Breast Cancer (BC) is a life-changing event. Compared to other malignancies in women, BC has received considerably more public attention. Despite improved neoadjuvant, adjuvant, and palliative treatment strategies for each characteristic molecular BC subtype, recommendations for evidence-based preventive strategies for BC treatment are not given equivalent attention. This may be partly due to the fact that high-quality long-term prevention studies are still difficult to carry out and are thus underrepresented in international studies. The aim of this review is to discuss the most relevant lifestyle factors associated with BC and to identify and discuss the evidence supporting practical prevention strategies that can be used in everyday clinical practice.

Keywords:
Breast cancer, Prevention, Lifestyle, Risk factors
1.
Robert Koch Institute (RKI), Zentrum für Krebsregisterdaten, www.rki.de/Krebs/DE/Content/Krebsarten/Brustkrebs/brustkrebs_node.html, 2014.
2.
American Cancer Society: Cancer Facts and Figures 2013. Atlanta, American Cancer Society, 2014.
3.
Vogelstein B, Papadopoulos N, Velculescu VE, Zhou S, Diaz LA Jr, Kinzler KW: Cancer genome landscapes. Science 2013;339:1546-1558.
4.
International Agency for Research on Cancer: GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. Lyon, International Agency for Research on Cancer/World Health Organization, 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx (accessed June 24, 2014).
5.
Ziegler RG, Hoover RN, Pike MC, Hildesheim A, Nomura AM, West DW, Wu-Williams AH, Kolonel LN, Horn-Ross PL, Rosenthal JF, Hyer MB: Migration patterns and breast cancer risk in Asian-American women. J Natl Cancer Inst 1993;85:1819-1827.
6.
Shin HR, Joubert C, Boniol M, Hery C, Ahn SH, Won YJ, Nishino Y, Sobue T, Chen CJ, You SL, Mirasol-Lumague MR, Law SC, Mang O, Xiang YB, Chia KS, Rattanamongkolgul S, Chen JG, Curado MP, Autier P: Recent trends and patterns in breast cancer incidence among Eastern and Southeastern Asian women. Cancer Causes Control 2010;21:1777-1785.
7.
World Cancer Research Fund/American Institute for Cancer Research (AICR): Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC, AICR, 2007.
8.
Thomson CA, McCullough ML, Wertheim BC, Chlebowski RT, Martinez ME, Stefanick ML, Rohan TE, Manson JE, Tindle HA, Ockene J, Vitolins MZ, Wactawski-Wende J, Sarto GE, Lane DS, Neuhouser ML: Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women's health initiative. Cancer Prev Res (Phila) 2014;7:42-53.
9.
La Vecchia C, Giordano SH, Hortobagyi GN, Chabner B: Overweight, obesity, diabetes, and risk of breast cancer: interlocking pieces of the puzzle. Oncologist 2011;16:726-729.
10.
McTiernan A: Obesity and cancer: the risks, science, and potential management strategies. Oncology (Williston Park) 2005;19:871-881; discussion 881-872, 885-876.
11.
Baer HJ, Colditz GA, Rosner B, et al.: Body fatness during childhood and adolescence and incidence of breast cancer in premenopausal women: a prospective cohort study. Breast Cancer Res 2005;7:314-325.
12.
Cheraghi Z, Poorolajal J, Hashem T, Esmailnasab N, Doosti Irani A: Effect of body mass index on breast cancer during premenopausal and postmenopausal periods: a meta-analysis. PLoS One 2012;7:e51446.
13.
Kotsopoulos J, Olopado OI, Ghadirian P, Lubinski J, Lynch HT, Isaacs C, Weber B, Kim-Sing C, Ainsworth P, Foulkes WD, Eisen A, Sun P, Narod SA: Changes in body weight and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res 2005;7:R833-R843.
14.
Krajinovic M, Ghadirian P, Richer C, Sinnett H, Gandini S, Perret C, Lacroix A, Labuda D, Sinnett D: Genetic susceptibility to breast cancer in French-Canadians: role of carcinogen-metabolizing enzymes and gene-environment interactions. Int J Cancer 2001;92:220-225.
15.
Ott JJ, Ullrich A, Mascarenhas M, Stevens GA: Global cancer incidence and mortality caused by behavior and infection. J Public Health (Oxf) 2011;33:223-233.
16.
Gaudet MM, Gapstur SM, Sun J, Diver WR, Hannan LM, Thun MJ: Active smoking and breast cancer risk: original cohort data and meta-analysis. J Natl Cancer Inst 2013;105:515-525.
17.
Anderson LM, Chhabra SK, Nerurkar PV, Souliotis VL, Kyrtopoulos SA: Alcohol-related cancer risk: a toxicokinetic hypothesis. Alcohol 1995;12:97-104.
18.
Weber A, Tannapfel A, Wittekind C, Bootz F: Carcinogen-induced site-specific mutagenesis and genetic susceptibility in squamous cell carcinoma of the head and neck. Onkologie 2002;25:8-13.
19.
Kohlmeier L: Biomarkers of fatty acid exposure and breast cancer risk. Am J Clin Nutr 1997;66(suppl 6):S1548-S1556.
20.
Smith-Warner SA, Spiegelman D, Yaun SS, van den Brandt PA, Folsom AR, Goldbohm RA, Graham S, Holmberg L, Howe GR, Marshall JR, Miller AB, Potter JD, Speizer FE, Willett WC, Wolk A, Hunter DJ: Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA 1998;279:535-540.
21.
Zhang SM, Lee IM, Manson JE, Cook NR, Willett WC, Buring JE: Alcohol consumption and breast cancer risk in the Women's Health Study. Am J Epidemiol 2007;165:667-676.
22.
Hamajima N, Hirose K, Tajima K, Rohan T, Calle EE, Heath CW Jr, Coates RJ, Liff JM, Talamini R, Chantarakul N, et al.: Alcohol, tobacco and breast cancer - collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer 2002;87:1234-1245.
23.
Brennan SF, Cantwell MM, Cardwell CR, Velentzis LS, Woodside JV: Dietary patterns and breast cancer risk: a systematic review and meta-analysis. Am J Clin Nutr 2010;91:1294-1302.
24.
Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, Pelucchi C, Bellocco R, Negri E, Corrao G, Rehm J, Boffetta P, La Vecchia C: Light alcohol drinking and cancer: a meta-analysis. Ann Oncol 2013;24:301-308.
25.
Giacosa A, Adam-Blondon AF, Baer-Sinnott S, Barale R, Bavaresco L, Di Gaspero G, Dugo L, Ellison RC, Gerbi V, Gifford D, Janssens J, La Vecchia C, Negri E, Pezzotti M, Santi L, Rondanelli M: Alcohol and wine in relation to cancer and other diseases. Eur J Cancer Prev 2012;21:103-108.
26.
Gerber B, Muller H, Reimer T, Krause A, Friese K: Nutrition and lifestyle factors on the risk of developing breast cancer. Breast Cancer Res Treat 2003;79:265-276.
27.
Tynes T, Hannevik M, Andersen A, Vistnes AI, Haldorsen T: Incidence of breast cancer in Norwegian female radio and telegraph operators. Cancer Causes Control 1996;7:197-204.
28.
Hansen J: Light at night, shiftwork, and breast cancer risk. J Natl Cancer Inst 2001;93:1513-1515.
29.
Lie JA, Roessink J, Kjaerheim K: Breast cancer and night work among Norwegian nurses. Cancer Causes Control 2006;17:39-44.
30.
Fritschi L, Erren TC, Glass DC, Girschik J, Thomson AK, Saunders C, Boyle T, El-Zaemey S, Rogers P, Peters S, Slevin T, D'Orsogna A, de Vocht F, Vermeulen R, Heyworth JS: The association between different night shiftwork factors and breast cancer: a case-control study. Br J Cancer 2013;109:2472-2480.
31.
Kamdar BB, Tergas AI, Mateen FJ, Bhayani NH, Oh J: Night-shift work and risk of breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2013;138:291-301.
32.
Erren TC, Pape HG, Reiter RJ, Piekarski C: Chronodisruption and cancer. Naturwissenschaften 2008;95:367-382.
33.
Fakri S, Al-Azzawi A, Al-Tawil N: Antiperspirant use as a risk factor for breast cancer in Iraq. East Mediterr Health J 2006;12:478-482.
34.
McGrath KG: An earlier age of breast cancer diagnosis related to more frequent use of antiperspirants/deodorants and underarm shaving. Eur J Cancer Prev 2003;12:479-485.
35.
Mirick DK, Davis S, Thomas DB: Antiperspirant use and the risk of breast cancer. J Natl Cancer Inst 2002;94:1578-1580.
36.
Darbre PD: Recorded quadrant incidence of female breast cancer in Great Britain suggests a disproportionate increase in the upper outer quadrant of the breast. Anticancer Res 2005;25:2543-2550.
37.
Darbre PD: Underarm antiperspirants/deodorants and breast cancer. Breast Cancer Res 2009;11(suppl 3):S5.
38.
Hardefeldt PJ, Edirimanne S, Eslick GD: Deodorant use and breast cancer risk. Epidemiology 2013;24:172.
39.
American Society of Plastic Surgery Procedural Statistics: Reconstructive breast surgery, 2013. www.plasticsurgery.org/Documents/news-resources/statistics/2013-statistics/cosmetic-procedures-national-trends-2013.pdf (accessed 16 July, 2014).
40.
Spear SL, Murphy DK, Slicton A, Walker PS: Inamed silicone breast implant core study results at 6 years. Plast Reconstr Surg 2007;120(7 suppl 1):S8-S16; discussion S17-S18.
41.
Bengtson BP, Van Natta BW, Murphy DK, Slicton A, Maxwell GP: Style 410 highly cohesive silicone breast implant core study results at 3 years. Plast Reconstr Surg 2007;120(7 suppl 1):S40-S48.
42.
Cunningham B, McCue J: Safety and effectiveness of Mentor's MemoryGel implants at 6 years. Aesthetic Plast Surg 2009;33:440-444.
43.
Maxwell GP, Van Natta BW, Murphy DK, Slicton A, Bengtson BP: Natrelle style 410 form-stable silicone breast implants: core study results at 6 years. Aesthet Surg J 2012;32:709-717.
44.
Spear SL, Murphy DK: Natrelle round silicone breast implants: core study results at 10 years. Plast Reconstr Surg 2014;133:1354-1361.
45.
Stevens WG, Harrington J, Alizadeh K, Berger L, Broadway D, Hester TR, Kress D, d'Incelli R, Kuhne J, Beckstrand M: Five-year follow-up data from the U.S. clinical trial for Sientra's U.S. Food and Drug Administration-approved Silimed(R) brand round and shaped implants with high-strength silicone gel. Plast Reconstr Surg 2012;130:973-981.
46.
US Food and Drug Administration: FDA update on the safety of silicone gel-filled breast implants. www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM260090.pdf (accessed 2 August, 2008).
47.
US Food and Drug Administration: FDA advises women with breast implants. www.fda.gov/forconsumers/consumerupdates/ucm240985.htm (accessed 16 July, 2014).
48.
Albuquerque RC, Baltar VT, Marchioni DM: Breast cancer and dietary patterns: a systematic review. Nutr Rev 2014;72:1-17.
49.
Aune D, Chan DS, Greenwood DC, Vieira AR, Rosenblatt DA, Vieira R, Norat T: Dietary fiber and breast cancer risk: a systematic review and meta-analysis of prospective studies. Ann Oncol 2012;23:1394-1402.
50.
Aune D, Chan DS, Vieira AR, Rosenblatt DA, Vieira R, Greenwood DC, Norat T: Fruits, vegetables and breast cancer risk: a systematic review and meta-analysis of prospective studies. Breast Cancer Res Treat 2012;134:479-493.
51.
Boffetta P, Couto E, Wichmann J, Ferrari P, Trichopoulos D, Bueno-de-Mesquita HB, van Duijnhoven FJ, Buchner FL, Key T, Boeing H, et al.: Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 2010;102:529-537.
52.
World Health Organization (WHO): Factsheet 311: Obesity and overweight. Update August 2014. www.who.int/mediacentre/factsheet/fs311/en/ (accessed on 8 August, 2014).
53.
Alexander DD, Morimoto LM, Mink PJ, Cushing CA: A review and meta-analysis of red and processed meat consumption and breast cancer. Nutr Res Rev 2010;23:349-365.
54.
Taylor VH, Misra M, Mukherjee SD: Is red meat intake a risk factor for breast cancer among premenopausal women? Breast Cancer Res Treat 2009;117:1-8.
55.
Friedenreich CM: The role of physical activity in breast cancer etiology. Semin Oncol 2010;37:297-302.
56.
McTiernan A, Kooperberg C, White E, Wilcox S, Coates R, Adams-Campbell LL, Woods N, Ockene J: Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women's Health Initiative Cohort Study. JAMA 2003;290:1331-1336.
57.
Wu Y, Zhang D, Kang S: Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat 2013;137:869-882.
58.
Hildebrand JS, Gapstur SM, Campbell PT, Gaudet MM, Patel AV: Recreational physical activity and leisure-time sitting in relation to postmenopausal breast cancer risk. Cancer Epidemiol Biomarkers Prev 2013;22:1906-1912.
59.
Kobayashi LC, Janssen I, Richardson H, Lai AS, Spinelli JJ, Aronson KJ: A case-control study of lifetime light intensity physical activity and breast cancer risk. Cancer Causes Control 2014;25:133-140.
60.
Chlebowski RT: Nutrition and physical activity influence on breast cancer incidence and outcome. Breast 2013;22(suppl 2):S30-S37.
61.
Furness S, Roberts H, Marjoribanks J, Lethaby A, Hickey M, Farquhar C: Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev 2009;(2):CD000402.
62.
Marjoribanks J, Farquhar C, Roberts H, Lethaby A: Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2012;(7):CD004143.
63.
Beral V: Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 2003;362:419-427.
64.
Chlebowski RT, Kuller LH, Prentice RL, Stefanick ML, Manson JE, Gass M, Aragaki AK, Ockene JK, Lane DS, Sarto GE, Rajkovic A, Schenken R, Hendrix SL, Ravdin PM, Rohan TE, Yasmeen S, Anderson G: Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med 2009;360:573-587.
65.
Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, et al.: Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004;291:1701-1712.
66.
Hulley S, Furberg C, Barrett-Connor E, Cauley J, Grady D, Haskell W, Knopp R, Lowery M, Satterfield S, Schrott H, Vittinghoff E, Hunninghake D: Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002;288:58-66.
67.
Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, Rodabough RJ, Gilligan MA, Cyr MG, Thomson CA, Khandekar J, Petrovitch H, McTiernan A: Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative randomized trial. JAMA 2003;289:3243-3253.
68.
North American Menopause Society: Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010;17:242-255.
69.
Gompel A, Rozenberg S, Barlow DH: The EMAS 2008 update on clinical recommendations on postmenopausal hormone replacement therapy. Maturitas 2008;61:227-232.
70.
Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD, Burger HG, Colditz GA, Davis SR, Gambacciani M, et al.: Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab 2010;95(7 suppl 1):S1-S66.
71.
Sturdee DW, Pines A, Archer DF, Baber RJ, Barlow D, Birkhauser MH, Brincat M, Cardozo L, de Villiers TJ, Gambacciani M, et al.: Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011;14:302-320.
72.
Giovannucci E, Harlan DM, Archer MC, Bergenstal RM, Gapstur SM, Habel LA, Pollak M, Regensteiner JG, Yee D: Diabetes and cancer: a consensus report. Diabetes Care 2010;33:1674-1685.
73.
Alvino CL, Ong SC, McNeil KA, Delaine C, Booker GW, Wallace JC, Forbes BE: Understanding the mechanism of insulin and insulin-like growth factor (IGF) receptor activation by IGF-II. PLoS One 2011;6:e27488.
74.
Tzivion G, Dobson M, Ramakrishnan G: FoxO transcription factors; regulation by AKT and 14-3-3 proteins. Biochim Biophys Acta 2011;1813:1938-1945.
75.
Fleming HE, Janzen V, Lo Celso C, Guo J, Leahy KM, Kronenberg HM, Scadden DT: Wnt signaling in the niche enforces hematopoietic stem cell quiescence and is necessary to preserve self-renewal in vivo. Cell Stem Cell 2008;2:274-283.
76.
Xu CX, Zhu HH, Zhu YM: Diabetes and cancer: associations, mechanisms, and implications for medical practice. World J Diabetes 2014;5:372-380.
77.
World Health Organization, Diabetes Programme: Country and regional data on diabetes. www.who.int/diabetes/facts/world_figures/en/ (accessed on 19 June, 2014).
78.
Verlato G, Zoppini G, Bonora E, Muggeo M: Mortality from site-specific malignancies in type 2 diabetic patients from Verona. Diabetes Care 2003;26:1047-1051.
79.
Stattin P, Bjor O, Ferrari P, Lukanova A, Lenner P, Lindahl B, Hallmans G, Kaaks R: Prospective study of hyperglycemia and cancer risk. Diabetes Care 2007;30:561-567.
80.
Zhou XH, Qiao Q, Zethelius B, Pyorala K, Soderberg S, Pajak A, Stehouwer CD, Heine RJ, Jousilahti P, Ruotolo G, Nilsson PM, Calori G, Tuomilehto J: Diabetes, prediabetes and cancer mortality. Diabetologia 2010;53:1867-1876.
81.
Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM: Fasting serum glucose level and cancer risk in Korean men and women. JAMA 2005;293:194-202.
82.
Seshasai SR, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, Whincup PH, Mukamal KJ, Gillum RF, Holme I, et al.: Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011;364:829-841.
83.
Larsson SC, Mantzoros CS, Wolk A: Diabetes mellitus and risk of breast cancer: a meta-analysis. Int J Cancer 2007;121:856-862.
84.
Schernhammer ES, Hankinson SE, Rosner B, Kroenke CH, Willett WC, Colditz GA, Kawachi I: Job stress and breast cancer risk: the Nurses' Health Study. Am J Epidemiol 2004;160:1079-1086.
85.
Price MA, Tennant CC, Butow PN, Smith RC, Kennedy SJ, Kossoff MB, Dunn SM: The role of psychosocial factors in the development of breast carcinoma: Part II. Life event stressors, social support, defense style, and emotional control and their interactions. Cancer 2001;91:686-697.
86.
Protheroe D, Turvey K, Horgan K, Benson E, Bowers D, House A: Stressful life events and difficulties and onset of breast cancer: case-control study. BMJ 1999;319:1027-1030.
87.
Sprague BL, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Hampton JM, Newcomb PA: Proportion of invasive breast cancer attributable to risk factors modifiable after menopause. Am J Epidemiol 2008;168:404-411.
© 2014 S. Karger AG, Freiburg
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.