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Yiallourou A, Pantavou K, Markozannes G, Pilavas A, Georgiou A, Hadjikou A, Economou M, Christodoulou N, Letsos K, Khattab E, Kossyva C, Constantinou M, Theodoridou M, Piovani D, Tsilidis KΚ, Bonovas S, Nikolopoulos GK. Non-genetic factors and breast cancer: an umbrella review of meta-analyses. BMC Cancer 2024; 24:903. [PMID: 39061008 PMCID: PMC11282738 DOI: 10.1186/s12885-024-12641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Previous research has found associations between various non-genetic factors and breast cancer (BrCa) risk. This study summarises and appraises the credibility of the available evidence on the association between non-genetic factors and BrCa risk. METHODS We conducted an umbrella review of meta-analyses. Medline, Scopus, and the Cochrane databases were systematically searched for meta-analyses examining non-genetic factors and BrCa incidence or mortality. The strength of the evidence was graded in four categories (i.e., weak, suggestive, highly suggestive, convincing). RESULTS A total of 781 meta-analyses from 280 publications were evaluated and graded. We included exposures related to anthropometric measurements, biomarkers, breast characteristics and diseases, diet and supplements, environment, exogenous hormones, lifestyle and social factors, medical history, medication, reproductive history, and pregnancy. The largest number of examined associations was found for the category of diet and supplements and for exposures such as aspirin use and active smoking. The statistically significant (P-value < 0.05) meta-analyses were 382 (49%), of which 204 (53.4%) reported factors associated with increased BrCa risk. Most of the statistically significant evidence (n = 224, 58.6%) was graded as weak. Convincing harmful associations with heightened BrCa risk were found for increased body mass index (BMI), BMI and weight gain in postmenopausal women, oral contraceptive use in premenopausal women, increased androstenedione, estradiol, estrone, and testosterone concentrations, high Breast Imaging Reporting and Data System (BIRADS) classification, and increased breast density. Convincing protective factors associated with lower BrCa risk included high fiber intake and high sex hormone binding globulin (SHBG) levels while highly suggestive protective factors included high 25 hydroxy vitamin D [25(OH)D] levels, adherence to healthy lifestyle, and moderate-vigorous physical activity. CONCLUSIONS Our findings suggest some highly modifiable factors that protect from BrCa. Interestingly, while diet was the most studied exposure category, the related associations failed to reach higher levels of evidence, indicating the methodological limitations in the field. To improve the validity of these associations, future research should utilise more robust study designs and better exposure assessment techniques. Overall, our study provides knowledge that supports the development of evidence-based BrCa prevention recommendations and guidance, both at an individual level and for public health initiatives. TRIAL REGISTRATION PROSPERO CRD42022370675.
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Affiliation(s)
- Anneza Yiallourou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Katerina Pantavou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, 45110, Greece
| | - Antonis Pilavas
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Andrea Georgiou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Andria Hadjikou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Mary Economou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | | | - Elina Khattab
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | - Maria Constantinou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Milan, 20089, Italy
| | - Konstantinos Κ Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, 45110, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Milan, 20089, Italy
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Najdi N, Esmailzadeh A, Shokrpour M, Nikfar S, Razavi SZ, Sepidarkish M, Maroufizadeh S, Safiri S, Almasi-Hashiani A. A systematic review and meta-analysis on tubal ligation and breast cancer risk. Syst Rev 2022; 11:126. [PMID: 35718766 PMCID: PMC9208107 DOI: 10.1186/s13643-022-02000-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Based on previous studies, it has been hypothesized that tube sterilization may be associated with a lower risk of breast cancer. This study aims to investigate the relationship between tubal ligation and the risk of breast cancer through a systematic review and meta-analysis. METHODS In this systematic review and meta-analysis, PubMed/Medline, Web of Science, Scopus, and Google Scholar were searched for relevant non randomized studies published up to November 2020. Then, we screened the papers to include the eligible papers in the meta-analysis. Finally, we pooled the extracted results of individual studies to estimate the summary effect size. All analyses were done using Stata software version 13 (Stata Corp, College Station, TX). RESULTS Four hundred sixty-four papers were retrieved from PubMed/Medline (160), Scopus (165), and Web of Science (139), and 21 papers from Google Scholar and manual search of references in selected full texts. After the removal of duplicates and screening of the papers, 11 articles (6 cohort and 5 case-control study) were included in the final analysis. The results of cohort (RR = 0.99, 95% CI = 0.97-1.0, I2 = 21.1%) and case control studies (OR = 0.87, 95% CI = 0.62-1.12, I2 = 88.9%) revealed that tubal ligation was not significantly associated with breast cancer risk. CONCLUSION According to our findings, tubal ligation cannot be considered as a risk factor associated with breast cancer risk.
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Affiliation(s)
- Nazila Najdi
- Department of Obstetrics and Gynecology, Arak University of Medical Sciences, Arak, Iran
| | - Arezoo Esmailzadeh
- Department of Obstetrics and Gynecology, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Shokrpour
- Department of Obstetrics and Gynecology, Arak University of Medical Sciences, Arak, Iran
| | - Somayeh Nikfar
- Department of Obstetrics and Gynecology, Arak University of Medical Sciences, Arak, Iran
| | | | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeid Safiri
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Golestan St., Arak, Iran. .,Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Golestan St., Arak, Iran.
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Park SK. Epidemiological characteristics of breast cancer in Koreans. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.8.424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Sue K. Park
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Biomedical Science, Graduate School, Seoul National University, Seoul, Korea
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Verkuyl DAA. Recent developments have made female permanent contraception an increasingly attractive option, and pregnant women in particular ought to be counselled about it. Contracept Reprod Med 2016; 1:23. [PMID: 29201412 PMCID: PMC5693528 DOI: 10.1186/s40834-016-0034-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/29/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the increased prevalence of reversible contraception, global unintended pregnancy rates are stable. Mistakes, method failures, side effects, alcohol, stock-outs, fears, costs, delays, myths, religious interference, doctors with other priorities, traditions and lack of health professionals may all factor in. Yet these unintended pregnancies - nearly a hundred million annually - cause much individual suffering, and in the long run, can aggravate conflicts, poverty, forced emigration and climate change. Presently, non-poor women postpone childbearing because of longer educational trajectories and careers. Sterilisations are therefore less often regretted or coerced. For poor-resourced women with a completed family, an unwanted pregnancy often has serious consequences, including crossing the (extreme) poverty line in the wrong direction, choosing an unsafe abortion, or even death. Caesarean sections (CSs), which currently stand at around 23 million annually, are increasing. On an "intention-never-to-become-pregnant-again" analysis, choosing a partial, and even more so a total bilateral tubectomy to be implemented during an - anyway performed - CS is by far the most reliable and safe contraceptive choice compared to meaning to start female or male sterilisation or any other contraceptive method later, and it reduces the chance of a future ovarian carcinoma substantially. CSs make subsequent pregnancies more dangerous. Simultaneously, they provide convenient, potentially cost-free opportunities for voluntary permanent contraception (PC): particularly important if there is no guaranteed future access to reliable contraception, safe abortion and well-supervised labour. PARTIAL SOLUTION Millions of women are within reach of attaining freedom from the "tyranny of excessive fertility" when they have a CS. Therefore, any woman who might conceivably be of the firm opinion that her family will be (over) completed after delivery should antenatally have "what if you have a CS" counselling to assess whether she would like a tubectomy/ligation. Yet many are not provided with this option: leading to frequent regret, more often than having been giving that choice would. CONCLUSION Withholding antenatal counselling about the option of PC for in case the delivery might become a CS is very prevalent, yet often more medically risky, and morally questionable than when, even in labour, a doctor sometimes decides in the absence of earlier counselling, considering numerous factors, to provide the choice to undergo a concurrent sterilisation if s/he is convinced that would be in the patient's best interest.
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Affiliation(s)
- Douwe A. A. Verkuyl
- Leinweberlaan 16, 3971 KZ Driebergen, The Netherlands
- CASAklinieken, Leiden, The Netherlands
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Gaitskell K, Coffey K, Green J, Pirie K, Reeves GK, Ahmed AA, Barnes I, Beral V. Tubal ligation and incidence of 26 site-specific cancers in the Million Women Study. Br J Cancer 2016; 114:1033-7. [PMID: 27115569 PMCID: PMC4984917 DOI: 10.1038/bjc.2016.80] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Tubal ligation is known to be associated with a reduction in ovarian cancer risk. Associations with breast, endometrial and cervical cancers have been suggested. We investigated associations for 26 site-specific cancers in a large UK cohort. METHODS Study participants completed a questionnaire on reproductive and lifestyle factors in 1996-2001, and were followed for cancer and death via national registries. Using Cox regression models, we estimated adjusted relative risks (RRs) for 26 site-specific cancers among women with vs without tubal ligation. RESULTS In 1 278 783 women without previous cancer, 167 430 incident cancers accrued during 13.8 years' follow-up. Significantly reduced risks were found in women with tubal ligation for cancers of the ovary (RR=0.80, 95% CI: 0.76-0.85; P<0.001; n=8035), peritoneum (RR=0.81, 0.66-0.98; P=0.03; n=730), and fallopian tube (RR=0.60, 0.37-0.96; P=0.04; n=168). No significant associations were found for endometrial, breast, or cervical cancers. CONCLUSIONS The reduced risks of ovarian, peritoneal and fallopian tube cancers are consistent with hypotheses of a common origin for many tumours at these sites, and with the suggestion that tubal ligation blocks cells, carcinogens or other agents from reaching the ovary, fallopian tubes and peritoneal cavity.
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Affiliation(s)
- Kezia Gaitskell
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Kate Coffey
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Kirstin Pirie
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Ahmed A Ahmed
- Nuffield Department of Obstetrics and Gynaecology and The Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK
| | - Isobel Barnes
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
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Tubal ligation in relation to menopausal symptoms and breast cancer risk. Br J Cancer 2013; 109:1291-5. [PMID: 23922107 PMCID: PMC3778289 DOI: 10.1038/bjc.2013.433] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/27/2013] [Accepted: 07/04/2013] [Indexed: 01/21/2023] Open
Abstract
Background: Local inflammation after tubal ligation may affect ovarian function and breast cancer risk. Methods: We analysed tubal ligation, menopausal characteristics, and breast cancer risk in the Sister Study cohort (N=50 884 women). Results: Tubal ligation was associated with hot flashes (hazard ratio (HR) 1.09; 95% confidence interval (CI): 1.06–1.12) but not menopausal age (HR 0.99; 95% CI: 0.96–1.02). Tubal ligation did not have an impact on breast cancer overall (HR 0.95; 95% CI: 0.85–1.06), but had a suggested inverse relation with oestrogen receptor+/progesterone receptor+ invasive tumours (HR 0.84; 95% CI: 0.70–1.01), possibly because of subsequent hysterectomy/bilateral oophorectomy. Conclusion: Tubal ligation does not influence overall breast cancer risk.
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Press DJ, Bernstein L. Invited commentary: reproductive organ surgeries and breast cancer risk--apples, oranges, or fruit cocktail? Am J Epidemiol 2013; 177:500-3. [PMID: 23416446 DOI: 10.1093/aje/kws438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Case-control and cohort studies are almost always complicated by nonrandom exposure allocation, which must be minimized in the design and analysis phases. Tubal sterilization is a common gynecological procedure that may be associated with other reproductive organ surgeries, which in turn may be associated with breast cancer risk. In this issue of the Journal, Gaudet et al. (Am J Epidemiol. 2013;177(6):492-499) argue successfully that tubal sterilization is unassociated with breast cancer risk. Scrutiny of the heterogeneous studies included in their meta-analysis underscores the role of confounding and effect modification in observational epidemiologic studies. Specifically, tubal sterilization is unassociated with breast cancer risk, but either oophorectomy or hysterectomy, or both, and the timing of these procedures warrant careful consideration in the design, analysis, and interpretation of observational research on reproductive factors.
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Affiliation(s)
- David J Press
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA.
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