A Complex Systems Model of Breast Cancer Etiology: The Paradigm II Conceptual Model

Abstract

Background: The etiology of breast cancer is a complex system of interacting factors from multiple domains. New knowledge about breast cancer etiology continues to be produced by the research community, and the communication of this knowledge to other researchers, practitioners, decision makers, and the public is a challenge.Methods: We updated the previously published Paradigm model (PMID: 25017248) to create a framework that describes breast cancer etiology in four overlapping domains of biologic, behavioral, environmental, and social determinants. This new Paradigm II conceptual model was part of a larger modeling effort that included input from multiple experts in fields from genetics to sociology, taking a team and transdisciplinary approach to the common problem of describing breast cancer etiology for the population of California women in 2010. Recent literature was reviewed with an emphasis on systematic reviews when available and larger epidemiologic studies when they were not. Environmental chemicals with strong animal data on etiology were also included.Results: The resulting model illustrates factors with their strength of association and the quality of the available data. The published evidence supporting each relationship is made available herein, and also in an online dynamic model that allows for manipulation of individual factors leading to breast cancer (https://cbcrp.org/causes/).Conclusions: The Paradigm II model illustrates known etiologic factors in breast cancer, as well as gaps in knowledge and areas where better quality data are needed.Impact: The Paradigm II model can be a stimulus for further research and for better understanding of breast cancer etiology.

Looking beyond the Lamppost: Population-Level Primary Prevention of Breast Cancer

“…Table 1 summarizes key risk factors for breast cancer. Environmental and behavioral factors are associated with 90 to 95 percent of breast cancer cases [6,13]. Behavioral risk factors have been given considerable attention in the literature [1,11,13,[21][22][23][24][25], with healthy diet (avoiding high calorie foods, processed meat, and alcohol consumption) and weight management as the most often discussed.…”

“…Other environmental and social determinants impact breast cancer incidence and mortality, with socioeconomic status and educational opportunity found to be driving factors of both [13]. Education, income, and ancestry are strongly associated with risk factors such as age at first birth, parity, breast feeding, and tobacco and alcohol use [13].…”

“…Other environmental and social determinants impact breast cancer incidence and mortality, with socioeconomic status and educational opportunity found to be driving factors of both [13]. Education, income, and ancestry are strongly associated with risk factors such as age at first birth, parity, breast feeding, and tobacco and alcohol use [13]. Further evidence suggests income is a strong determinant of cancer survivorship and low socioeconomic status is related to difficulty finding/affording healthy foods and is connected to poor cancer treatment outcomes, including increased risk of death from treatable cancers [35].…”

“…This may reflect the general trend toward treatment over prevention in medicine, specifically within oncology [10]. Numerous strategies have been recommended to reduce the risk for breast cancer (i.e., reducing alcohol consumption, increasing physical activity, healthy diet) [11], but such behaviors are encapsulated by multiple environmental/contextual issues, such as structural inequalities, physical environment, food security, policies concerning air and water safety, and chemical use [6,12,13]. Such factors influence an individual's ability to adopt health-promoting habits, thus hindering their protective impact on prevalence risk [14].…”

Learning from and Leveraging Multi-Level Changes in Responses to the COVID 19 Pandemic to Facilitate Breast Cancer Prevention Efforts

“…Many factors have been identified as risk factors for breast cancer [ 7 , 8 ]. These risk factors occur and/or are influenced at multiple levels, including the built, social, natural, social, political and healthcare environment and individual and biological levels ( Figure 1 ) [ 9 ].…”