title: Lower Breast Cancer Risk among Women following the World Cancer Research Fund and American Institute for Cancer Research Lifestyle Recommendations: EpiGEICAM Case-Control Study.
abstract: BACKGROUND
  According to the "World Cancer Research Fund" and the "American Institute of Cancer Research" (WCRF/AICR) one in four cancer cases could be prevented through a healthy diet, weight control and physical activity.
  
  
  OBJECTIVE
  To explore the association between the WCRF/AICR recommendations and risk of breast cancer.
  
  
  METHODS
  During the period 2006 to 2011 we recruited 973 incident cases of breast cancer and 973 controls from 17 Spanish Regions. We constructed a score based on 9 of the WCRF/AICR recommendations for cancer prevention:: 1)Maintain adequate body weight; 2)Be physically active; 3)Limit the intake of high density foods; 4)Eat mostly plant foods; 5)Limit the intake of animal foods; 6)Limit alcohol intake; 7)Limit salt and salt preserved food intake; 8)Meet nutritional needs through diet; S1)Breastfeed infants exclusively up to 6 months. We explored its association with BC by menopausal status and by intrinsic tumor subtypes (ER+/PR+ & HER2-; HER2+; ER&PR-&HER2-) using conditional and multinomial logistic models respectively.
  
  
  RESULTS
  Our results point to a linear association between the degree of noncompliance and breast cancer risk. Taking women who met 6 or more recommendations as reference, those meeting less than 3 showed a three-fold excess risk (OR=2.98(CI95%:1.59-5.59)), especially for postmenopausal women (OR=3.60(CI95%:1.24;10.47)) and ER+/PR+&HER2- (OR=3.60(CI95%:1.84;7.05)) and HER2+ (OR=4.23(CI95%:1.66;10.78)) tumors. Noncompliance of recommendations regarding the consumption of foods and drinks that promote weight gain in premenopausal women (OR=2.24(CI95%:1.18;4.28); p for interaction=0.014) and triple negative tumors (OR=2.93(CI95%:1.12-7.63)); the intake of plant foods in postmenopausal women (OR=2.35(CI95%:1.24;4.44)) and triple negative tumors (OR=3.48(CI95%:1.46-8.31)); and the alcohol consumption in ER+/PR+&HER2- tumors (OR=1.52 (CI95%:1.06-2.19)) showed the strongest associations.
  
  
  CONCLUSIONS
  Breast cancer prevention might be possible by following the "World Cancer Research Fund" and the "American Institute of Cancer Research" recommendations, even in settings like Spain, where a high percentage of women already comply with many of them.
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, IIS Puerta de Hierro (IDIPHIM), Majadahonda, Madrid, Spain.
authors.forename: Adela
authors.initials: A
authors.lastname: Castelló
authors.affiliation: Medical Oncology Unit, Hospital Clínico Universitario San Carlos, Madrid, Spain; Medical Oncology Unit, Instituto De Investigación Sanitaria Gregorio Marañón/ Universidad Complutense, Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Martín
authors.affiliation: Medical Oncology Unit, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Ruiz
authors.affiliation: Medical Oncology Unit, Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Casas
authors.affiliation: Medical Oncology Unit, Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Baena-Cañada
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, IIS Puerta de Hierro (IDIPHIM), Majadahonda, Madrid, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Lope
authors.affiliation: Medical Oncology Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Antolín
authors.affiliation: Medical Oncology Unit, Complejo Hospitalario de Jaén, Jaén, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Sánchez
authors.affiliation: Medical Oncology Unit, Centro Oncológico de Galicia, A Coruña, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramos
authors.affiliation: Medical Oncology Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Antón
authors.affiliation: Medical Oncology Unit, Hospital Clinic I Provincial, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Muñoz
authors.affiliation: Medical Oncology Unit, Hospital Clínico, Valencia, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Bermejo
authors.affiliation: Medical Oncology Unit, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: De Juan-Ferré
authors.affiliation: Medical Oncology Unit, Fundación Hospitalaria de Alcorcón, Alcorcón, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Jara
authors.affiliation: Medical Oncology Unit, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: José I
authors.initials: JI
authors.lastname: Chacón
authors.affiliation: Start-up Unit, Spanish Breast Cancer Research Group (GEICAM) Headquarters, San Sebastián De Los Reyes, Madrid, Spain.
authors.forename: María A
authors.initials: MA
authors.lastname: Jimeno
authors.affiliation: Medical Oncology Unit, Instituto De Investigación Sanitaria Gregorio Marañón/ Universidad Complutense, Madrid, Spain.
authors.forename: Petra
authors.initials: P
authors.lastname: Rosado
authors.affiliation: Medical Oncology Unit, Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Díaz
authors.affiliation: Medical Oncology Unit, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Guillem
authors.affiliation: Medical Oncology Unit, Hospital Clínico, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Lluch
authors.affiliation: Medical Oncology Unit, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Carrasco
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, IIS Puerta de Hierro (IDIPHIM), Majadahonda, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pérez-Gómez
authors.affiliation: Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Epidemiology Department, Universidad Miguel Hernandez, Sant Joan d'Alacant, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Vioque
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, IIS Puerta de Hierro (IDIPHIM), Majadahonda, Madrid, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Pollán
mesh_terms: D000047:Academies and Institutes; D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology*; D016022:Case-Control Studies; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D014481:United States; D055815:Young Adult