title: A prospective investigation of predictive and modifiable risk factors for breast cancer in unaffected BRCA1 and BRCA2 gene carriers.
abstract: BACKGROUND
  Breast cancer is the most common female cancer worldwide. The lifetime risk of a woman being diagnosed with breast cancer is approximately 12.5%. For women who carry the deleterious mutation in either of the BRCA genes, BRCA1 or BRCA2, the risk of developing breast or ovarian cancer is significantly increased. In recent years there has been increased penetrance of BRCA1 and BRCA2 associated breast cancer, prompting investigation into the role of modifiable risk factors in this group. Previous investigations into this topic have relied on participants recalling lifetime weight changes and subjective methods of recording physical activity. The influence of obesity-related biomarkers, which may explain the link between obesity, physical activity and breast cancer risk, has not been investigated prospectively in this group. This paper describes the design of a prospective cohort study investigating the role of predictive and modifiable risk factors for breast cancer in unaffected BRCA1 and BRCA2 gene mutation carriers.
  
  
  METHODS
  Participants will be recruited from breast cancer family risk clinics and genetics clinics. Lifestyle risk factors that will be investigated will include body composition, metabolic syndrome and its components, physical activity and dietary intake. PBMC telomere length will be measured as a potential predictor of breast cancer occurrence. Measurements will be completed on entry to the study and repeated at two years and five years. Participants will also be followed annually by questionnaire to track changes in risk factor status and to record cancer occurrence. Data will be analysed using multiple regression models. The study has an accrual target of 352 participants.
  
  
  CONCLUSIONS
  The results from this study will provide valuable information regarding the role of modifiable lifestyle risk factors for breast cancer in women with a deleterious mutation in the BRCA gene. Additionally, the study will attempt to identify potential blood biomarkers which may be predictive of breast cancer occurrence.
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St, James's Hospital, Dublin, Ireland. emguinan@tcd.ie
authors.forename: Emer M
authors.initials: EM
authors.lastname: Guinan
authors.forename: Juliette
authors.initials: J
authors.lastname: Hussey
authors.forename: Sarah A
authors.initials: SA
authors.lastname: McGarrigle
authors.forename: Laura A
authors.initials: LA
authors.lastname: Healy
authors.forename: Jacintha N
authors.initials: JN
authors.lastname: O'Sullivan
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Connolly
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000209:etiology*; D002985:Clinical Protocols; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D009154:Mutation; D011379:Prognosis; D011446:Prospective Studies; D019655:Quantitative Trait, Heritable; D012307:Risk Factors