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Onset of Breast Development in a Longitudinal Cohort
Open accessAbstract
BACKGROUND AND OBJECTIVES: There is growing evidence of pubertal maturation occurring at earlier ages, with many studies based on cross-sectional observations. This study examined age at onset of breast development (thelarche), and the impact of BMI and race/ethnicity, in the 3 puberty study sites of the Breast Cancer and the Environment Research Program, a prospective cohort of >1200 girls. METHODS: Girls, 6 to 8 years at enrollment, were followed longitudinally at regular intervals from 2004 to 2011 in 3 geographic areas: the San Francisco Bay Area, Greater Cincinnati, and New York City. Sexual maturity assessment using Tanner staging was conducted by using standardized observation and palpation methods by trained and certified staff. Kaplan-Meier analyses were used to describe age at onset of breast maturation by covariates. RESULTS: The age at onset of breast stage 2 varied by race/ethnicity, BMI at baseline, and site. Median age at onset of breast stage 2 was 8.8, 9.3, 9.7, and 9.7 years for African American, Hispanic, white non-Hispanic, and Asian participants, respectively. Girls with greater BMI reached breast stage 2 at younger ages. Age-specific and standardized prevalence of breast maturation was contrasted to observations in 2 large cross-sectional studies conducted 10 to 20 years earlier (Pediatric Research in Office Settings and National Health and Nutrition Examination Survey III) and found to have occurred earlier among white, non-Hispanic, but not African American girls. CONCLUSIONS: We observed the onset of thelarche at younger ages than previously documented, with important differences associated with race/ethnicity and BMI, confirming and extending patterns seen previously. These findings are consistent with temporal changes in BMI.
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“Black girls enter puberty at younger ages than their White, Latinx, and Asian American counterparts and spend longer periods in the pubertal transition than Black girls in previous generations (Biro et al., 2013;Dorn, Dahl, Woodward, & Biro, 2006;Herman-Giddens et al., 1997).”
From Ethnic‐Racial Socialization Among Mothers of Black and Black‐White Biracial Daughters During the Pubertal Transition (2022) · cites this paper as Biro et al., 2013
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In the citing paper
“Black girls enter puberty at younger ages than their White, Latinx, and Asian American counterparts and spend longer periods in the pubertal transition than Black girls in previous generations (Biro et al., 2013;Dorn, Dahl, Woodward, & Biro, 2006;Herman-Giddens et al., 1997).”
From Ethnic‐Racial Socialization Among Mothers of Black and Black‐White Biracial Daughters During the Pubertal Transition (2022) · cites this paper as Biro et al., 2013
Experimental — accuracy not yet measuredIn the citing paper
“Pubertal onset is also occurring earlier in developed nations, particularly in unserved populations”
From Does puberty mark a transition in sensitive periods for plasticity in the associative neocortex? (2017) · cites this paper as Biro et al., 2013
In the citing paper
“Over the last decades, the average age at puberty onset in girls has advanced by multiple years”
From Does puberty mark a transition in sensitive periods for plasticity in the associative neocortex? (2017) · cites this paper as Biro et al., 2013
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“In one study, the mean age of breast budding in black or Hispanic girls occurred at 8.8 and 9.3 years old (respectively) compared to 9.7 in white or Asian girls”
From Does puberty mark a transition in sensitive periods for plasticity in the associative neocortex? (2017) · cites this paper as Biro et al., 2013
In the citing paper
“In North American boys and girls, earlier maturation is more common in black, Hispanic and low socioeconomic status children”
From Does puberty mark a transition in sensitive periods for plasticity in the associative neocortex? (2017) · cites this paper as Biro et al., 2013
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Metadata
- Authors
- Biro, F. M., Greenspan, L. C., Galvez, M. P., Pinney, S. M., Teitelbaum, S., Windham, G. C., Deardorff, J., Herrick, R. L., Succop, P. A., Hiatt, R. A., Kushi, L. H., & Wolff, M. S.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Kaiser Permanente (US)
- Department of Preventive Medicine, and
- University of Cincinnati (US)
- California Department of Public Health (US)
- University of California, Berkeley (US)
- University of California, San Francisco (US)
- Icahn School of Medicine at Mount Sinai (US)
- ORCID
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2013-12-01
- Volume
- 132
- Issue
- 6
- Pages
- 1019-1027
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC3838525
- OpenAlex
- W2113207708
- Cited by
- 362
- References
- 45
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 26 · 2023: 21 · 2022: 48 · 2021: 33 · 2020: 42 · 2019: 30 · 2018: 26 · 2017: 31 · 2016: 32 · 2015: 19 · 2014: 18 · 2013: 2
- FWCI
- 28.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Kaiser Permanente
- Michigan State University
- University of Cincinnati
- National Institutes of Health (5ul1rr026314-03, UL1TR000077)
- National Institute of Environmental Health Sciences (P01ES009584, U01ES012800, U01ES019457, U01ES012771, T32-ES 10957, U01ES012770, P30ES006096, U01ES019435, U01ES019453, U01ES012801, U01ES019454, T32ES010957)
- National Center for Research Resources (UL1RR024131, UL1RR029887, UL1-RR026314, CSTA-UL1RR026314, CSTA-UL1RR029887)
- National Center for Chronic Disease Prevention and Health Promotion
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Adolescent Sexual and Reproductive Health
- Keywords
- thelarche, breast development, puberty onset, pubertal timing, body mass index, racial and ethnic differences, African American girls, Hispanic girls, Tanner stages, longitudinal cohort, childhood obesity
- MeSH terms
- Adolescent, Age Factors, Breast, Child, Female, Humans, Longitudinal Studies, New York City, Ohio, Prospective Studies, Puberty, San Francisco, Body Mass Index, Linear Models, Kaplan-Meier Estimate
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