title: Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor-positive invasive breast cancer.
abstract: OBJECTIVE
  An outcome of considerable concern among breast cancer survivors is the development of second primary breast cancer. However, evidence regarding how potentially modifiable lifestyle factors modulate second breast cancer risk is limited. We evaluated the relationships between obesity, alcohol consumption, and smoking on risk of second primary invasive contralateral breast cancer among breast cancer survivors.
  
  
  METHODS
  Utilizing a population-based nested case-control study design, we enrolled 365 patients diagnosed with an estrogen receptor-positive (ER+) first primary invasive breast cancer and a second primary contralateral invasive breast cancer, and 726 matched controls diagnosed with only an ER+ first primary invasive breast cancer. Obesity, alcohol use, and smoking data were ascertained from medical record reviews and participant interviews. Using conditional logistic regression we evaluated associations between these three exposures and second primary contralateral breast cancer risk.
  
  
  RESULTS
  Obesity, consumption of >or= 7 alcoholic beverages per week, and current smoking were all positively related to risk of contralateral breast cancer (odds ratio [OR], 1.4; 95% CI, 1.0 to 2.1; OR, 1.9; 95% CI, 1.1 to 3.2; and OR, 2.2; 95% CI, 1.2 to 4.0, respectively). Compared with women who consumed fewer than seven alcoholic beverages per week and were never or former smokers, women who consumed >or= 7 drinks per week and were current smokers had a 7.2-fold (95% CI, 1.9 to 26.5) elevated risk of contralateral breast cancer.
  
  
  CONCLUSIONS
  Our population-based study adds to the limited available literature and suggests that obesity, smoking, and alcohol consumption influence contralateral breast cancer risk, affording breast cancer survivors three means of potentially reducing this risk.
authors.affiliation: Divisions of Public Health Sciences and Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. cili@fhcrc.org
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Li
authors.forename: Janet R
authors.initials: JR
authors.lastname: Daling
authors.forename: Peggy L
authors.initials: PL
authors.lastname: Porter
authors.forename: Mei-Tzu C
authors.initials: MT
authors.lastname: Tang
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Malone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000473:pathology*; D009765:Obesity / Q000150:complications; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D017741:Survivors
chemical_list: D011960:Receptors, Estrogen