Lifestyle Factors

International differences in breast cancer occurrence might be partly explained on the basis of lifestyle factors, such as diet and alcohol consumption. Among the dietary factors, the most of the studies have focused on diet content of fat and fiber. As for micronutrients, phytoestrogens have been largely and still inconclusively investigated. Alcohol consumption has shown a moderate effect on breast cancer risk. The existing evidence about dietary components and alcohol intake in affecting breast cancer risk is discussed in detail further in the following chapters of this manuscript.

Numerous epidemiologic studies on the putative association between cigarette smoking and breast cancer have been conducted with mixed results.26 An elegant paper by Band et al.27 isolates the competing effects of cigarette smoking by stratifying smoking study subjects by menopausal status, and, among those who are parous, comparing the time of smoking initiation relative to first pregnancy. In contrast to postmenopausal women, circulating estrogen levels in premenopausal women do not appear to be strongly affected by smoking.28 Among pre-menopausal women, the beginning of smoking before the first pregnancy occurrence was associated with an increased breast cancer risk (adjusted odds ratio [OR]: 1.47, 95% confidence interval [CI]: 1.02 to 2.10). According to the authors, this finding might reflect a different degree of susceptibility of the mammary gland to carcinogens, resulting from maturation and differentiation of breast tissue in response to hormonal events occurring during pregnancy. Among postmeno-pausal women, those who began smoking after their first pregnancy were relatively protected against breast cancer (adjusted OR: 0.63, 0.41 to 0.96). This suggests that an antiestrogenic effect of smoking can protect women whose breast tissue is relatively refractory to tobacco mutagens.

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