Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Nena Karavasiloglou, Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany., Germany
  • Anika Hüsing, Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany., Germany
  • Giovanna Masala, Cancer Risk Factors and Life-Style Epidemiology Unit. Institute for Cancer Research, Prevention and Clinical Network - ISPRO, 50141, Florence, Italy., Italy
  • Carla H van Gils, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Netherlands
  • Renée Turzanski Fortner, Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany., Germany
  • Jenny Chang-Claude, Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany., Germany
  • Inge Huybrechts, Biostatistics Group, International Agency for Research on Cancer, Lyon, France., France
  • Elisabete Weiderpass, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway., Norway
  • Marc Gunter, Biostatistics Group, International Agency for Research on Cancer, Lyon, France., France
  • Patrick Arveux, Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre, UNICANCER, Dijon, France., France
  • Agnès Fournier, CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France; Gustave Roussy, F-94805, Villejuif, France., France
  • Marina Kvaskoff, CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France; Gustave Roussy, F-94805, Villejuif, France., France
  • Anne Tjønneland, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Denmark
  • Cecilie Kyrø, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Denmark
  • Christina C Dahm
  • Helene Tilma Vistisen
  • Marije F Bakker, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Netherlands
  • Maria-Jose Sánchez, Hospitales Universitarios de Granada, Universidad de Granada, 18014 Granada, Spain. miguel.rodriguez.barranco.easp@juntadeandalucia.es., Spain
  • María Dolores Chirlaque López, Department of Health and Social Sciences, University of Murcia, Murcia, Spain., Spain
  • Carmen Santiuste, Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain., Spain
  • Eva Ardanaz, Navarre Public Health Institute, Pamplona, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain., Spain
  • Virginia Menéndez, Public Health Directorate, Asturias, Spain., Spain
  • Antonio Agudo, Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain., Spain
  • Antonia Trichopoulou, Hellenic Health Foundation, Athens, Greece., Greece
  • Anna Karakatsani, 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece., Greece
  • Carlo La Vecchia, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy., Italy
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Greece
  • Domenico Palli, Cancer Risk Factors and Life-Style Epidemiology Unit. Institute for Cancer Research, Prevention and Clinical Network - ISPRO, 50141, Florence, Italy., Italy
  • Claudia Agnoli, 12 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Italy
  • Salvatore Panico, Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy. spanico@unina.it., Italy
  • Rosario Tumino, Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP) Ragusa, Italy., Italy
  • Carlotta Sacerdote, Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy., Italy
  • Salma Tunå Butt, Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden, Sweden
  • Signe Borgquist
  • Guri Skeie, Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK., United Kingdom
  • Matthias Schulze, Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany., Germany
  • Timothy Key, Nuffield Department of Population Health, University of Oxford, Oxford, UK., United Kingdom
  • Kay-Tee Khaw, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., United Kingdom
  • Kostantinos K Tsilidis, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece. ktsilidis@gmail.com., Greece
  • Merete Ellingjord-Dale, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., United Kingdom
  • Elio Riboli, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., United Kingdom
  • Rudolf Kaaks, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany. r.kaaks@dkfz-heidelberg.de., Germany
  • Laure Dossus, Biostatistics Group, International Agency for Research on Cancer, Lyon, France., France
  • Sabine Rohrmann, Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland., Switzerland
  • Tilman Kühn, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. t.kuehn@dkfz.de., Germany

BACKGROUND: Even though in situ breast cancer (BCIS) accounts for a large proportion of the breast cancers diagnosed, few studies have investigated potential risk factors for BCIS. Their results suggest that some established risk factors for invasive breast cancer have a similar impact on BCIS risk, but large population-based studies on lifestyle factors and BCIS risk are lacking. Thus, we investigated the association between lifestyle and BCIS risk within the European Prospective Investigation into Cancer and Nutrition cohort.

METHODS: Lifestyle was operationalized by a score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. The recommendations utilized in these analyses were the ones pertinent to healthy body weight, physical activity, consumption of plant-based foods, energy-dense foods, red and processed meat, and sugary drinks and alcohol, as well as the recommendation on breastfeeding. Cox proportional hazards regression was used to assess the association between lifestyle score and BCIS risk. The results were presented as hazard ratios (HR) and corresponding 95% confidence intervals (CI).

RESULTS: After an overall median follow-up time of 14.9 years, 1277 BCIS cases were diagnosed. Greater adherence to the WCRF/AICR cancer prevention recommendations was not associated with BCIS risk (HR = 0.98, 95% CI 0.93-1.03; per one unit of increase; multivariable model). An inverse association between the lifestyle score and BCIS risk was observed in study centers, where participants were recruited mainly via mammographic screening and attended additional screening throughout follow-up (HR = 0.85, 95% CI 0.73-0.99), but not in the remaining ones (HR = 0.99, 95% CI 0.94-1.05).

CONCLUSIONS: While we did not observe an overall association between lifestyle and BCIS risk, our results indicate that lifestyle is associated with BCIS risk among women recruited via screening programs and with regular screening participation. This suggests that a true inverse association between lifestyle habits and BCIS risk in the overall cohort may have been masked by a lack of information on screening attendance. The potential inverse association between lifestyle and BCIS risk in our analyses is consistent with the inverse associations between lifestyle scores and breast cancer risk reported from previous studies.

Original languageEnglish
Article number221
JournalBMC Medicine
Volume17
Issue1
Number of pages11
ISSN1741-7015
DOIs
Publication statusPublished - 2 Dec 2019

    Research areas

  • cohort, in situ breast cancer, lifestyle, lifestyle score, prevention

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