These results support the idea that possible elevations in serum estrogen levels by an adult exposure to a high-fat diet would increase breast cancer risk. Furthermore, menopausal status was observed to affect women's risk of breast cancer. Higher risks of breast cancer were found in post-menopausal women consuming diets high in total fat and polyunsaturated fats. Conversely, dietary fat appears to have preventative effects in pre-menopausal women. This study takes a transformative approach combining epidemiological, biomedical, and evolutionary theory to evaluate how biocultural variations in risk factors (i.e., diet and reproduction) affect the evolution of breast cancers.

The Breast Cancer Campaign Tissue Bank (BCCTB) was initiated in 2010 after the charity Breast Cancer Campaign heard from breast cancer experts that insufficient high quality breast cancer tissue was preventing research which would impact people with breast cancer1. The charity decided to involve patient advocates in the development of the BCCTB from the beginning. Two advocates reviewed the initial applications to form the BCCTB. These included both single and multi-centre applications so they suggested that, rather than choosing one centre to form the Bank, the charity consider a collaboration of centres. Throughout the development of the BCCTB, the patient advocates asked the ‘elephant in the room’ questions and brought a different perspective. They also helped to design the Bank's processes, including the consent process and asking that all tissue applicants produce a lay summary of their research. There are now two advocates on the Board which provides strategic direction to the BCCTB. The advocates have equal status to other Board members. There are also three advocates on the Tissue Access Committee which controls the use of tissue in the Bank. Lay summaries of projects have to be approved by all advocates before an application can proceed. This means that no precious tissue is released without the approval of a lay person, who can ensure maximum patient benefit will be achieved from any research. The Bank's data return policy was also driven by the patient advocates who were keen that the tissues donated were used to their maximum benefit. This has resulted in the first publication from BCCTB2 Patient advocates have been involved in promoting the use of tissue from the bank presenting at conferences and at BCCTB road shows. Patient advocates have also been involved in asking potential donors to consent to donate to the tissue bank. The involvement of patient advocates in the development and oversight of the BCCTB has shown researchers that patient and public involvement works. The advocates can also help promote the Bank and the benefits of tissue donation to both professionals and lay groups. The patient advocates involved in the Breast Cancer Campaign Tissue Bank are members of the charity Independent Cancer Patients’ Voice 1. Thompson P, Brennan K, Cox A, Gee J, Harcourt D, Harris A, Harvie M, Holen I, Howell A, Nicholson R, Steel M, Streuli C. Evaluation of the current knowledge limitations in breast cancer research: a gap analysis. Breast Cancer Res 2008: 10(2); R26. 2. Speirs V, Morgan A. Investment biobanking – increased returns on tissue samples. Nat Rev Clin Onc 2013; 10:128-129. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-10-01.

The human genome was adapted to an environment different from that experienced by modern industrialized humans. The reconstruction of lifestyle, reproductive and dietary characteristics of human ancestors is therefore important in understanding breast cancer. Moreover, cultural evolution occurs at a faster rate than genetic adaptation, resulting in evolutionary discordance between modern human genes and lifestyle. This mismatch between genetic biology and modern lifestyle factors may foster the development and propagation of breast cancer because of potential impact on circulating hormones and body mass. Diet and exercise may differentially affect breast cancer risk during reproductive and menopausal years. This study examines evolutionary discordance in energy consumption, expenditure and reproductive events as it relates to risk of female breast cancer. Published literature evaluating relationships between breast cancer risk and dietary fat, and exercise was systematically reviewed up to May of 2010. Descriptive data, estimates of relative risk and 95% confidence interval (CI) were extracted from relative studies, sorted according to inclusion criteria and analyzed using the random effects model of DerSimonian and Laird. The results reveal disparity between exercise load, fat intake, study type and reproductive status. Cohort study results indicated significant summary relative risks between poly-unsaturated fat and breast cancer (1.091, 95% CI: 1.001; 1.184). In case-control studies no association between fat and breast cancer was observed. Reproductive status influenced the affect of dietary fat on breast cancer risk. Post-menopausal women exhibited a significant association between total fat (1.042, 95%CI: 1.013; 1.073), poly-unsaturated fat intake (1.22, 95% CI: 1.08; 1.381) and breast cancer. A non-significant inverse relationship between fat types and breast cancer was identified in premenopausal women. Evidence for significant inverse relationships between exercise and breast cancer were observed in all categories. In sum: a. Higher levels of exercise could decrease breast cancer risk b. Higher consumption of dietary fat may increase breast cancer risk c. Reproductive status may influence breast cancer risk in women These results have important implications for future breast cancer research. Interactions between modern cultural factors and ancestral biology may be expressed as higher rates of breast cancers in modern, industrialized nations. Clinical studies do not cumulatively examine population variations in socio-economic, cultural and biological risk factors and breast cancer occurrence. Applying an anthropological and biocultural perspective to future research could identify evolutionary roots to causes and risk factors of female reproductive diseases. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3733. doi:10.1158/1538-7445.AM2011-3733