date BibTeX implementation like “bibtex8” or
% “biber”.

@ARTICLE{Pizzato:300228,
      author       = {M. Pizzato and V. McCormack and L. Dossus and U. Al-Alem
                      and C. Delpierre and S. Lamy and A. Macciotta and F. Ricceri
                      and L. Mellemkjær and A. Tjønneland and C. C. Dahm and C.
                      S. Antoniussen and P. Guénel and A. Fournier and P. Frenoy
                      and M. B. Schulze and R. Kaaks$^*$ and R.
                      Turzanski-Fortner$^*$ and P. Ferrari and V. Pala and S.
                      Panico and R. Tumino and G. Masala and K. S. Olsen and I. T.
                      Gram and T. Braaten and C. Castro and P. A. Etxezarreta and
                      A. Atxega and J. M. Huerta and M.-J. Sánchez and M. Guevara
                      and T. Gathani and S. Rinaldi and P. Vineis and S.
                      Vaccarella},
      title        = {{E}ducation level and risk of breast cancer by tumor
                      subtype in the {EPIC} cohort.},
      journal      = {International journal of cancer},
      volume       = {157},
      number       = {4},
      issn         = {0020-7136},
      address      = {Bognor Regis},
      publisher    = {Wiley-Liss},
      reportid     = {DKFZ-2025-00690},
      pages        = {672-686},
      year         = {2025},
      note         = {2025 Aug 15;157(4):672-686},
      abstract     = {Breast cancer (BC) is a heterogeneous disease with subtypes
                      based on receptor status (estrogen receptor [ER],
                      progesterone receptor [PR], and human epidermal growth
                      factor receptor 2 [HER2]), influencing prognosis and
                      treatment. A higher socioeconomic position (SEP) is
                      associated with an increased BC risk, but its relation to BC
                      subtypes is less clear. This study analyzed 311,631 women
                      from the EPIC cohort, focusing on the incidence of in situ
                      and invasive BC (overall and by receptor status and
                      subtype). Educational attainment was used as a proxy for
                      SEP, and hazard ratios (HRs) were calculated using Cox
                      regression models. Mediation analyses were performed to
                      evaluate the extent to which selected risk factors explained
                      the educational gradient. Over 14 years, 14,432 BC cases
                      were identified, including 12,863 invasive cases. Lower
                      education was associated with a reduced risk of both in situ
                      and invasive BCs. The HRs for primary versus tertiary
                      education were 0.61 $(95\%$ CI 0.49-0.73) for in situ and
                      0.81 $(95\%$ CI 0.75-0.87) for invasive BC overall, with
                      similar reductions across ER-positive, PR-positive,
                      HER2-positive, Luminal A, BH-, and BH+. No significant
                      association was found between education and ER-negative, and
                      HER2-enriched BCs. Reproductive and lifestyle factors
                      explained $20-40\%$ of the educational differences in BC
                      risk. While many of the risk factors through which education
                      impacts the development of subtype-specific BC were
                      identified, others remain to be fully elucidated.
                      Differences in screening attendance could partially explain
                      the higher ER-positive BC risk among highly educated; this
                      study further contributes to the understanding of the
                      complex nature of BC in terms of its social gradient and
                      aetiology.},
      keywords     = {breast cancer risk (Other) / education level (Other) /
                      estrogen receptor (Other) / molecular subtypes (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40170258},
      doi          = {10.1002/ijc.35413},
      url          = {https://inrepo02.dkfz.de/record/300228},
}