title: Healthy lifestyle and risk of breast cancer for indigenous and non-indigenous women in New Zealand: a case control study.
abstract: BACKGROUND
  The reasons for the increasing breast cancer incidence in indigenous Māori compared to non-Māori New Zealand women are unknown. The aim of this study was to assess the association of an index of combined healthy lifestyle behaviours with the risk of breast cancer in Māori and non-Māori women.
  
  
  METHODS
  A population-based case-control study was conducted, including breast cancer cases registered in New Zealand from 2005-2007. Controls were matched by ethnicity and 5-year age bands. A healthy lifestyle index score (HLIS) was generated for 1093 cases and 2118 controls, based on public health and cancer prevention recommendations. The HLIS was constructed from eleven factors (limiting red meat, cream, and cheese; consuming more white meat, fish, fruit and vegetables; lower alcohol consumption; not smoking; higher exercise levels; lower body mass index; and longer cumulative duration of breastfeeding). Equal weight was given to each factor. Logistic regression was used to estimate the associations between breast cancer and the HLIS for each ethnic group stratified by menopausal status.
  
  
  RESULTS
  Among Māori, the mean HLIS was 5.00 (range 1-9); among non-Māori the mean was 5.43 (range 1.5-10.5). There was little evidence of an association between the HLIS and breast cancer for non-Māori women. Among postmenopausal Māori, those in the top HLIS tertile had a significantly lower odds of breast cancer (Odds Ratio 0.47, 95% confidence interval 0.23-0.94) compared to those in the bottom tertile.
  
  
  CONCLUSIONS
  These findings suggest that healthy lifestyle recommendations could be important for reducing breast cancer risk in postmenopausal Māori women.
authors.affiliation: International Agency for Research on Cancer, Lyon, France. mckenzief@fellows.iarc.fr.
authors.forename: Fiona
authors.initials: F
authors.lastname: McKenzie
authors.forename: Lis
authors.initials: L
authors.lastname: Ellison-Loschmann
authors.forename: Mona
authors.initials: M
authors.lastname: Jeffreys
authors.forename: Ridvan
authors.initials: R
authors.lastname: Firestone
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000208:ethnology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D016022:Case-Control Studies; D004032:Diet / Q000208:ethnology; D015444:Exercise; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008019:Life Style / Q000208:ethnology*; D016015:Logistic Models; D008593:Menopause / Q000208:ethnology; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000208:ethnology; D013997:Time Factors; D016387:Women's Health / Q000208:ethnology*