Population Attributable Risk for Breast Cancer: Diet, Nutrition, and Physical Exercise

Maura, Mezzetti; Boyle, Peter; Vecchia, Carlo La; Decarli, Adriano; Talamini, Renato; Franceschi, Silvia

doi:10.1093/jnci/90.5.389

Cited by 170 publications

(19 citation statements)

References 34 publications

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“…For physical inactivity, mainly higher PAF estimates than ours (5.5 %) were reported in Europe, of around 10–14 % [25, 28, 34], except for the UK (3.4 %) [35]. Numbers in the U.S. even rise up to 16 % [36].…”

Section: Discussioncontrasting

confidence: 54%

The proportion of postmenopausal breast cancer cases in the Netherlands attributable to lifestyle-related risk factors

Gemert

Lanting

Goldbohm

et al. 2015

Breast Cancer Res Treat

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We aimed to estimate the proportion of Dutch postmenopausal breast cancer cases in 2010 that is attributable to lifestyle-related risk factors. We calculated population attributable fractions (PAFs) of potentially modifiable risk factors for postmenopausal breast cancer in Dutch women aged >50 in 2010. First, age-specific PAFs were calculated for each risk factor, based on their relative risks for postmenopausal breast cancer (from meta-analyses) and age-specific prevalence in the population (from national surveys) around the year 2000, assuming a latency period of 10 years. To obtain the overall PAF, age-specific PAFs were summed in a weighted manner, using the age-specific breast cancer incidence rates (2010) as weights. 95 % confidence intervals for PAF estimates were derived by Monte Carlo simulations. Of Dutch women >40 years, in 2000, 51 % were overweight/obese, 55 % physically inactive (<5 days/week 30 min activity), 75 % regularly consumed alcohol, 42 % ever smoked cigarettes and 79 % had a low-fibre intake (<3.4 g/1000 kJ/day). These factors combined had a PAF of 25.7 % (95 % CI 24.2–27.2), corresponding to 2,665 Dutch postmenopausal breast cancer cases in 2010. PAFs were 8.8 % (95 % CI 6.3–11.3) for overweight/obesity, 6.6 % (95 % CI 5.2–8.0) for alcohol consumption, 5.5 % (95 % CI 4.0–7.0) for physical inactivity, 4.6 % (95 % CI 3.3–6.0) for smoking and 3.2 % (95 % CI 1.6–4.8) for low-fibre intake. Our findings imply that modifiable risk factors are jointly responsible for approximately one out of four Dutch postmenopausal breast cancer cases. This suggests that incidence rates can be lowered substantially by living a more healthy lifestyle.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-015-3447-7) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 54%

The proportion of postmenopausal breast cancer cases in the Netherlands attributable to lifestyle-related risk factors

Gemert

Lanting

Goldbohm

et al. 2015

Breast Cancer Res Treat

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“…5 Another study estimated that “alcohol intake + physical activity” were the most important in premenopausal women, and “physical activity + BMI” were important in postmenopausal women. 23 Sprague et al 24 estimated that summary PAFs were 40.7% for modifiable factors, and weight gain and physical inactivity had the highest PAFs (21.3% and 15.7%), whereas Clarke et al 4 estimated that PAFs were 2% to 11% for HRT use, 1% to 20% for alcohol intake, and 2% to 15% for physical inactivity, and 2% to 11% for breastfeeding. The message that physical activity is the most important modifiable factor as an intervention in breast cancer is consistent in our and previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…4,5,23,24 These study variations might be caused by not only differences in the prevalence and ORs between populations but also in the cut-points for categorization, which are known to have a large effect on PAF. 33 …”

Section: Discussionmentioning

confidence: 99%

Attribution to Heterogeneous Risk Factors for Breast Cancer Subtypes Based on Hormone Receptor and Human Epidermal Growth Factor 2 Receptor Expression in Korea

et al. 2016

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“…A large body of literature exists on the association between alcohol consumption and risk of breast cancer (Swanson et al, 1997, Bowlin et al, 1997, Ferraroni et al, 1998, Maura et al, 1998, World Cancer Research Fund, 2007). Nevertheless, questions remain regarding this association and findings have often been conflicting, especially in relation to potential risks from low-level consumption.…”

Section: Introductionmentioning

confidence: 99%

“…Other studies have suggested that there may also be increased risk at even one drink per day (containing 12-14g of ethanol). These studies have reported risk estimates ranging from 1.21 (0.95-1.55) to 1.52 (1.19-1.93) (Bowlin et al, 1997; Ferraroni et al, 1998; Maura et al, 1998; Swanson et al, 1997). Other research has found only weak associations between low level alcohol consumption and breast cancer, with similar odds ratios ranging from 1.06 (95% CI: 1.00, 1.11) to 1.10 (95% CI): 1.06, 1.14) (Ellison et al, 2001; Sneyd et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

Methodological Biases in Estimating the Relationship Between Alcohol Consumption and Breast Cancer: The Role of Drinker Misclassification Errors in Meta‐Analytic Results

Zeisser

Stockwell

Chikritzhs

2014

Alcoholism Clin & Exp Res

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Background While alcohol consumption has been linked to breast cancer in women, few studies have controlled for possible biases created by including former or occasional drinkers in the abstainer reference group. We explored the potential for such misclassification errors as sources of bias in estimates of the alcohol-breast cancer relationship. Methods Meta-analyses of population case-control, hospital case-control, and cohort studies to examine relationships between level of alcohol use and breast cancer morbidity and/or mortality in groups of studies with and without different misclassification errors. Results Of 60 studies identified, only 6 were free of all misclassification errors. The abstainer reference group was biased by the inclusion of former drinkers in 49 studies, occasional drinkers (<10g ethanol per week) in 22 and by both these groups in 18. Occasional drinkers were also mixed with light or hazardous level drinkers in 21 studies. Unbiased estimates of the OR for breast cancer were 1.011 (95% CI: 0.891-1.148) among former drinkers (n = 11) and 1.034 (95% CI: 1.003-1.064) among occasional drinkers (n=17). Hazardous level drinking (>20g<41g ethanol/day) was not significantly associated with breast cancer in studies with occasional drinker bias. However, in studies free from occasional drinker bias, the OR for breast cancer was 1.085 (95% CI: 1.015-1.160) for low level (<21g/day) drinkers (n=17), 1.374 (95% CI: 1.319-1.431) for hazardous level drinkers (n=26) and 1.336 (95% CI: 1.228-1.454) for harmful level (>40g/day) drinkers (n=9). Conclusions While the great majority of studies of the alcohol-breast cancer link include misclassification errors, only misclassification of occasional drinkers was found to bias risk estimates significantly. Estimates based on error free studies confirmed that low, hazardous and harmful levels of alcohol use each significantly increase the risk of breast cancer.

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Population Attributable Risk for Breast Cancer: Diet, Nutrition, and Physical Exercise

Abstract: Exposure to a few selected and potentially modifiable risk indicators explained about one third of the cases of breast cancer in this Italian population, indicating the theoretical scope for prevention of the disease.

Cited by 170 publications

References 34 publications

The proportion of postmenopausal breast cancer cases in the Netherlands attributable to lifestyle-related risk factors

The proportion of postmenopausal breast cancer cases in the Netherlands attributable to lifestyle-related risk factors

Attribution to Heterogeneous Risk Factors for Breast Cancer Subtypes Based on Hormone Receptor and Human Epidermal Growth Factor 2 Receptor Expression in Korea

Methodological Biases in Estimating the Relationship Between Alcohol Consumption and Breast Cancer: The Role of Drinker Misclassification Errors in Meta‐Analytic Results

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