Breast cancer hypothesis: a single cause for the majority of cases.
OBJECTIVE
The main cause of breast cancer remains unknown. Numerous causal factors or predisposing conditions have been proposed, but account for only a small percentage of the total disease. The current search for multiple causes is unavailing. This report explores whether any single aetiological agent may be responsible for the majority of cases, and attempts to define its properties.


METHODS
Examination of all relevant epidemiological and biological evidence.


RESULTS
Genetic inheritance is not the main cause of breast cancer because most cases are sporadic, there is a low prevalence of family history, and genetically similar women have differing rates after migration. Environmental exposure, such as pollution by industrialisation, is not a major cause, as deduced from a spectrum of epidemiological data. The possibility of infection as cause is not persuasive as there is no direct biological evidence and no epidemiological support. Oestrogen status is closely related to breast cancer risk, but there are numerous inconsistencies and paradoxes. It is suggested that oestrogens are not the proximate agent but are promoters acting in concert with the causal agent. Dietary factors, and especially fat, are associated with the aetiology of breast cancer as shown by intervention and ecological correlation studies, but the evidence from case-control and cohort studies is inconsistent and contradictory.


CONCLUSIONS
The hypothesis that best fits the epidemiological data is that dietary fat is not itself the causal agent, but produces depletion of an essential factor that is normally protective against the development of breast cancer. Many of the observed inconsistencies in the epidemiology are explainable if deficiency of this agent is permissive for breast cancer to develop. Some properties of the putative agent are outlined, and research investigations proposed.
Wiseman
R A
RA
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT. richard.wiseman@lshtm.ac.uk
D000328:Adult; D000818:Animals; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000235:genetics; D002274:Carcinogens, Environmental / Q000009:adverse effects; D015984:Causality; D004041:Dietary Fats / Q000009:adverse effects; D004967:Estrogens / Q000009:adverse effects; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007221:Industry; D007239:Infections / Q000150:complications; D008325:Mammary Neoplasms, Experimental / Q000209:etiology; D051379:Mice; D008875:Middle Aged; D011247:Pregnancy; D015995:Prevalence; D051381:Rats; D012923:Social Class
D002274:Carcinogens, Environmental; D004041:Dietary Fats; D004967:Estrogens