Abstract
Purpose
Several modifiable risk factors have been associated with risk of female cancers, but there is limited data regarding their combined effect on risk among Canadian women. Therefore, we assessed the joint association of modifiable risk factors, using a healthy lifestyle index (HLI) score, with risk of specific reproductive cancers.
Method
This study included a subcohort of 3,185 of the 39,618 women, who participated in the Canadian Study of Diet, Lifestyle, and Health, and in whom 410, 177, and 100 postmenopausal breast, endometrial, and ovarian cancers, respectively, were ascertained. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards regression models modified for the case-cohort design.
Results
Each unit increase in the HLI score was associated with 3% and 5% reductions in risk of postmenopausal breast cancer and endometrial cancer, respectively (HR 0.97; 95% CI 0.94–0.99 and HR 0.95; 95% CI 0.90–0.99, respectively). Compared to those with HLI score in the lowest category, those in the highest category had 30% and 46% reductions in risk of these cancers, respectively. The HLI score was not associated with altered risk of ovarian cancer.
Conclusion
Our findings suggest that promoting a healthy lifestyle may aid in the primary prevention of postmenopausal breast and endometrial cancers.
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References
Harvie M, Howell A, Evans DG. (2015) Can diet and lifestyle prevent breast cancer: what is the evidence? Am Soc Clin Oncol Educ Book 35:e66–e73
Kapil U, Bhadoria AS, Sareen N, Singh P, Dwivedi SN (2014) Reproductive factors and risk of breast cancer: a review. Indian J Cancer 51:571–576
World Cancer Research Fund/American Institute for Cancer Research (2014) Continuous update project report. Food, nutrition, physical activity, and the prevention of ovarian cancer 2014. Available at: http://www.dietandcancerreport.org/cup/cup_resources.php. Accessed 4 May 2017
Wu S, Powers S, Zhu W, Hannun YA (2016) Substantial contribution of extrinsic risk factors to cancer development. Nature 529:43–47
Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV et al (2012) American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA Cancer J Clin 62:30–67
Gomez SL, Noone A, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L et al (2013) Cancer incidence trends among Asian American populations in the United States, 1990–2008. J Natl Cancer Inst 105:1096–1110
Lee J, Demissie K, Lu S, Rhoads GG (2007) Cancer incidence among Korean-American immigrants in the United States and native Koreans in South Korea. Cancer Control 14:78–85
World Cancer Research Fund/American Institute for Cancer Research. (2017) Continuous update project report. Food, nutrition, physical activity, and the prevention of breast cancer. Available at: http://www.wcrf.org/breast-cancer-2017. Accessed 31 May 2017
World Cancer Research Fund/American Institute for Cancer Research. (2013) Continuous update project report. Food, nutrition, physical activity, and the prevention of endometrial cancer. Available at: http://www.wcrf.org/sites/default/files/Endometrial-Cancer-2013-Report.pdf. Accessed 4 May 2017
Catsburg C, Miller AB, Rohan TE (2014) Adherence to cancer prevention guidelines and risk of breast cancer. Int J Cancer 135:2444–2452
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
Makarem N, Lin Y, Bandera EV, Jacques PF, Parekh N (2015) Concordance with world cancer research fund/American institute for cancer research (WCRF/AICR) guidelines for cancer prevention and obesity-related cancer risk in the Framingham offspring cohort (1991–2008). Cancer Causes Control 26(2):277–286
Masala G, Bendinelli B, Assedi M, Occhini D, Zanna I, Sieri S et al (2017) 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(2):311–320
Catsburg C, Miller AB, Rohan TE (2015) Active cigarette smoking and risk of breast cancer. Int J Cancer 136(9):2204–2209
Thomson CA, McCullough ML, Wertheim BC, Chlebowski RT, Martinez ME, Stefanick ML et al (2014) Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women’s health initiative. Cancer Prev Res 7:42
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
Kabat GC, Matthews CE, Kamensky V, Hollenbeck AR, Rohan TE (2015) Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study. Am J Clin Nutr 101:558–569
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
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
Sánchez-Zamorano L, Flores-Luna L, Angeles-Llerenas A, Romieu I, Lazcano-Ponce E, Miranda-Hernández H et al (2011) Healthy lifestyle on the risk of breast cancer. Cancer Epidemiol Biomarkers Prev 20:912–922
Dartois L, Fagherazzi G, Boutron-Ruault M, Mesrine S, Clavel-Chapelon F (2014) Association between five lifestyle habits and cancer risk: results from the E3N cohort. Cancer Prev Res 7:516
Grundy A, Poirier AE, Khandwala F, Grevers X, Friedenreich CM, Brenner DR (2017) Cancer incidence attributable to lifestyle and environmental factors in Alberta in 2012: summary of results. CMAJ Open 5:E540–E545
Rohan TE, Soskolne CL, Carroll KK, Kreiger N (2007) The Canadian study of diet, lifestyle, and health: design and characteristics of a new cohort study of cancer risk. Cancer Detect Prev 31(1):12–17
Jain MG, Rohan TE, Soskolne CL, Kreiger N (2003) Calibration of the dietary questionnaire for the Canadian study of diet, lifestyle and health cohort. Public Health Nutr 6(1):79–86
Catsburg C, Kirsh VA, Soskolne CL, Kreiger N, Bruce E, Ho T et al (2014) Associations between anthropometric characteristics, physical activity, and breast cancer risk in a Canadian cohort. Breast Cancer Res Treat 145:545–552
Hall S, Schulze K, Groome P, Mackillop W, Holowaty E (2006) Using cancer registry data for survival studies: the example of the Ontario cancer registry. J Clin Epidemiol 59(1):67–76
Statistics Canada (2013) Annual migration estimates by census division/census metropolitan area. Available at: http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=4101. Accessed May 8 2017
Wacholder S (1991) Practical considerations in choosing between the case-cohort and nested case–control designs. Epidemiol 2:155–158
Barlow WE, Ichikawa L, Rosner D, Izumi S (1999) Analysis of case-cohort designs. J Clin Epidemiol 52:1165–1172
Jones E, Sweeting MJ, Sharp SJ, Thompson SG (2015) A method making fewer assumptions gave the most reliable estimates of exposure-outcome associations in stratified case–cohort studies. J Clin Epidemiol 68:1397–1405
Langholz B, Jiao J (2007) Computational methods for case-cohort studies. Comput Stat Data Anal 51:3737–3748
Pronk NP, Anderson LH, Crain AL, Martinson BC, O’Connor PJ, Sherwood NE et al (2004) Meeting recommendations for multiple healthy lifestyle factors: prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med 27:25–33
Pronk NP, Peek CJ, Goldstein MG (2004) Addressing multiple behavioral risk factors in primary care. Am J Prev Med 27:4–17
Nomura SJO, Dash C, Rosenberg L, Yu J, Palmer JR, Adams-Campbell LL (2016) Adherence to diet, physical activity and body weight recommendations and breast cancer incidence in the black women’s health study. Int J Cancer 139:2738–2752
Castelló A, Martin M, Ruiz A, Casas AM, Baena-Cañada J,M, Lope V et al (2015) Lower breast cancer risk among women following the world cancer research fund and american institute for cancer research lifestyle recommendations: EpiGEICAM case–control study. PLoS ONE 10:e0126096
Romaguera D, Vergnaud A, 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
Merritt MA, Cramer DW, Vitonis AF, Titus LJ, Terry KL (2013) Dairy foods and nutrients in relation to risk of ovarian cancer and major histological subtypes. Int J Cancer 132:1114–1124
Köbel M, Kalloger SE, Boyd N, McKinney S, Mehl E, Palmer C et al (2008) Ovarian carcinoma subtypes are different diseases: implications for biomarker studies. PLoS Med 5:e232
Slattery ML, Lundgreen A, Torres-Mejia G, Wolff RK, Hines L, Baumgartner K et al (2014) Diet and lifestyle factors modify immune/inflammation response genes to alter breast cancer risk and prognosis: the breast cancer health disparities study. Mutat Res 770:19–28
Al-Sader H, Abdul-Jabar H, Allawi Z, Haba Y (2009) Alcohol and breast cancer: the mechanisms explained. J Clin Med Res 1:125–131
Orecchioni S, Reggiani F, Talarico G, Bertolini F (2015) Mechanisms of obesity in the development of breast cancer. Discov Med 20:121–128
McTiernan A (2008) Mechanisms linking physical activity with cancer. Nat Rev Cancer 8:205–211
Acknowledgments
Drs. Arthur and Rohan are supported by a grant from the Breast Cancer Research Foundation (BCRF-16-137).
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Arthur, R., Kirsh, V.A., Kreiger, N. et al. A healthy lifestyle index and its association with risk of breast, endometrial, and ovarian cancer among Canadian women. Cancer Causes Control 29, 485–493 (2018). https://doi.org/10.1007/s10552-018-1032-1
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DOI: https://doi.org/10.1007/s10552-018-1032-1