Breast Cancer Research and Treatment

, Volume 170, Issue 3, pp 613–622 | Cite as

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

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



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.


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.


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.


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.


Breast cancer Lifestyle score Estrogen metabolism Behavior Epidemiology Prospective cohort study 



Ratio of 2- to 16-hydroxylated estrogen metabolites


American Institute for Cancer Research


Body mass index


Confidence interval


Continuous Update Project


Dietary questionnaire




Estrogen metabolites


European Prospective Investigation into Cancer and Nutrition


Estrogen receptor


Estrogen-related dietary pattern


Estrogen-related lifestyle score


Hazard ratio


Odds ratio


Physical activity


Postmenopausal hormone


Progesterone receptor


Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial


Standard deviation


United States Department of Agriculture


World Cancer Research Fund



This work was made possible in part by Grant Number T32-GM081740 from NIH-NIGMS. DPS is supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01 ES-044005 l). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIGMS or NIH.

Compliance with ethical standards

Conflict of interest

The authors do not declare any conflicts of interest.

Supplementary material

10549_2018_4784_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 kb)
10549_2018_4784_MOESM2_ESM.docx (12 kb)
Supplementary material 2 (DOCX 11 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Behavioral and Epidemiology Research GroupAmerican Cancer SocietyAtlantaUSA
  2. 2.Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  3. 3.Epidemiology BranchNational Institute of Environmental Health Sciences, National Institutes of HealthResearch Triangle ParkUSA
  4. 4.Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaUSA

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