Top

Breast Cancer Research and Treatment

Published in:

01-08-2018 | Epidemiology

An estrogen-related lifestyle score is associated with risk of postmenopausal breast cancer in the PLCO cohort

Authors: Mark A. Guinter, Alexander C. McLain, Anwar T. Merchant, Dale P. Sandler, Susan E. Steck

Published in: Breast Cancer Research and Treatment | Issue 3/2018

Abstract

Purpose

Healthy or unhealthy lifestyle behaviors are often adopted together. We aimed to investigate the combined effect of estrogen-related lifestyle factors on postmenopausal breast cancer risk.

Methods

Data from 27,153 women enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial were used. We created an estrogen-related lifestyle score (ERLS) by incorporating a previously developed measure of estrogenic diet, alcohol intake, body mass index (BMI), and physical activity. The scores ranged from 0 to 6 with alcohol and BMI accounting for higher weights than the other factors. To evaluate the preventive possibilities of a low estrogen-related lifestyle and to be consistent with other published lifestyle scores, higher scores were set to correspond with potentially lower estrogenic lifestyle. The association between the ERLS and incident breast cancer was examined using Cox proportional hazards models.

Results

Participants with an ERLS of 4 or ≥ 5 had a 23% (HR 0.77; 95% CI 0.67–0.89) and 34% (HR 0.66; 95% CI 0.56–0.78) lower risk of breast cancer, respectively, compared to those with an ERLS ≤ 2 after multivariable adjustment. Estimates were similar when restricting to invasive cases or estrogen receptor-positive subtypes. No single lifestyle component appeared to drive the association.

Conclusions

Our findings suggest that the combined effect of a lifestyle characterized by a low estrogenic diet, low alcohol consumption, low body weight, and high levels of physical activity are associated with a reduction in postmenopausal breast cancer risk, possibly through an influence on estrogen metabolism.

Available only for authorised users

Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67:7–30. https://doi.org/10.3322/caac.21387 CrossRefPubMed

American Cancer Society (2015) Breast cancer facts & figures 2015-2016. American Cancer Society, Atlanta

World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. World Cancer Research Fund/American Institute for Cancer Research, Washington, DC

Continuous Update Project Report (2017) Diet, nutrition, physical activity and breast cancer

Brennan SF, Cantwell MM, Cardwell CR, Velentzis LS, Woodside JV (2010) Dietary patterns and breast cancer risk: a systematic review and meta-analysis. Am J Clin Nutr 91:1294–1302. https://doi.org/10.3945/ajcn.2009.28796 CrossRefPubMed

Mourouti N, Kontogianni MD, Papavagelis C, Panagiotakos DB (2015) Diet and breast cancer: a systematic review. Int J Food Sci Nutr 66:1–42. https://doi.org/10.3109/09637486.2014.950207 CrossRefPubMed

Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC (2000) Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 343:16–22. https://doi.org/10.1056/NEJM200007063430103 CrossRefPubMed

Romaguera D, Vergnaud A-C, Peeters PH, van Gils CH, Chan DS, Ferrari P et al (2012) Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr 96:150–163. https://doi.org/10.3945/ajcn.111.031674 CrossRefPubMed

Sánchez-Zamorano LM, Flores-Luna L, Ángeles-Llerenas A, Romieu I, Lazcano-Ponce E, Miranda-Hernández H et al (2011) Healthy lifestyle on the risk of breast cancer. Cancer Epidemiol Prev Biomarkers 20(5):912–922CrossRef

10.

McKenzie F, Ferrari P, Freisling H, Chajès V, Rinaldi S, de Batlle J et al (2015) Healthy lifestyle and risk of breast cancer among postmenopausal women in the European Prospective Investigation into Cancer and Nutrition cohort study. Int J Cancer 136:2640–2648. https://doi.org/10.1002/ijc.29315 CrossRefPubMed

11.

McKenzie F, Ellison-Loschmann L, Jeffreys M, Firestone R, Pearce N, Romieu I (2014) Healthy lifestyle and risk of breast cancer for indigenous and non-indigenous women in New Zealand: a case control study. BMC Cancer 14:12. https://doi.org/10.1186/1471-2407-14-12 CrossRefPubMedPubMedCentral

12.

McKenzie F, Biessy C, Ferrari P, Freisling H, Rinaldi S, Chajès V et al (2016) Healthy lifestyle and risk of cancer in the European Prospective Investigation into Cancer and Nutrition Cohort Study. Medicine (Baltimore) 95:e2850. https://doi.org/10.1097/MD.0000000000002850 CrossRef

13.

Romaguera D, Gracia-Lavedan E, Molinuevo A, de Batlle J, Mendez M, Moreno V et al (2017) Adherence to nutrition-based cancer prevention guidelines and breast, prostate and colorectal cancer risk in the MCC-Spain case-control study. Int J Cancer 141:83–93. https://doi.org/10.1002/ijc.30722 CrossRefPubMed

14.

Nomura SJO, Inoue-Choi M, Lazovich D, Robien K (2016) WCRF/AICR recommendation adherence and breast cancer incidence among postmenopausal women with and without non-modifiable risk factors. Int J Cancer 138:2602–2615. https://doi.org/10.1002/ijc.29994 CrossRefPubMedPubMedCentral

15.

Harris HR, Bergkvist L, Wolk A (2016) Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and breast cancer risk. Int J Cancer 138:2657–2664. https://doi.org/10.1002/ijc.30015 CrossRefPubMed

16.

Samavat H, Kurzer MS (2015) Estrogen metabolism and breast cancer. Cancer Lett 356:231–243. https://doi.org/10.1016/j.canlet.2014.04.018 CrossRefPubMed

17.

Hankinson SE, Willett WC, Manson JE, Hunter DJ, Colditz GA, Stampfer MJ et al (1995) Alcohol, height, and adiposity in relation to estrogen and prolactin levels in postmenopausal women. J Natl Cancer Inst 87:1297–1302. https://doi.org/10.1093/JNCI/87.17.1297 CrossRefPubMed

18.

Choudhury F, Bernstein L, Hodis HN, Stanczyk FZ, Mack WJ (2011) Physical activity and sex hormone levels in estradiol- and placebo-treated postmenopausal women. Menopause 18:1079–1086. https://doi.org/10.1097/gme.0b013e318215f7bd CrossRefPubMedPubMedCentral

19.

Harris HR, Bergkvist L, Wolk A (2015) An estrogen-associated dietary pattern and breast cancer risk in the Swedish Mammography Cohort. Int J Cancer 137:2149–2154. https://doi.org/10.1002/ijc.29586 CrossRefPubMed

20.

Guinter MA, McLain AC, Merchant AT, Sandler DP, Steck SE (2018) A dietary pattern based on estrogen metabolism is associated with breast cancer risk in a prospective cohort of postmenopausal women. Int J Cancer. https://doi.org/10.1002/ijc.31387 PubMedCrossRef

21.

Fung TT, Schulze MB, Hu FB, Hankinson SE, Holmes MD (2012) A dietary pattern derived to correlate with estrogens and risk of postmenopausal breast cancer. Breast Cancer Res Treat 132:1157–1162. https://doi.org/10.1007/s10549-011-1942-z CrossRefPubMedPubMedCentral

22.

Prorok PC, Andriole GL, Bresalier RS, Buys SS, Chia D, Crawford ED et al (2000) Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Control Clin Trials 21:273S–309SCrossRefPubMed

23.

Fuhrman BJ, Schairer C, Gail MH, Boyd-Morin J, Xu X, Sue LY et al (2012) Estrogen metabolism and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 104:326–339. https://doi.org/10.1093/jnci/djr531 CrossRefPubMedPubMedCentral

24.

Tippett KS, Cypel YS (1997) Design and operation: the continuing survey of food intakes by individuals and the diet and health knowledge survey 1994–96. National Food Survey Report. USDA-Agricultural Research Service, Maryland, p 96

25.

US Department of Health and Human Services (2015) 2015–2020 dietary guidelines for Americans, 8th edn. US Department of Health and Human Services, Washington, DC

26.

Hayes RB, Sigurdson A, Moore L, Peters U, Huang W-Y, Pinsky P et al (2005) Methods for etiologic and early marker investigations in the PLCO trial. Mutat Res 592:147–154. https://doi.org/10.1016/j.mrfmmm.2005.06.013 CrossRefPubMed

27.

Cox DR (1972) Regression models and life-tables. J R Stat Soc B 34:187–220. https://doi.org/10.2307/2985181 CrossRef

28.

Schoenfeld D (1982) Partial residuals for the proportional hazards regression model. Biometrika 69:239–241. https://doi.org/10.1093/biomet/69.1.239 CrossRef

29.

Lunn M, McNeil D (1995) Applying cox regression to competing risks. Biometrics 51:524. https://doi.org/10.2307/2532940 CrossRefPubMed

30.

Hulka BS, Moorman PG (2001) Breast cancer: hormones and other risk factors. Maturitas 38:103–113CrossRefPubMed

31.

Ziegler RG, Fuhrman BJ, Moore SC, Matthews CE (2015) Epidemiologic studies of estrogen metabolism and breast cancer. Steroids 99:67–75. https://doi.org/10.1016/j.steroids.2015.02.015 CrossRefPubMedPubMedCentral

32.

Albenberg LG, Wu GD (2014) Diet and the intestinal microbiome: associations, functions, and implications for health and disease. Gastroenterology 146:1564–1572. https://doi.org/10.1053/j.gastro.2014.01.058 CrossRefPubMedPubMedCentral

33.

Shapira I, Sultan K, Lee A, Taioli E (2013) Evolving concepts: how diet and the intestinal microbiome act as modulators of breast malignancy. ISRN Oncol 2013:1–10. https://doi.org/10.1155/2013/693920 CrossRef

34.

Gavaler JS, Van Thiel DH (1992) The association between moderate alcoholic beverage consumption and serum estradiol and testosterone levels in normal postmenopausal women: relationship to the literature. Alcohol Clin Exp Res 16:87–92CrossRefPubMed

35.

Rose DP, Komninou D, Stephenson GD (2004) Obesity, adipocytokines, and insulin resistance in breast cancer. Obes Rev 5:153–165. https://doi.org/10.1111/j.1467-789X.2004.00142.x CrossRefPubMed

36.

Schmidt S, Monk JM, Robinson LE, Mourtzakis M (2015) The integrative role of leptin, oestrogen and the insulin family in obesity-associated breast cancer: potential effects of exercise. Obes Rev 16:473–487. https://doi.org/10.1111/obr.12281 CrossRefPubMedPubMedCentral

37.

Calder PC, Ahluwalia N, Brouns F, Buetler T, Clement K, Cunningham K et al (2011) Dietary factors and low-grade inflammation in relation to overweight and obesity. Br J Nutr 106(Suppl):S5–S78. https://doi.org/10.1017/s0007114511005460 CrossRefPubMed

38.

Barbaresko J, Koch M, Schulze MB, Nothlings U (2013) Dietary pattern analysis and biomarkers of low-grade inflammation: a systematic literature review. Nutr Rev 71:511–527. https://doi.org/10.1111/nure.12035 CrossRefPubMed

39.

Greenberg AS, Obin MS (2006) Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr 83:461S–465SCrossRefPubMed

40.

O’Connor M-F, Irwin MR (2010) Links between behavioral factors and inflammation. Clin Pharmacol Ther 87:479–482. https://doi.org/10.1038/clpt.2009.255 CrossRefPubMedPubMedCentral

41.

Willett W (2012) Nutritional epidemiology. Oxford University Press, New York. https://doi.org/10.1093/acprof:oso/9780199754038.001.0001

42.

Lin CJ, DeRoo LA, Jacobs SR, Sandler DP (2012) Accuracy and reliability of self-reported weight and height in the Sister Study. Public Health Nutr 15:989–999. https://doi.org/10.1017/S1368980011003193 CrossRefPubMed

Title: An estrogen-related lifestyle score is associated with risk of postmenopausal breast cancer in the PLCO cohort
Authors: Mark A. Guinter
Alexander C. McLain
Anwar T. Merchant
Dale P. Sandler
Susan E. Steck
Publication date: 01-08-2018
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2018
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-018-4784-0

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Association of reproductive history with breast tissue characteristics and receptor status in the normal breast

Pre-diagnostic changes in body mass index and mortality among breast cancer patients

Clinical and biological roles of Kelch-like family member 7 in breast cancer: a marker of poor prognosis

Use of dual mTOR inhibitor MLN0128 against everolimus-resistant breast cancer

Menopausal hormone therapy and the risk of breast cancer by histological type and race: a meta-analysis of randomized controlled trials and cohort studies

Effect of eribulin on patients with metastatic breast cancer: multicenter retrospective observational study in Taiwan

Keynote webinar | Spotlight on antibody–drug conjugates in cancer