The purpose of this study was to examine total white blood cell count (TWBCC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and neutrophil-to-lymphocyte ratio’s (NLR) association with the risk of incident breast cancer (BCa). A prospective analysis was conducted among a cohort of 2,873 women from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study. In the present analysis, the association found between lower ALC and increased BCa risk was no longer statistically significant after adjusting for age. Additionally, no statically significant associations were found between any level of ANC, NLR, and TWBCC with incident BCa. Therefore, additional studies, which address the limitations encountered in the present analysis, are needed to validate, or rule out, their use as biomarkers of BCa risk in women.
Published in | Cancer Research Journal (Volume 4, Issue 3) |
DOI | 10.11648/j.crj.20160403.13 |
Page(s) | 52-57 |
Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
Copyright |
Copyright © The Author(s), 2016. Published by Science Publishing Group |
Breast Cancer, Lymphocyte Count, Neutrophil Count, Neutrophil-to-Lymphocyte Ratio Risk, White Blood Cell
[1] | National Cancer Institute, National Institutes of Health (2016). SEER Stat Fact Sheets: Female Breast Cancer. Retrieved from http://seer.cancer.gov/statfacts/html/breast.html |
[2] | U.S. Cancer Statistics Working Group (2015). United States Cancer Statistics: 1999–2012 Incidence and Mortality Web-based Report. Retrieved from https://nccd.cdc.gov/uscs/ |
[3] | Bleyer, A., & Welch, H. G. (2012). Effect of three decades of screening mammography on breast-cancer incidence. New England Journal of Medicine, 367(21), 1998-2005. |
[4] | Berry, D. A., Cronin, K. A., Plevritis, S. K., Fryback, D. G., Clarke, L., Zelen, M., ... & Feuer, E. J. (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine, 353(17), 1784-1792. |
[5] | Pace, L. E., & Keating, N. L. (2014). A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA, 311(13), 1327-1335. |
[6] | Weigel, M. T., & Dowsett, M. (2010). Current and emerging biomarkers in breast cancer: prognosis and prediction. Endocrine-related cancer, 17(4), R245-R262. |
[7] | Coussens, L. M., & Werb, Z. (2002). Inflammation and cancer. Nature, 420(6917), 860-867. |
[8] | Eiró, N., & Vizoso, F. J. (2012). Inflammation and cancer. World J Gastrointest Surg, 4(3), 62-72. |
[9] | Mantovani, A., Romero, P., Palucka, A. K., & Marincola, F. M. (2008). Tumour immunity: effector response to tumour and role of the microenvironment. The Lancet, 371(9614), 771-783. |
[10] | Finn, O. J. (2012). Immuno-oncology: understanding the function and dysfunction of the immune system in cancer. Annals of oncology, 23(suppl 8), viii6-viii9. |
[11] | Grivennikov, S. I., Greten, F. R., & Karin, M. (2010). Immunity, inflammation, and cancer. Cell, 140(6), 883-899. |
[12] | Margolis, K. L., Rodabough, R. J., Thomson, C. A., Lopez, A. M., & McTiernan, A. (2007). Prospective study of leukocyte count as a predictor of incident breast, colorectal, endometrial, and lung cancer and mortality in postmenopausal women. Archives of internal medicine, 167(17), 1837-1844. |
[13] | Fodor, J. (1975). Peripheral blood lymphocyte counts and survival in breast cancer. Neoplasma, 23(3), 311-313. |
[14] | Ownby, H. E., Roi, L. D., Isenberg, R. R., & Brennan, M. J. (1983). Peripheral lymphocyte and eosinophil counts as indicators of prognosis in primary breast cancer. Cancer, 52(1), 126-130. |
[15] | Wen, J., Ye, F., Huang, X., Li, S., Yang, L., Xiao, X., & Xie, X. (2015). Prognostic Significance of Preoperative Circulating Monocyte Count in Patients With Breast Cancer: Based on a Large Cohort Study. Medicine, 94(49), e2266. |
[16] | Thornton, L. M., Andersen, B. L., & Carson, W. 3. (2008). Immune, endocrine, and behavioral precursors to breast cancer recurrence: a case-control analysis. Cancer Immunology, Immunotherapy: CII, 57(10), 1471-1481. doi:10.1007/s00262-008-0485-6. |
[17] | Azab, B., Shah, N., Radbel, J., Tan, P., Bhatt, V., Vonfrolio, S., ... & Bloom, S. (2013). Pretreatment neutrophil/lymphocyte ratio is superior to platelet/lymphocyte ratio as a predictor of long-term mortality in breast cancer patients. Medical oncology, 30(1), 1-11. |
[18] | Koh, Y. W., Lee, H. J., Ahn, J. H., Lee, J. W., & Gong, G. (2014). Prognostic significance of the ratio of absolute neutrophil to lymphocyte counts for breast cancer patients with ER/PR-positivity and HER2-negativity in neoadjuvant setting. Tumor Biology, 35(10), 9823-9830. |
[19] | Van Hemelrijck, M., Holmberg, L., Garmo, H., Hammar, N., Walldius, G., Binda, E., ... & Jungner, I. (2011). Association between levels of C-reactive protein and leukocytes and cancer: three repeated measurements in the Swedish AMORIS study. Cancer Epidemiology Biomarkers & Prevention, 20(3), 428-437. |
[20] | Okuturlar, Y., Gunaldi, M., Tiken, E. E., Oztosun, B., Inan, Y. O., Ercan, T., ... & Kumbasar, A. (2015). Utility of peripheral blood parameters in predicting breast cancer risk. Asian Pacific journal of cancer prevention: APJCP, 16(6), 2409. |
[21] | Centers for Disease Control and Prevention (2015). NHANES I Epidemiologic Followup Study (NHEFS). Retrieved from http://www.cdc.gov/nchs/nhanes/nhefs/nhefs.htm |
[22] | Centers for Disease Control and Prevention (2015). Data and Documentation/Codebook Files, NHANES I (1971-1974). Retrieved from http://www.cdc.gov/nchs/nhanes/nhanesi.htm |
[23] | Centers for Disease Control and Prevention (2015). Public Use Data Files and Documentation, NHANES I Epidemiologic Follow up Study. Retrieved from http://www.cdc.gov/nchs/nhanes/nhefs/nhefspuf.htm |
[24] | National Center for Health Statistics (1979). Hematology and Clinical Chemistry Procedures Developed or Utilized by the Center for Disease Control, Bureau of laboratories, 1971-1975. Retrieved from http://www.cdc.gov/nchs/data/nhanes/nhanesi/16-71_75.pdf |
[25] | Cox CS, Mussolino ME, Rothwell ST, et al. Plan and operation of the NHANES I Epidemiologic Follow up Study 1992. National Center for Health Statistics. Vital Health Stat 1(35). 1997. |
[26] | American Cancer Society (2016). Types of Breast Cancer. Retrieved from http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-breast-cancer-types |
[27] | Sprague, B. L., Trentham-Dietz, A., Klein, B. E., Klein, R., Cruickshanks, K. J., Lee, K. E., & Hampton, J. M. (2008). Physical activity, white blood cell count, and lung cancer risk in a prospective cohort study. Cancer Epidemiology Biomarkers & Prevention, 17(10), 2714-2722. |
[28] | Iida, M., Ikeda, F., Ninomiya, T., Yonemoto, K., Doi, Y., Hata, J.,... & Kiyohara, Y. (2012). White Blood Cell Count and Risk of Gastric Cancer Incidence in a General Japanese Population The Hisayama Study. American journal of epidemiology, 175(6), 504-510. |
[29] | Krenn-Pilko, S., Langsenlehner, U., Thurner, E. M., Stojakovic, T., Pichler, M., Gerger, A., ... & Langsenlehner, T. (2014). The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients. British journal of cancer, 110(10). |
[30] | DeSantis, C., Ma, J., Bryan, L., & Jemal, A. (2014). Breast cancer statistics, 2013. CA: a cancer journal for clinicians, 64(1), 52-62. |
[31] | Anderson, K. N., Schwab, R. B., & Martinez, M. E. (2014). Reproductive risk factors and breast cancer subtypes: a review of the literature. Breast cancer research and treatment, 144(1), 1-10. |
[32] | Linton, P. J., & Dorshkind, K. (2004). Age-related changes in lymphocyte development and function. Nature immunology, 5(2), 133-139. |
[33] | Fridlender, Z. G., Sun, J., Kim, S., Kapoor, V., Cheng, G., Ling, L., ... & Albelda, S. M. (2009). Polarization of tumor-associated neutrophil phenotype by TGF-β: “N1” versus “N2” TAN. Cancer cell, 16(3), 183-194. |
[34] | Schmielau, J., & Finn, O. J. (2001). Activated granulocytes and granulocyte-derived hydrogen peroxide are the underlying mechanism of suppression of t-cell function in advanced cancer patients. Cancer research, 61(12), 4756-4760. |
[35] | Pharoah, P. D., Day, N. E., Duffy, S., Easton, D. F., & Ponder, B. A. (1997). Family history and the risk of breast cancer: A systematic review and meta‐analysis. International Journal of cancer, 71(5), 800-809. |
[36] | Anothaisintawee, T., Wiratkapun, C., Lerdsitthichai, P., Kasamesup, V., Wongwaisayawan, S., Srinakarin, J., ... & Thakkinstian, A. (2013). Risk Factors of Breast Cancer A Systematic Review and Meta-Analysis. Asia-Pacific Journal of Public Health, 1010539513488795. |
[37] | Bergmann, M. M., Calle, E. E., Mervis, C. A., Miracle-McMahill, H. L., & Thun, M. J. (1998). Validity of self-reported Cancers in a Propsective Cohort Study in Comparison with Data from State Cancer Registries. American Journal of Epidemiology, 147(6), 556-562. |
[38] | DeSantis, C., Ma, J., Bryan, L., & Jemal, A. (2014). Breast cancer statistics, 2013. CA: a cancer journal for clinicians, 64(1), 52-62. |
APA Style
Erik Cook. (2016). Total White Blood Cell Count, Absolute Neutrophil Count, Absolute Lymphocyte Count, Neutrophil-to-Lymphocyte Ratio and the Risk of Breast Cancer: The NHANES I Epidemiologic Follow-up Study. Cancer Research Journal, 4(3), 52-57. https://doi.org/10.11648/j.crj.20160403.13
ACS Style
Erik Cook. Total White Blood Cell Count, Absolute Neutrophil Count, Absolute Lymphocyte Count, Neutrophil-to-Lymphocyte Ratio and the Risk of Breast Cancer: The NHANES I Epidemiologic Follow-up Study. Cancer Res. J. 2016, 4(3), 52-57. doi: 10.11648/j.crj.20160403.13
AMA Style
Erik Cook. Total White Blood Cell Count, Absolute Neutrophil Count, Absolute Lymphocyte Count, Neutrophil-to-Lymphocyte Ratio and the Risk of Breast Cancer: The NHANES I Epidemiologic Follow-up Study. Cancer Res J. 2016;4(3):52-57. doi: 10.11648/j.crj.20160403.13
@article{10.11648/j.crj.20160403.13, author = {Erik Cook}, title = {Total White Blood Cell Count, Absolute Neutrophil Count, Absolute Lymphocyte Count, Neutrophil-to-Lymphocyte Ratio and the Risk of Breast Cancer: The NHANES I Epidemiologic Follow-up Study}, journal = {Cancer Research Journal}, volume = {4}, number = {3}, pages = {52-57}, doi = {10.11648/j.crj.20160403.13}, url = {https://doi.org/10.11648/j.crj.20160403.13}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20160403.13}, abstract = {The purpose of this study was to examine total white blood cell count (TWBCC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and neutrophil-to-lymphocyte ratio’s (NLR) association with the risk of incident breast cancer (BCa). A prospective analysis was conducted among a cohort of 2,873 women from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study. In the present analysis, the association found between lower ALC and increased BCa risk was no longer statistically significant after adjusting for age. Additionally, no statically significant associations were found between any level of ANC, NLR, and TWBCC with incident BCa. Therefore, additional studies, which address the limitations encountered in the present analysis, are needed to validate, or rule out, their use as biomarkers of BCa risk in women.}, year = {2016} }
TY - JOUR T1 - Total White Blood Cell Count, Absolute Neutrophil Count, Absolute Lymphocyte Count, Neutrophil-to-Lymphocyte Ratio and the Risk of Breast Cancer: The NHANES I Epidemiologic Follow-up Study AU - Erik Cook Y1 - 2016/05/14 PY - 2016 N1 - https://doi.org/10.11648/j.crj.20160403.13 DO - 10.11648/j.crj.20160403.13 T2 - Cancer Research Journal JF - Cancer Research Journal JO - Cancer Research Journal SP - 52 EP - 57 PB - Science Publishing Group SN - 2330-8214 UR - https://doi.org/10.11648/j.crj.20160403.13 AB - The purpose of this study was to examine total white blood cell count (TWBCC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and neutrophil-to-lymphocyte ratio’s (NLR) association with the risk of incident breast cancer (BCa). A prospective analysis was conducted among a cohort of 2,873 women from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study. In the present analysis, the association found between lower ALC and increased BCa risk was no longer statistically significant after adjusting for age. Additionally, no statically significant associations were found between any level of ANC, NLR, and TWBCC with incident BCa. Therefore, additional studies, which address the limitations encountered in the present analysis, are needed to validate, or rule out, their use as biomarkers of BCa risk in women. VL - 4 IS - 3 ER -