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Up to one-third of breast cancer cases in post-menopausal Mediterranean women might be avoided by modifying lifestyle habits: the EPIC Italy study

Breast Cancer Research and Treatment volume 161, pages 311–320 (2017)Cite this article

Abstract

Purpose

Breast cancer (BC) is the most frequent cancer among women in developed countries. Physical activity (PA), body mass index (BMI), and alcohol intake have been identified as relevant lifestyle modifiable risk factors for post-menopausal BC. We aimed to evaluate the role of these factors in modulating post-menopausal BC risk and to estimate the proportion of BC cases attributable to low PA, high BMI, and alcohol taking into account non-modifiable factors.

Methods

In the Italian section of the EPIC study, 15,010 post-menopausal women were recruited and provided information about dietary and lifestyle habits including PA, smoking, reproductive history, and anthropometric measurements. During 14.8 years of median follow-up, 672 incident BC cases (607 invasive and 65 in situ) were identified.

Results

In multivariate models, inverse associations with BC risk emerged for increasing level of total (p trend 0.02), leisure time (p trend 0.04), and occupational (p trend 0.007) PA. High BMI (HR 1.21; 95% CI 1.02–1.43 and HR 1.33; 95% CI 1.06–1.65 for overweight and obesity, respectively) and alcohol consumption higher than 10 g/day (HR 1.30; 95% CI 1.09–1.54) were associated with BC risk. We estimated that 30% (95% CI 8–50%) of post-menopausal BC cases would be avoided through an increase of leisure time PA, a BMI below 25.0, and consuming no more than one drink/day.

Conclusions

This large study carried out in Mediterranean women confirms the role of PA, BMI, and alcohol consumption in modulating post-menopausal BC risk and supports the potential benefits obtainable by modifying these lifestyle factors.

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Abbreviations

BC:

Breast cancer

PA:

Physical activity

BMI:

Body mass index

EPIC:

European Prospective Investigation into Cancer and Nutrition

HR:

Hazard ratios

CI:

Confidence intervals

PAR:

Population attributable risk

IARC:

International Agency for Research on Cancer

FFQ:

Food frequency questionnaire

MET:

Metabolic equivalent

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Acknowledgements

The authors wish to acknowledge the cooperation of all study participants and staff members. The EPIC Italy project has been supported by AIRC (Milan, Italy).

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Author notes

    Authors and Affiliations

    1. Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A “Mario Fiori” Via delle Oblate 4, 50141, Florence, Italy

      Giovanna Masala, Benedetta Bendinelli, Melania Assedi, Daniela Occhini, Ines Zanna, Calogero Saieva & Domenico Palli

    2. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 20133, Milan, Italy

      Sabina Sieri & Claudia Agnoli

    3. Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy

      Carlotta Sacerdote & Fulvio Ricceri

    4. Unit of Epidemiology, Regional Health Service ASL TO3, Via Sabaudia 164, 10095, Grugliasco, TO, Italy

      Fulvio Ricceri

    5. Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Via Pansini 5, 80131, Naples, Italy

      Amalia Mattiello & Salvatore Panico

    6. Cancer Registry and Histopatology Unit, “Civic - M.P. Arezzo” Hospital, ASP Ragusa, Via Dante 109, 97100, Ragusa, Italy

      Rosario Tumino

    7. Cancer Registry, ASP Ragusa, Via Dante 109, 97100, Ragusa, Italy

      Graziella Frasca

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    1. Giovanna Masala
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    2. Benedetta Bendinelli
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    Correspondence to Giovanna Masala.

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    The authors declare that they have no conflict of interest.

    Ethical approval

    The EPIC study has been approved by the Ethical Review Board of the International Agency for Research on Cancer (IARC), Lyon and by the local Florence Ethical Committee (2001/96) and have been performed in accordance with the ethical standard as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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    Giovanna Masala and Benedetta Bendinelli contributed equally to this work.

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    Masala, G., Bendinelli, B., Assedi, M. et al. Up to one-third of breast cancer cases in post-menopausal Mediterranean women might be avoided by modifying lifestyle habits: the EPIC Italy study. Breast Cancer Res Treat 161, 311–320 (2017). https://doi.org/10.1007/s10549-016-4047-x

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    Keywords

    • Post-menopausal breast cancer
    • Population attributable risk
    • Physical activity
    • Body mass index
    • Alcohol
    • Prospective study