Socioeconomic position and lifestyle in relation to breast cancer incidence among postmenopausal women: A prospective cohort study, Denmark, 1993-2006

Background: In Denmark, the incidence of breast cancer is higher among women with higher socioeconomic position. We investigated whether differences in exposure to certain risk factors contribute to this gradient, as measured from education, income and occupation. Methods: We conducted a cohort study of 23 111 postmenopausal women aged 50-65 years who were enrolled in the prospective Danish 'Diet, Cancer and Health' study between 1993 and 1995. At baseline, all women filled in a questionnaire on lifestyle and food frequency. The results were analysed in Cox proportional hazard models. Results: Part of the association with socioeconomic position is due to the potential mediators reproductive pattern, use of hormone replacement therapy and alcohol consumption. After simultaneous adjustment for these factors, the hazard ratios were 1.06 (95% confidence interval [CI], 0.88-1.27) for women with higher education and 1.07 (95% CI, 0.85-1.34) for women with higher income. The HR ratio for women working as higher officials when compared with unskilled workers was 1.23 (0.96-1.59). Conclusion: The results support the hypothesis that the higher incidence of breast cancer among socially advantaged women is mediated partly by differences in exposure to reproductive factors, hormone replacement therapy and alcohol.