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Assi N, Thomas DC, Leitzmann M, Stepien M, Chajès V, Philip T, Vineis P, Bamia C, Boutron-Ruault MC, Sandanger TM, Molinuevo A, Boshuizen HC, Sundkvist A, Kühn T, Travis RC, Overvad K, Riboli E, Gunter MJ, Scalbert A, Jenab M, Ferrari P, Viallon V. Are Metabolic Signatures Mediating the Relationship between Lifestyle Factors and Hepatocellular Carcinoma Risk? Results from a Nested Case-Control Study in EPIC. Cancer Epidemiol Biomarkers Prev 2018; 27:531-540. [PMID: 29563134 PMCID: PMC7444360 DOI: 10.1158/1055-9965.epi-17-0649] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/20/2017] [Accepted: 01/17/2018] [Indexed: 12/16/2022] Open
Abstract
Background: The "meeting-in-the-middle" (MITM) is a principle to identify exposure biomarkers that are also predictors of disease. The MITM statistical framework was applied in a nested case-control study of hepatocellular carcinoma (HCC) within European Prospective Investigation into Cancer and Nutrition (EPIC), where healthy lifestyle index (HLI) variables were related to targeted serum metabolites.Methods: Lifestyle and targeted metabolomic data were available from 147 incident HCC cases and 147 matched controls. Partial least squares analysis related 7 lifestyle variables from a modified HLI to a set of 132 serum-measured metabolites and a liver function score. Mediation analysis evaluated whether metabolic profiles mediated the relationship between each lifestyle exposure and HCC risk.Results: Exposure-related metabolic signatures were identified. Particularly, the body mass index (BMI)-associated metabolic component was positively related to glutamic acid, tyrosine, PC aaC38:3, and liver function score and negatively to lysoPC aC17:0 and aC18:2. The lifetime alcohol-specific signature had negative loadings on sphingomyelins (SM C16:1, C18:1, SM(OH) C14:1, C16:1 and C22:2). Both exposures were associated with increased HCC with total effects (TE) = 1.23 (95% confidence interval = 0.93-1.62) and 1.40 (1.14-1.72), respectively, for BMI and alcohol consumption. Both metabolic signatures mediated the association between BMI and lifetime alcohol consumption and HCC with natural indirect effects, respectively, equal to 1.56 (1.24-1.96) and 1.09 (1.03-1.15), accounting for a proportion mediated of 100% and 24%.Conclusions: In a refined MITM framework, relevant metabolic signatures were identified as mediators in the relationship between lifestyle exposures and HCC risk.Impact: The understanding of the biological basis for the relationship between modifiable exposures and cancer would pave avenues for clinical and public health interventions on metabolic mediators. Cancer Epidemiol Biomarkers Prev; 27(5); 531-40. ©2018 AACR.
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Affiliation(s)
- Nada Assi
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, Regensburg University, Regensburg, Germany
| | - Magdalena Stepien
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Véronique Chajès
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Thierry Philip
- Unité Cancer et Environnement, Centre Léon Bérard, Lyon, France
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Christina Bamia
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | | | - Torkjel M Sandanger
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Amaia Molinuevo
- Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia-San Sebastián, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Hendriek C Boshuizen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Anneli Sundkvist
- Department of Radiation Sciences Oncology, Umeå University, Umeå, Sweden
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ruth C Travis
- Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Kim Overvad
- The Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Augustin Scalbert
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Mazda Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Pietro Ferrari
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
| | - Vivian Viallon
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
- Université de Lyon, Université Claude Bernard Lyon1, Ifsttar, UMRESTTE, Lyon, France
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Lammert J, Grill S, Kiechle M. Modifiable Lifestyle Factors: Opportunities for (Hereditary) Breast Cancer Prevention - a Narrative Review. Breast Care (Basel) 2018; 13:109-114. [PMID: 29887787 DOI: 10.1159/000488995] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Increasing rates of obesity, lack of physical activity, sedentary behavior, and frequent alcohol consumption are major lifestyle-related risk factors for breast cancer. In fact, it has been estimated that about one-third of breast cancer cases are attributable to factors women can change. Most research has focused on examining the impact of one single exposure on breast cancer risk while adjusting for other risk modifiers. Capitalizing on big data, major efforts have been made to evaluate the combined impact of well-established lifestyle factors on overall breast cancer risk. At the individual level, data indicate that even simple behavior modifications could have a considerable impact on breast cancer prevention. Moreover, there is emerging new evidence that adopting a healthy lifestyle may be particularly relevant for women with hereditary susceptibility to breast cancer. On the absolute risk scale, studies suggest that the presence of certain risk factors, such as excessive body weight, had a substantially higher impact on breast cancer risk if women had a hereditary predisposition to cancer. The existing body of knowledge gives the medical professionals guidance as to which factors to focus on when counseling patients. However, well-designed randomized controlled trials utilizing objective methods are crucial to providing concrete recommendations.
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Affiliation(s)
- Jacqueline Lammert
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, University Hospital rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Sabine Grill
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, University Hospital rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, University Hospital rechts der Isar, Technical University of Munich (TUM), Munich, Germany
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53
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Arthur R, Kirsh VA, Kreiger N, Rohan T. A healthy lifestyle index and its association with risk of breast, endometrial, and ovarian cancer among Canadian women. Cancer Causes Control 2018; 29:485-493. [PMID: 29667103 DOI: 10.1007/s10552-018-1032-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 04/11/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Several modifiable risk factors have been associated with risk of female cancers, but there is limited data regarding their combined effect on risk among Canadian women. Therefore, we assessed the joint association of modifiable risk factors, using a healthy lifestyle index (HLI) score, with risk of specific reproductive cancers. METHOD This study included a subcohort of 3,185 of the 39,618 women, who participated in the Canadian Study of Diet, Lifestyle, and Health, and in whom 410, 177, and 100 postmenopausal breast, endometrial, and ovarian cancers, respectively, were ascertained. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards regression models modified for the case-cohort design. RESULTS Each unit increase in the HLI score was associated with 3% and 5% reductions in risk of postmenopausal breast cancer and endometrial cancer, respectively (HR 0.97; 95% CI 0.94-0.99 and HR 0.95; 95% CI 0.90-0.99, respectively). Compared to those with HLI score in the lowest category, those in the highest category had 30% and 46% reductions in risk of these cancers, respectively. The HLI score was not associated with altered risk of ovarian cancer. CONCLUSION Our findings suggest that promoting a healthy lifestyle may aid in the primary prevention of postmenopausal breast and endometrial cancers.
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Affiliation(s)
- Rhonda Arthur
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA.
| | - Victoria A Kirsh
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nancy Kreiger
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA
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Guinter MA, McLain AC, Merchant AT, Sandler DP, Steck SE. An estrogen-related lifestyle score is associated with risk of postmenopausal breast cancer in the PLCO cohort. Breast Cancer Res Treat 2018; 170:613-622. [PMID: 29651647 DOI: 10.1007/s10549-018-4784-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/07/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE Healthy or unhealthy lifestyle behaviors are often adopted together. We aimed to investigate the combined effect of estrogen-related lifestyle factors on postmenopausal breast cancer risk. METHODS Data from 27,153 women enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial were used. We created an estrogen-related lifestyle score (ERLS) by incorporating a previously developed measure of estrogenic diet, alcohol intake, body mass index (BMI), and physical activity. The scores ranged from 0 to 6 with alcohol and BMI accounting for higher weights than the other factors. To evaluate the preventive possibilities of a low estrogen-related lifestyle and to be consistent with other published lifestyle scores, higher scores were set to correspond with potentially lower estrogenic lifestyle. The association between the ERLS and incident breast cancer was examined using Cox proportional hazards models. RESULTS Participants with an ERLS of 4 or ≥ 5 had a 23% (HR 0.77; 95% CI 0.67-0.89) and 34% (HR 0.66; 95% CI 0.56-0.78) lower risk of breast cancer, respectively, compared to those with an ERLS ≤ 2 after multivariable adjustment. Estimates were similar when restricting to invasive cases or estrogen receptor-positive subtypes. No single lifestyle component appeared to drive the association. CONCLUSIONS Our findings suggest that the combined effect of a lifestyle characterized by a low estrogenic diet, low alcohol consumption, low body weight, and high levels of physical activity are associated with a reduction in postmenopausal breast cancer risk, possibly through an influence on estrogen metabolism.
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Affiliation(s)
- Mark A Guinter
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. .,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA.
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Arthur R, Wassertheil-Smoller S, Manson JE, Luo J, Snetselaar L, Hastert T, Caan B, Qi L, Rohan T. The Combined Association of Modifiable Risk Factors with Breast Cancer Risk in the Women's Health Initiative. Cancer Prev Res (Phila) 2018; 11:317-326. [PMID: 29483073 DOI: 10.1158/1940-6207.capr-17-0347] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/09/2018] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
Abstract
Although several modifiable risk factors have been independently associated with risk of breast cancer, few studies have investigated their joint association with breast cancer risk. Using a healthy lifestyle index (HLI) score, we assessed the association of a combination of selected modifiable risk factors (diet, alcohol, physical activity, BMI, and smoking) with risk of invasive breast cancer in the Women's Health Initiative (WHI). This study comprised 131,833 postmenopausal women, of whom 8,168 had breast cancer, who were enrolled in the WHI Observational Study or the WHI clinical trials. Cox proportional hazards regression was used to estimate the HRs and 95% confidence intervals (CI) for the association of the score with the risk of developing breast cancer overall and according to specific breast cancer clinicopathologic characteristics. There was a 4% reduction in the risk of breast cancer per unit increase in the HLI score. Compared with those with an HLI score in the lowest quintile level, those in the highest quintile level had 30%, 37%, and 30% lower risk for overall, ER+/PR+, and HER2+ breast cancer, respectively (HR = 0.70; 95% CI, 0.64-0.76; 0.63, 0.57-0.69; and 0.70; 0.55-0.90, respectively). We also observed inverse associations between the score and risk of breast cancer irrespective of nodal status, tumor grade, and stage of the disease. Most individual lifestyle factors were independently associated with the risk of breast cancer. Our findings support the view that promoting healthy lifestyle practices may be beneficial with respect to lowering risk of breast cancer among postmenopausal women. Cancer Prev Res; 11(6); 317-26. ©2018 AACRSee related editorial by Friedenreich and McTiernan, p. 313.
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Affiliation(s)
- Rhonda Arthur
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana
| | - Linda Snetselaar
- Department of Epidemiology, School of Public Health, University of Iowa, Iowa City, Iowa
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Bette Caan
- Division of Research, Kaiser Permanente, Oakland, California
| | - Lihong Qi
- Department of Public Health Science, School of Medicine, UC Davis, Davis, California
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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56
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Paz MFCJ, de Alencar MVOB, Gomes Junior AL, da Conceição Machado K, Islam MT, Ali ES, Shill MC, Ahmed MI, Uddin SJ, da Mata AMOF, de Carvalho RM, da Conceição Machado K, Sobral ALP, da Silva FCC, de Castro e Souza JM, Arcanjo DDR, Ferreira PMP, Mishra SK, da Silva J, de Carvalho Melo-Cavalcante AA. Correlations between Risk Factors for Breast Cancer and Genetic Instability in Cancer Patients-A Clinical Perspective Study. Front Genet 2018; 8:236. [PMID: 29503660 PMCID: PMC5821102 DOI: 10.3389/fgene.2017.00236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/27/2017] [Indexed: 11/18/2022] Open
Abstract
Molecular epidemiological studies have identified several risk factors linking to the genes and external factors in the pathogenesis of breast cancer. In this sense, genetic instability caused by DNA damage and DNA repair inefficiencies are important molecular events for the diagnosis and prognosis of therapies. Therefore, the objective of this study was to analyze correlation between sociocultural, occupational, and lifestyle risk factors with levels of genetic instability in non-neoplastic cells of breast cancer patients. Total 150 individuals were included in the study that included 50 breast cancer patients submitted to chemotherapy (QT), 50 breast cancer patients submitted to radiotherapy (RT), and 50 healthy women without any cancer. Cytogenetic biomarkers for apoptosis and DNA damage were evaluated in samples of buccal epithelial and peripheral blood cells through micronuclei and comet assay tests. Elder age patients (61-80 years) had higher levels of apoptosis (catriolysis by karyolysis) and DNA damage at the diagnosis (baseline damage) with increased cell damage during QT and especially during RT. We also reported the increased frequencies of cytogenetic biomarkers in patients who were exposed to ionizing radiation as well as for alcoholism and smoking. QT and RT induced high levels of fragmentation (karyorrhexis) and nuclear dissolution (karyolysis) and DNA damage. Correlations were observed between age and karyorrhexis at diagnosis; smoking and karyolysis during RT; and radiation and karyolysis during QT. These correlations indicate that risk factors may also influence the genetic instability in non-neoplastic cells caused to the patients during cancer therapies.
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Affiliation(s)
| | | | - Antonio Luiz Gomes Junior
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, Brazil
- Biomedicine Department, UNINOVAFAPI University, Teresina, Brazil
| | | | - Muhammad Torequl Islam
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, Brazil
- Department of Pharmacy, Southern University Bangladesh, Chittagong, Bangladesh
| | - Eunus S. Ali
- School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Manik Chandra Shill
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Md. Iqbal Ahmed
- Pharmacy Discipline, Life Science School, Khulna University, Khulna, Bangladesh
| | - Shaikh Jamal Uddin
- Pharmacy Discipline, Life Science School, Khulna University, Khulna, Bangladesh
| | | | | | | | | | | | | | | | - Paulo Michel Pinheiro Ferreira
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, Brazil
- Department of Biophysics and Physiology, Universidade Federal do Piauí, Teresina, Brazil
| | - Siddhartha Kumar Mishra
- Cancer Biology Laboratory, School of Biological Sciences (Zoology), Dr. Harisingh Gour Central University, Sagar, India
| | - Juliana da Silva
- Program in Cellular and Molecular Biology Applied to Health Sciences, Universidade Luterana do Brasil, Canoas, Brazil
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Hagen KB, Aas T, Kvaløy JT, Søiland H, Lind R. Diet in women with breast cancer compared to healthy controls – What is the difference? Eur J Oncol Nurs 2018; 32:20-24. [DOI: 10.1016/j.ejon.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 12/13/2022]
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Breast Cancer Status in Iran: Statistical Analysis of 3010 Cases between 1998 and 2014. Int J Breast Cancer 2017; 2017:2481021. [PMID: 29201466 PMCID: PMC5671722 DOI: 10.1155/2017/2481021] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 12/29/2022] Open
Abstract
Background Breast cancer is the 5th leading cause of cancer death in Iranian women. This study analyzed 3010 women with breast cancer that had been referred to a cancer research center in Tehran between 1998 and 2014. Methods In this retrospective study, we analyzed 3010 breast cancer cases with 32 clinical and paraclinical attributes. We checked the data quality rigorously and removed any invalid values or records. The method was data mining (problem definition, data preparation, data exploration, modeling, evaluation, and deployment). However, only the descriptive analyses' results of the variables are presented in this article. To our knowledge, this is the most comprehensive study on breast cancer status in Iran. Results A typical Iranian breast cancer patient has been a 40–50-year-old married woman with two children, who has a high school diploma and no history of abortion, smoking, or diabetes. Most patients were estrogen and progesterone receptor positive, human epidermal growth factor (HER) negative, and P53 negative. Most cases were detected in stage 2 with intermediate grade. Conclusion This study revealed original findings which can be used in national policymaking to find the best early detection method and improve the care quality and breast cancer prevention in Iran.
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Shapira N. The potential contribution of dietary factors to breast cancer prevention. Eur J Cancer Prev 2017; 26:385-395. [PMID: 28746163 PMCID: PMC5553235 DOI: 10.1097/cej.0000000000000406] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/21/2017] [Indexed: 12/30/2022]
Abstract
Breast cancer (BC), the leading cancer in women, is increasing in prevalence worldwide, concurrent with western metabolic epidemics, that is, obesity, metabolic syndrome, and diabetes, and shares major risk factors with these diseases. The corresponding potential for nutritional contributions toward BC prevention is reviewed and related to critical stages in the life cycle and their implications for carcinogenic and pathometabolic trajectories. BC initiation potentially involves diet-related pro-oxidative, inflammatory, and procarcinogenic processes, that interact through combined lipid/fatty acid peroxidation, estrogen metabolism, and related DNA-adduct/depurination/mutation formation. The pathometabolic trajectory is affected by high estrogen, insulin, and growth factor cascades and resultant accelerated proliferation/progression. Anthropometric risk factors - high birth weight, adult tallness, adiposity/BMI, and weight gain - are often reflective of these trends. A sex-based nutritional approach targets women's specific risk in western obesogenic environments, associated with increasing fatness, estrogen metabolism, n-6 : n-3 polyunsaturated fatty acid ratio, and n-6 polyunsaturated fatty acid conversion to proinflammatory/carcinogenic eicosanoids, and effects of timing of life events, for example, ages at menarche, full-term pregnancy, and menopause. Recent large-scale studies have confirmed the effectiveness of the evidence-based recommendations against BC risk, emphasizing low-energy density diets, highly nutritious plant-based regimes, physical activity, and body/abdominal adiposity management. Better understanding of dietary inter-relationships with BC, as applied to food intake, selection, combination, and processing/preparation, and recommended patterns, for example, Mediterranean, DASH, plant-based, low energy density, and low glycemic load, with high nutrient/phytonutrient density, would increase public motivation and authoritative support for early/timely prevention, optimally merging with other dietary/health goals, for lifelong BC prevention.
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Affiliation(s)
- Niva Shapira
- Department of Nutrition, School of Health Professions, Ashkelon Academic College, Ashkelon, Israel
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60
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Larsson SC, Kaluza J, Wolk A. Combined impact of healthy lifestyle factors on lifespan: two prospective cohorts. J Intern Med 2017; 282:209-219. [PMID: 28561269 DOI: 10.1111/joim.12637] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The impact of multiple healthy lifestyle factors on survival time is unclear. OBJECTIVE The aim of this study was to examine differences in survival time associated with a healthy lifestyle versus a less healthy lifestyle. METHODS This study consisted of 33 454 men (Cohort of Swedish Men) and 30 639 women (Swedish Mammography Cohort) aged 45-83 years and free of cancer and cardiovascular disease at baseline. The healthy lifestyle factors included the following: (i) nonsmoking; (ii) physical activity at least 150 min per week; (iii) alcohol consumption of 0-14 drinks per week; (iv) and healthy diet defined as a modified Dietary Approaches to Stop Hypertension Diet score above the median. Cox proportional hazards regression models and Laplace regression were used to estimate, respectively, hazard ratios of all-cause mortality and differences in survival time. RESULTS During follow-up from 1998 through 2014, 8630 deaths amongst men and 6730 deaths amongst women were ascertained through linkage to the Swedish Cause of Death Register. Each of the four healthy lifestyle factors was inversely associated with all-cause mortality and increased survival time. Compared with individuals with no or one healthy lifestyle factor, the multivariable hazard ratios of all-cause mortality for individuals with all four health behaviours were 0.47 (95% 95% confidence interval [CI]: 0.44-0.51) in men and 0.39 (95% CI: 0.35-0.44) in women. This corresponded to a difference in survival time of 4.1 (95% CI: 3.6-4.6) years in men and 4.9 (95% CI: 4.3-5.6) years in women. CONCLUSION Adopting healthy lifestyle behaviours may markedly increase lifespan.
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Affiliation(s)
- S C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Kaluza
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Nutrition Research Laboratory, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - A Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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61
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Geyer C. When Diet and Exercise Aren't Enough: The Added Benefits of Connection, Community, and Psychosocial Support in Navigating Breast Cancer Treatment. Am J Lifestyle Med 2017; 11:436-439. [PMID: 30202367 DOI: 10.1177/1559827617713170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Breast cancer is the most common cancer diagnosis in women, and many lifestyle factors have been linked to an elevated risk for development of the disease. This case provides an example of how breast cancer can occur even in people who engage in healthy lifestyle behaviors, yet underscores the importance of exercise, healthy dietary patterns, and addressing psychological distress in supporting women through their treatment and beyond.
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Paquet L, Simmonds L, Yang C, Verma S. An exploratory study of patients' views about being at high-risk for breast cancer and risk management beliefs and intentions, before and after risk counselling: Preliminary evidence of the influence of beliefs on post-counselling prevention intentions. PATIENT EDUCATION AND COUNSELING 2017; 100:575-582. [PMID: 27756584 DOI: 10.1016/j.pec.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/24/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES 1) To describe how women at high-risk for breast cancer (BC) perceive their at-risk status and the options available to manage this risk, before and after risk counselling; 2) to explore the contributions of pre-counselling demographic, clinical, cognitive and emotional factors to post-counselling risk management intentions. METHODS 58 of 173 eligible patients (34%) enrolled and were asked to fill surveys including measures of 1) subjective risk, 2) illness (being at high-risk for BC) and 3) treatment (surveillance, lifestyle modifications, and chemoprevention) cognitions, 4) BC fear and 5) future risk management intentions, prior to and 3 months after risk consultation. RESULTS 48 of 58 participants (83%) completed both surveys. Beliefs and emotions about their condition and its management were stable over time. Surveillance and lifestyle were associated with stronger intentions, higher perceived need, and lower concerns than chemoprevention (all ps <0.001). The strongest predictors of intentions strengths were the women's beliefs about the risk reduction methods, especially for lifestyle and chemoprevention (all ps <0.01). CONCLUSIONS The findings emphasize the importance of patients' beliefs in risk management decisions. PRACTICAL IMPLICATIONS Patients' treatment beliefs appear to influence their choice of BC risk reduction strategies and should be discussed during risk reduction consultations.
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Affiliation(s)
- Lise Paquet
- Department of Psychology, Carleton University, Ottawa K1S 5B6, Canada.
| | - Lisa Simmonds
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Charles Yang
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Shailendra Verma
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
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Krokstad S, Ding D, Grunseit AC, Sund ER, Holmen TL, Rangul V, Bauman A. Multiple lifestyle behaviours and mortality, findings from a large population-based Norwegian cohort study - The HUNT Study. BMC Public Health 2017; 17:58. [PMID: 28068991 PMCID: PMC5223537 DOI: 10.1186/s12889-016-3993-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/23/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Lifestyle risk behaviours are responsible for a large proportion of disease burden and premature mortality worldwide. Risk behaviours tend to cluster in populations. We developed a new lifestyle risk index by including emerging risk factors (sleep, sitting time, and social participation) and examine unique risk combinations and their associations with all-cause and cardio-metabolic mortality. METHODS Data are from a large population-based cohort study in a Norway, the Nord-Trøndelag Health Study (HUNT), with an average follow-up time of 14.1 years. Baseline data from 1995-97 were linked to the Norwegian Causes of Death Registry. The analytic sample comprised 36 911 adults aged 20-69 years. Cox regression models were first fitted for seven risk factors (poor diet, excessive alcohol consumption, current smoking, physical inactivity, excessive sitting, too much/too little sleep, and poor social participation) separately and then adjusted for socio-demographic covariates. Based on these results, a lifestyle risk index was developed. Finally, we explored common combinations of the risk factors in relation to all-cause and cardio-metabolic mortality outcomes. RESULTS All single risk factors, except for diet, were significantly associated with both mortality outcomes, and were therefore selected to form a lifestyle risk index. Risk of mortality increased as the index score increased. The hazard ratio for all-cause mortality increased from 1.37 (1.15-1.62) to 6.15 (3.56-10.63) as the number of index risk factors increased from one to six respectively. Among the most common risk factor combinations the association with mortality was particularly strong when smoking and/or social participation were included. CONCLUSIONS This study adds to previous research on multiple risk behaviours by incorporating emerging risk factors. Findings regarding social participation and prolonged sitting suggest new components of healthy lifestyles and potential new directions for population health interventions.
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Affiliation(s)
- Steinar Krokstad
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, NSW Australia
- Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD Australia
| | - Anne C. Grunseit
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Erik R. Sund
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway
| | - Turid Lingaas Holmen
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway
| | - Vegar Rangul
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway
| | - Adrian Bauman
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, NSW Australia
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Tagliabue G, Borgini A, Tittarelli A, van Donkelaar A, Martin RV, Bertoldi M, Fabiano S, Maghini A, Codazzi T, Scaburri A, Favia I, Cau A, Barigelletti G, Tessandori R, Contiero P. Atmospheric fine particulate matter and breast cancer mortality: a population-based cohort study. BMJ Open 2016; 6:e012580. [PMID: 28076275 PMCID: PMC5129133 DOI: 10.1136/bmjopen-2016-012580] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/15/2016] [Accepted: 10/13/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Atmospheric fine particulate matter (PM2.5) has multiple adverse effects on human health. Global atmospheric levels of PM2.5 increased by 0.55 μg/m3/year (2.1%/year) from 1998 through 2012. There is evidence of a causal relationship between atmospheric PM2.5 and breast cancer (BC) incidence, but few studies have investigated BC mortality and atmospheric PM2.5. We investigated BC mortality in relation to atmospheric PM2.5 levels among patients living in Varese Province, northern Italy. METHODS We selected female BC cases, archived in the local population-based cancer registry, diagnosed at age 50-69 years, between 2003 and 2009. The geographic coordinates of each woman's place of residence were identified, and individual PM2.5 exposures were assessed from satellite data. Grade, stage, age at diagnosis, period of diagnosis and participation in BC screening were potential confounders. Kaplan-Meir and Nelson-Aalen methods were used to test for mortality differences in relation to PM2.5 quartiles. Multivariable Cox proportional hazards modelling estimated HRs and 95% CIs of BC death in relation to PM2.5 exposure. RESULTS Of 2021 BC cases, 325 died during follow-up to 31 December 2013, 246 for BC. Risk of BC death was significantly higher for all three upper quartiles of PM2.5 exposure compared to the lowest, with HRs of death: 1.82 (95% CI 1.15 to 2.89), 1.73 (95% CI 1.12 to 2.67) and 1.72 (95% CI 1.08 to 2.75). CONCLUSIONS Our study indicates that the risk of BC mortality increases with PM2.5 exposure. Although additional research is required to confirm these findings, they are further evidence that PM2.5 exposure is harmful and indicate an urgent need to improve global air quality.
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Affiliation(s)
- Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Borgini
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Tittarelli
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts, USA
| | - Martina Bertoldi
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabrina Fabiano
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Maghini
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tiziana Codazzi
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Scaburri
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Imma Favia
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Cau
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulio Barigelletti
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Up to one-third of breast cancer cases in post-menopausal Mediterranean women might be avoided by modifying lifestyle habits: the EPIC Italy study. Breast Cancer Res Treat 2016; 161:311-320. [PMID: 27832394 DOI: 10.1007/s10549-016-4047-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Breast cancer (BC) is the most frequent cancer among women in developed countries. Physical activity (PA), body mass index (BMI), and alcohol intake have been identified as relevant lifestyle modifiable risk factors for post-menopausal BC. We aimed to evaluate the role of these factors in modulating post-menopausal BC risk and to estimate the proportion of BC cases attributable to low PA, high BMI, and alcohol taking into account non-modifiable factors. METHODS In the Italian section of the EPIC study, 15,010 post-menopausal women were recruited and provided information about dietary and lifestyle habits including PA, smoking, reproductive history, and anthropometric measurements. During 14.8 years of median follow-up, 672 incident BC cases (607 invasive and 65 in situ) were identified. RESULTS In multivariate models, inverse associations with BC risk emerged for increasing level of total (p trend 0.02), leisure time (p trend 0.04), and occupational (p trend 0.007) PA. High BMI (HR 1.21; 95% CI 1.02-1.43 and HR 1.33; 95% CI 1.06-1.65 for overweight and obesity, respectively) and alcohol consumption higher than 10 g/day (HR 1.30; 95% CI 1.09-1.54) were associated with BC risk. We estimated that 30% (95% CI 8-50%) of post-menopausal BC cases would be avoided through an increase of leisure time PA, a BMI below 25.0, and consuming no more than one drink/day. CONCLUSIONS This large study carried out in Mediterranean women confirms the role of PA, BMI, and alcohol consumption in modulating post-menopausal BC risk and supports the potential benefits obtainable by modifying these lifestyle factors.
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Lassale C, Gunter MJ, Romaguera D, Peelen LM, Van der Schouw YT, Beulens JWJ, Freisling H, Muller DC, Ferrari P, Huybrechts I, Fagherazzi G, Boutron-Ruault MC, Affret A, Overvad K, Dahm CC, Olsen A, Roswall N, Tsilidis KK, Katzke VA, Kühn T, Buijsse B, Quirós JR, Sánchez-Cantalejo E, Etxezarreta N, Huerta JM, Barricarte A, Bonet C, Khaw KT, Key TJ, Trichopoulou A, Bamia C, Lagiou P, Palli D, Agnoli C, Tumino R, Fasanelli F, Panico S, Bueno-de-Mesquita HB, Boer JMA, Sonestedt E, Nilsson LM, Renström F, Weiderpass E, Skeie G, Lund E, Moons KGM, Riboli E, Tzoulaki I. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study. PLoS One 2016; 11:e0159025. [PMID: 27409582 PMCID: PMC4943719 DOI: 10.1371/journal.pone.0159025] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/24/2016] [Indexed: 01/10/2023] Open
Abstract
Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.
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Affiliation(s)
- Camille Lassale
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Marc J. Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Dora Romaguera
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
- Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Linda M. Peelen
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Yvonne T. Van der Schouw
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joline W. J. Beulens
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Pietro Ferrari
- International Agency for Research on Cancer, Lyon, France
| | | | - Guy Fagherazzi
- Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population, Health, U1018, Team 9, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
- Paris South University, Unité Mixte de Recherche 1018, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population, Health, U1018, Team 9, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
- Paris South University, Unité Mixte de Recherche 1018, Villejuif, France
| | - Aurélie Affret
- Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population, Health, U1018, Team 9, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
- Paris South University, Unité Mixte de Recherche 1018, Villejuif, France
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christina C. Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anja Olsen
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | - Nina Roswall
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Verena A. Katzke
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke German Institute of Human Nutrition, Potsdam, Germany
| | - Tilman Kühn
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke German Institute of Human Nutrition, Potsdam, Germany
| | - Brian Buijsse
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - José-Ramón Quirós
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Public Health Directorate, Asturias, Oviedo, Spain
| | - Emilio Sánchez-Cantalejo
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
| | - Nerea Etxezarreta
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Public Health Direction and Biodonostia Basque Regional Health Department, San Sebastian, Spain
| | - José María Huerta
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
| | - Aurelio Barricarte
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - Catalina Bonet
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, Spain
| | - Kay-Tee Khaw
- University of Cambridge School of Clinical Medicine, Clinical Gerontology Unit, Cambridge, United Kingdom
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Antonia Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Christina Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Department of Preventive and Predictive Medicine, Foundation of the Carlo Besta Neurological Institute, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, “Civic MP Arezzo” Hospital, Ragusa, Italy
| | | | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - H. Bas Bueno-de-Mesquita
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jolanda M. A. Boer
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Emily Sonestedt
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Lena Maria Nilsson
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Frida Renström
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Karel G. M. Moons
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
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Kuo CS, Chen GR, Hung SH, Liu YL, Huang KC, Cheng SY. Women with abnormal screening mammography lost to follow-up: An experience from Taiwan. Medicine (Baltimore) 2016; 95:e3889. [PMID: 27310983 PMCID: PMC4998469 DOI: 10.1097/md.0000000000003889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Breast cancer has the highest incidence among all cancers for women in Taiwan. The current screening policy in Taiwan suggested a biennial mammography for all women 40 to 69 years of age. A recommendation for additional testing is recommended for women with a BI-RADS result of 0 or 4; a request made via postal mail. Approximately 20% of high-risk patients do not receive additional follow-up. Therefore, we aimed to explore the causes of these patients being lost to follow-up, despite an abnormal mammogram. Two questionnaires were designed separately according to the conceptual framework of the Health Belief Model. Study participants, women who received a screening mammography at the National Taiwan University Hospital in 2011 with a BI-RAD of 0 or 4, were interviewed via telephone. The dependent variable was receipt of follow-up or not. The analyses were performed by using χ tests and logistic regression models. In total, 528 women were enrolled in the study: 51.2% in BI-RADS 0 group and 56.6% in BI-RADS 4, respectively. In the BI-RADS 0 group, those patients who received a follow-up examination cited the most likely causes to be physician suggestion, health implications, and concerns regarding breast cancer. Patients who did not receive a follow-up examination cited a lack of time and a perception of good personal health as primary reasons. In the BI-RADS 4 group, those patients who received a follow-up examination cited the physician's recommendation and a recognition of the importance of follow-up examinations. Patients who did not receive a follow-up examination cited having received follow-up at another hospital and a desire for a second opinion. In the BI-RADS 0 group, multivariate analysis showed that patients with higher scores in the "perceived benefits" domain were statistically more likely to receive a follow-up examination. There was no significant difference in perceived threats, perceived barriers, action cues, or self-efficacy between groups. We conclude that additional education to raise breast cancer awareness in the general public and healthcare providers will be needed to improve the rate of follow-up examinations after an abnormal screening mammogram.
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Affiliation(s)
- Chia-Sheng Kuo
- Department of Community and Family Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin
- College of Public health, National Taiwan University
| | - Guan-Ru Chen
- Department of Community and Family Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin
| | - Shou-Hung Hung
- Department of Community and Family Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin
| | - Yi-Lien Liu
- Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital BeiHu Branch
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University Hospital
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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McKenzie F, Biessy C, Ferrari P, Freisling H, Rinaldi S, Chajès V, Dahm CC, Overvad K, Dossus L, Lagiou P, Trichopoulos D, Trichopoulou A, Bueno-de-Mesquita HB, May A, Peeters PH, Weiderpass E, Sanchez MJ, Navarro C, Ardanaz E, Ericson U, Wirfält E, Travis RC, Romieu I. Healthy Lifestyle and Risk of Cancer in the European Prospective Investigation Into Cancer and Nutrition Cohort Study. Medicine (Baltimore) 2016; 95:e2850. [PMID: 27100409 PMCID: PMC4845813 DOI: 10.1097/md.0000000000002850] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/10/2015] [Accepted: 01/22/2016] [Indexed: 12/31/2022] Open
Abstract
It has been estimated that at least a third of the most common cancers are related to lifestyle and as such are preventable. Key modifiable lifestyle factors have been individually associated with cancer risk; however, less is known about the combined effects of these factors. This study generated a healthy lifestyle index score (HLIS) to investigate the joint effect of modifiable factors on the risk of overall cancers, alcohol-related cancers, tobacco-related cancers, obesity-related cancers, and reproductive-related cancers. The study included 391,608 men and women from the multinational European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The HLIS was constructed from 5 factors assessed at baseline (diet, physical activity, smoking, alcohol consumption, and anthropometry) by assigning scores of 0 to 4 to categories of each factor, for which higher values indicate healthier behaviors. Hazard ratios (HR) were estimated by Cox proportional regression and population attributable fractions (PAFs) estimated from the adjusted models. There was a 5% lower risk (adjusted HR 0.952, 95% confidence interval (CI): 0.946, 0.958) of all cancers per point score of the index for men and 4% (adjusted HR 0.961, 95% CI: 0.956, 0.966) for women. The fourth versus the second category of the HLIS was associated with a 28% and 24% lower risk for men and women respectively across all cancers, 41% and 33% for alcohol-related, 49% and 46% for tobacco-related, 41% and 26% for obesity-related, and 21% for female reproductive cancers. Findings suggest simple behavior modifications could have a sizeable impact on cancer prevention, especially for men.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Dimitrios Trichopoulos
- From the International Agency for Research on Cancer (IARC), Lyon (FM, CB, PF, HF, SR, VC, IR), INSERM, Centre for Research in Epidemiology and Population Health (CESP) (LD), Paris South University, UMRS 1018 (LD), Department of Public Health, Aarhus University, Aarhus, Denmark (CCD, KO), Institute Gustave Roussy (LD), INSERM, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France (LD), Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School (PL), Bureau of Epidemiologic Research, Academy of Athens (PL, DT), Hellenic Health Foundation, Athens, Greece (DT, AT), Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT), National Institute for Public Health and the Environment (RIVM), Bilthoven (HBBM), Department of Gastroenterology and Hepatology, University Medical Centre (HBBM), Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands (AM, PHP), School of Public Health, Imperial College, London (HBBM, PHP), Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom (RCT), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBM), Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø (EW), Department of Research, Cancer Registry of Norway, Oslo, Norway (EW), Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (EW), Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden (UE, EW), Samfundet Folkhälsan, Helsinki, Finland (EW), CIBER Epidemiology and Public Health (CIBERESP), España (M-JS, CN, EA), Andalusian School of Public Health, University of Granada, Granada (M-JS), Department of Epidemiology, Murcia Regional Health Council (CN), Department of Health and Social Sciences, Universidad de Murcia, Murcia (CN), Navarra Public Health Institute (EA), and Navarra Institute for Health Research (IdiSNA), Pamplona, Spain (EA)
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Karimi N, Dabidi Roshan V, Fathi Bayatiyani Z. Individually and Combined Water-Based Exercise With Ginger Supplement, on Systemic Inflammation and Metabolic Syndrome Indices, Among the Obese Women With Breast Neoplasms. IRANIAN JOURNAL OF CANCER PREVENTION 2015; 8:e3856. [PMID: 26855719 PMCID: PMC4736069 DOI: 10.17795/ijcp-3856] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/16/2015] [Accepted: 11/15/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Breast neoplasms has known as the most common cancer among the women worldwide, and relationship between obesity, metabolic syndrome, inflammation and cancer has been recognized since many years ago. OBJECTIVES The aim of this study was to determine the individual and concomitant effect of 6-weeks water-based exercise and oral ginger supplement on markers that have related to metabolic syndrome and systemic inflammation in obese women with breast neoplasms. PATIENTS AND METHODS Forty women whose have diagnosed with breast neoplasms have volunteered to participate in the study. Subjects have randomly assigned into four groups; placebo, exercise training, ginger supplement and exercise training+ ginger supplement groups. Subjects in the ginger supplement group and the exercise training+ ginger supplement group have orally received 4 capsules, 7 days a week and for 6 weeks. The water-based exercise training program have collected at a progressive intensity and time, have ranged from 50% to 75% of heart rate reserve, in a pool, 4 times a week for 6 weeks. Fasting blood sampling has collected at the pretest and post-test. RESULTS The ginger supplementation and the water-base exercise have resulted in a reduction of hs-CRP, IL-10, insulin, glucose, insulin resistance, LDL-C, TG; but an increase in HDL-C and HDL-C/LDL-C. The water-base exercise and ginger supplement group have significantly shown larger positive effect in all outcomes, in comparison with the water-base exercise or ginger supplement alone groups. CONCLUSIONS Findings have suggested that obese breast neoplasms survivors have commonly shown metabolic syndrome and elevated inflammation, which placed them at an increased risk for cardiovascular diseases. Moreover, data has indicated a protective effect of the nondrug strategies, such as water-base exercise and ginger supplementation have played an important role in pathogenesis of inflammatory and metabolic responses, among diagnosed breast neoplasms.
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Affiliation(s)
- Niloofar Karimi
- Department of Sport Physiology, Faculty of Physical Education and Sport Sciences, University of Mazandaran, Babolsar, IR Iran
| | - Valiollah Dabidi Roshan
- Department of Sport Physiology, Faculty of Physical Education and Sport Sciences, University of Mazandaran, Babolsar, IR Iran
| | - Zohreh Fathi Bayatiyani
- Department of Sport Physiology, Faculty of Physical Education and Sport Sciences, University of Mazandaran, Babolsar, IR Iran
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Bai A, Li H, Huang Y, Liu X, Gao Y, Wang P, Dai H, Song F, Hao X, Chen K. A survey of overall life satisfaction and its association with breast diseases in Chinese women. Cancer Med 2015; 5:111-9. [PMID: 26640035 PMCID: PMC4708902 DOI: 10.1002/cam4.565] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 12/17/2022] Open
Abstract
To investigate the association between overall life satisfaction and healthy lifestyle, knowledge of breast cancer, physical examination, and detection rate of breast cancer and benign breast disease in Chinese women. In a multicentered breast disease screening program in China, we enrolled 33,057 women aged 45-65 years without prior diagnosis of breast cancer. After completing an epidemiological questionnaire, all participants were examined by clinical breast examination, breast ultrasound, and mammography independently. All breast cancer cases and a selected sample of benign breast diseases were confirmed pathologically. Univariate and multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the association between life satisfaction and lifestyle, knowledge of breast cancer, physical examination, and detection rate of breast diseases. Overall life satisfaction was positively associated with women's healthy lifestyle. Compared with less satisfied women, satisfied women were less likely to be smokers (OR = 0.54; 95% CI: 0.47-0.62), have more exercise (OR = 1.49; 95% CI: 1.26-1.75), eat less fried (OR = 0.60; 95% CI: 0.50-0.71), smoked (OR = 0.54, 95% CI: 0.47-0.63), pickled (OR = 0.66, 95% CI: 0.55-0.79), and grilled (OR = 0.63, 95% CI: 0.54-0.74) foods. Satisfied women were more likely to have knowledge of breast cancer (OR = 1.48, 95% CI: 1.29-1.70), and have regular physical examinations (OR = 1.11, 95% CI: 1.01-1.12). Compared to less satisfied women, we found significantly lower detection rate of benign breast diseases (OR = 0.90, 95% CI: 0.82-0.99), and lower but nonsignificant detection rate of breast cancer (OR = 0.66, 95% CI: 0.35-1.25) in satisfied women. Women with a higher overall life satisfaction are more likely to have healthy lifestyle, knowledge of breast cancer, and regular physical examination, thus resulting in a lower detection rate of breast diseases in screening.
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Affiliation(s)
- Aili Bai
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Haixin Li
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Yubei Huang
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xueou Liu
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Ying Gao
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Peishan Wang
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Hongji Dai
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Fengju Song
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xishan Hao
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Kexin Chen
- Departments of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
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Wang J, Jin P, Wang WH, He M, Zhang ZT, Liu Y. Association of A118G polymorphism in the μ-opioid receptor gene with smoking behaviors: a meta-analysis. J Toxicol Sci 2015; 40:711-8. [PMID: 26558451 DOI: 10.2131/jts.40.711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Many studies have investigated the association between the A118G polymorphism in the μ-opioid receptor gene and smoking behaviors, but the results remain controversial. This meta-analysis aimed to derive a more reliable estimate of the effect of the A118G polymorphism on smoking behaviors. We systematically searched the PubMed/Medline, Embase and Web of Science databases for eligible articles published up to October 23, 2014. A total of six studies were selected. Odds ratios (ORs) as well as their corresponding 95% confidence intervals (CIs) were used to estimate the association between A118G polymorphism and smoking behaviors in four genetic models. Heterogeneity analysis and publication bias were also performed. Subgroup analysis was conducted according to different ethnicities. The meta-analysis was performed using either a fixed- or random-effects model as deemed appropriate. In the result of the meta-analysis, a significant association was detected in the dominant model in the Caucasian subgroup (OR = 3.26, 95% CI = 2.65-4.05). This result indicated that Caucasians carrying the G allele (AG + GG) of the A118G polymorphism in the μ-opioid receptor gene were more likely to be addicted to smoking compared with those with the AA homozygote. However, no significant association was found in other genetic models.
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Affiliation(s)
- Juan Wang
- Department of Clinical Laboratory, Renmin Hospital, Hubei University of Medicine, China
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