1. Epidemiology and Global Health
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Sense of coherence and risk of breast cancer

  1. Kejia Hu
  2. Mikael Eriksson
  3. Yvonne Wengström
  4. Kamila Czene
  5. Per Hall
  6. Fang Fang  Is a corresponding author
  1. Karolinska Institutet, Sweden
Research Article
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Cite this article as: eLife 2020;9:e61469 doi: 10.7554/eLife.61469

Abstract

Sense of coherence (SoC) is the origin of health according to Antonovsky. The link between SoC and risk of cancer has however rarely been assessed. We performed a cohort study of 46,436 women from the Karolinska Mammography Project for Risk Prediction of Breast Cancer (Karma). Participants answered a SoC-13 questionnaire at recruitment to Karma and were subsequently followed up for incident breast cancer. Multivariate Cox models were used to assess the hazard ratios (HRs) of breast cancer in relation to SoC. We identified 771 incident cases of breast cancer during follow-up (median time: 5.2 years). No association was found between SoC, either as a categorical (strong vs. weak SoC, HR: 1.08, 95% CI: 0.90-1.29) or continuous (HR: 1.08; 95% CI: 1.00-1.17 per standard deviation increase of SoC) variable, and risk of breast cancer. In summary, we found little evidence to support an association between SoC and risk of breast cancer.

Data availability

The datasets analysed during the present study can be shared and are available from the corresponding author on reasonable request. More information regarding the data access to KARMA can be found at: [https://karmastudy.org/contact/data-access/]. The data are not publicly available due to Swedish laws.

The following previously published data sets were used

Article and author information

Author details

  1. Kejia Hu

    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-6680-8107
  2. Mikael Eriksson

    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    Competing interests
    The authors declare that no competing interests exist.
  3. Yvonne Wengström

    Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
    Competing interests
    The authors declare that no competing interests exist.
  4. Kamila Czene

    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    Competing interests
    The authors declare that no competing interests exist.
  5. Per Hall

    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    Competing interests
    The authors declare that no competing interests exist.
  6. Fang Fang

    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
    For correspondence
    fang.fang@ki.se
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-3310-6456

Funding

Cancerfonden (CAN 2017/322)

  • Fang Fang

Swedish Research Council for Health, Working Life, and Welfare (2017-00531)

  • Fang Fang

Karolinska Institutet (Karolinska Institutet Senior Researcher Award)

  • Fang Fang

Karolinska Institutet (Strategic Research Area in Epidemiology Award)

  • Fang Fang

China Scholarship Council (201806240005)

  • Kejia Hu

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval was granted by the Regional Ethics Review Board in Stockholm, Sweden (Dnr 2010/958-31/1). Informed consent was obtained from all individual participants included in the study.

Reviewing Editor

  1. Belinda Nicolau, McGill University, Canada

Publication history

  1. Received: July 27, 2020
  2. Accepted: November 20, 2020
  3. Accepted Manuscript published: November 23, 2020 (version 1)
  4. Version of Record published: December 4, 2020 (version 2)

Copyright

© 2020, Hu et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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    Methods: We did a nested case-control study comprising incident CHD cases and 1:1 matched controls who were identified from the 10-year follow-up of the China Kadoorie Biobank. Methylation level of baseline blood leukocyte DNA was measured by Infinium Methylation EPIC BeadChip. We performed the single cytosine-phosphate-guanine (CpG) site association analysis and network approach to identify CHD-associated CpG sites and co-methylation gene module.

    Results: After quality control, 982 participants (mean age 50.1 years) were retained. Methylation level at 25 CpG sites across the genome was associated with incident CHD (genome-wide false discovery rate [FDR] < 0.05 or module-specific FDR <0.01). One SD increase in methylation level of identified CpGs was associated with differences in CHD risk, ranging from a 47% decrease to a 118% increase. Mediation analyses revealed 28.5% of the excessed CHD risk associated with smoking was mediated by methylation level at the promoter region of ANKS1A gene (P for mediation effect = 0.036). Methylation level at the promoter region of SNX30 was associated with blood pressure and subsequent risk of CHD, with the mediating proportion to be 7.7% (P = 0.003) via systolic blood pressure and 6.4% (P = 0.006) via diastolic blood pressure. Network analysis revealed a co-methylation module associated with CHD.

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    Funding: This work was supported by National Natural Science Foundation of China (81390544 and 91846303). The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (202922/Z/16/Z, 088158/Z/09/Z, 104085/Z/14/Z), grant (2016YFC0900500, 2016YFC0900501, 2016YFC0900504, 2016YFC1303904) from the National Key and Program of China, and Chinese Ministry of Science and Technology (2011BAI09B01).