Multiple studies have found the neutrophil to lymphocyte ratio (nLR) to be associated with adverse breast cancer (BC) prognosis and survival. Very limited data exist on the role of NLR and risk of BC. The BREOGAN study is a population-based case-control study conducted in Galicia, Spain. We examined the WBC-and NLR-BC relationships. The risk of BC increased with increasing levels of neutrophils percentage (NE%) (multivariable OR for the highest category (95% CI) = 2.14 (1.39-3.32), P-trend < 0.001) and of the NLR (multivariable OR for the highest category (95% CI) = 1.93 (1.26-2.97), P-trend < 0.001). Lymphocytes absolute (L#) and percentage (L%) were associated with a decreased risk of BC (multivariable OR for the highest category (95% CI) = 0.54 (0.35-0.83), and 0.51 (0.33-0.79), P-trend = 0.001 and < 0.001, respectively). The NLR-BC association was more pronounced among Luminal A BC (multivariable OR for the highest category (95% CI) = 2.00 (1.17-3.45), P-trend < 0.001), HER2-negative BC (multivariable OR for the highest category (95% CI) = 1.87 (1.16-3.02), P-trend < 0.001), and those with high total cholesterol and low H 2 o 2 levels. In 2018, 32,825 new breast cancer cases were diagnosed in Spain, representing 12% of all cancer cases, and 29% of all cancers in women 1. It was responsible for 6,421 deaths (6% of all cancer deaths). Breast cancer is the most frequent cancer in Spain and ranks the fourth in cancer-related mortality. There has been a 30% increase in breast cancer incidence between 2012 and 2018 1. High concentration of blood neutrophils is seen in patients with advanced cancer and are associated with poor survival 2,3. Similarly, there is abundant evidence for an adverse prognostic value of neutrophil to lymphocyte ratio (NLR) on breast cancer. Multiple studies have shown that higher NLR was associated with poorer survival 4-9 , and a recent meta-analysis found that higher NLR was associated with both worse disease-free survival and overall survival 6. Several previous studies have found that higher NLR was also associated with more advanced or aggressive breast cancer 3,7,10,11. For this reason, the ratios between neutrophils in blood and other leukocytes, as the NLR, have been suggested as a prognostic value in cancer 3,12,13. NLR is higher in patients with more advanced cancers 10 , and correlates with poor survival in many cancers 14,15. Thus, NLR, a simple and inexpensive biomarker, has been introduced as a significant prognostic factor in many tumour types 3. However, it has not been accepted in many clinical settings since neutrophilia can be also the result of elevated granulopoiesis and, therefore, may not be an adverse sign for cancer progression 3. Another reason is that neutrophilia is associated with poor clinical outcome in all cancers except one, stomach cancer, in which a high NLR is a marker of good prognosis 3,16. However, the evidence for a