title: Risk factors of breast cancer in the Eastern Mediterranean Region: a systematic review and meta-analysis.
abstract: BACKGROUND
  Identifying risk factors of breast cancer is a key point for preventive strategies to reduce the incidence. The aim of current study was to determine most important risk factors for breast cancer in the Eastern Mediterranean Region (EMR) using a systematic review.
  
  
  METHODS
  PubMed, Scopus, Web of Science till August 24, 2012 and the reference lists of all included studies were searched. Analytic studies which had reported odds ratios (OR), relative risk (RR) or required data to calculate them were included. A total of 343 studies were critically appraised and finally 30 studies were meta-analyzed. Heterogeneity between the studies was assessed by I2 and Cochran's Q. Egger's test was used to assess publication bias.
  
  
  RESULTS
  Twenty five case- control studies, one nested case-control and four cohort studies were included. The largest ORs were obtained for history of no live birth (2.25; 95%CI: 1.58-3.18), body mass index (BMI) more than 30 (2.21; 95%CI: 1.71-2.36), age at first pregnancy more than 30 years old (1.52; 95%CI: 1.30-1.77) and meat consumption more than three times per week (1.39; 95%CI: 1.03-1.87). The other important predictors were higher education and smoking as risk factors, physical activity and ovulatory stimulating medication as protective factors.
  
  
  CONCLUSIONS
  The most important predictors of breast cancer in EMR were history of no live birth, BMI more than 30, age at first pregnancy more than 30 years old, physical inactivity and smoking. Almost all these risk factors are consistent with known risk factors for this cancer in other parts of the world.
authors.affiliation: Department of Community Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran E-mail : mnojomi@iums.ac.ir.
authors.forename: Nasim
authors.initials: N
authors.lastname: Namiranian
authors.forename: Maziar
authors.initials: M
authors.lastname: Moradi-Lakeh
authors.forename: Seid Kazem
authors.initials: SK
authors.lastname: Razavi-Ratki
authors.forename: Mahdyie
authors.initials: M
authors.lastname: Doayie
authors.forename: Marzieh
authors.initials: M
authors.lastname: Nojomi
mesh_terms: D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D019083:Mediterranean Region / Q000453:epidemiology; D016017:Odds Ratio; D011247:Pregnancy; D012306:Risk; D012307:Risk Factors