Open Access Research article

Postmenopausal breast cancer in Iran; risk factors and their population attributable fractions

Reza Ghiasvand1*, Shahram Bahmanyar2, Kazem Zendehdel13, Sedigheh Tahmasebi4, Abdolrasoul Talei4, Hans-Olov Adami35 and Sven Cnattingius2

Author Affiliations

1 Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran

2 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden

3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

4 Department of Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

5 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

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BMC Cancer 2012, 12:414  doi:10.1186/1471-2407-12-414

Published: 19 September 2012



Causes of the rapidly increasing incidence of breast cancer in Middle East and Asian countries are incompletely understood. We evaluated risk factors for postmenopausal breast cancer and estimated their attributable fraction in Iran.


We performed a hospital-based case–control study, including 493 women, diagnosed with breast cancer at 50 years or later between 2005–2008, and 493 controls. We used logistic regression models to estimate multivariable odds ratios (OR) and 95% confidence intervals (CI), and population attributable fractions (PAF) for significant risk factors.


The risk of breast cancer decreased with increasing parity. Compared with nulliparous women, the adjusted OR (95% CI) was 0.53 (0.25-1.15) for parity 1–3, 0.47 (0.29-0.93) for parity 4–6 and 0.23 (0.11-0.50) for parity ≥7. The estimated PAF for parity (<7) was 52%. The positive association between body mass index (BMI) and breast cancer risk was confined to women diagnosed at 58 years or later. Compared with normal weight women (BMI 18.5-24.9), overweight (BMI 25–29.9) and obese (BMI ≥30) women were at increased risk of breast cancer diagnosed at 58 years or later (ORs [95% CI] 1.27 [0.97-2.65] and 2.34 [1.33-4.14], respectively). The estimated PAF for obesity/overweight (BMI >25) was approximately 25%. The family history was significantly associated with increased breast cancer risk, but not increasing height, early age at menarche, late age at first birth or short breastfeeding.


Decreasing parity and increasing obesity are determinants of increasing breast cancer incidence among Iranian women. These trends predict a continuing upward trend of postmenopausal breast cancer.

Breast neoplasm; Postmenopausal; Middle East; Risk factor; Attributable fraction