Up to one-third of breast cancer cases in post-menopausal Mediterranean women might be avoided by modifying lifestyle habits: the EPIC Italy study.
Breast cancer (BC) is the most frequent cancer among women in developed countries. Physical activity (PA), body mass index (BMI), and alcohol intake have been identified as relevant lifestyle modifiable risk factors for post-menopausal BC. We aimed to evaluate the role of these factors in modulating post-menopausal BC risk and to estimate the proportion of BC cases attributable to low PA, high BMI, and alcohol taking into account non-modifiable factors.



In the Italian section of the EPIC study, 15,010 post-menopausal women were recruited and provided information about dietary and lifestyle habits including PA, smoking, reproductive history, and anthropometric measurements. During 14.8 years of median follow-up, 672 incident BC cases (607 invasive and 65 in situ) were identified.



In multivariate models, inverse associations with BC risk emerged for increasing level of total (p trend 0.02), leisure time (p trend 0.04), and occupational (p trend 0.007) PA. High BMI (HR 1.21; 95% CI 1.02-1.43 and HR 1.33; 95% CI 1.06-1.65 for overweight and obesity, respectively) and alcohol consumption higher than 10 g/day (HR 1.30; 95% CI 1.09-1.54) were associated with BC risk. We estimated that 30% (95% CI 8-50%) of post-menopausal BC cases would be avoided through an increase of leisure time PA, a BMI below 25.0, and consuming no more than one drink/day.



This large study carried out in Mediterranean women confirms the role of PA, BMI, and alcohol consumption in modulating post-menopausal BC risk and supports the potential benefits obtainable by modifying these lifestyle factors.
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori" Via delle Oblate 4, 50141, Florence, Italy. g.masala@ispo.toscana.it.
Giovanna
G
Masala
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori" Via delle Oblate 4, 50141, Florence, Italy.
Benedetta
B
Bendinelli
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori" Via delle Oblate 4, 50141, Florence, Italy.
Melania
M
Assedi
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori" Via delle Oblate 4, 50141, Florence, Italy.
Daniela
D
Occhini
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori" Via delle Oblate 4, 50141, Florence, Italy.
Ines
I
Zanna
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 20133, Milan, Italy.
Sabina
S
Sieri
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 20133, Milan, Italy.
Claudia
C
Agnoli
Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy.
Carlotta
C
Sacerdote
Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy.|Unit of Epidemiology, Regional Health Service ASL TO3, Via Sabaudia 164, 10095, Grugliasco, TO, Italy.
Fulvio
F
Ricceri
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Via Pansini 5, 80131, Naples, Italy.
Amalia
A
Mattiello
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Via Pansini 5, 80131, Naples, Italy.
Salvatore
S
Panico
Cancer Registry and Histopatology Unit, "Civic - M.P. Arezzo" Hospital, ASP Ragusa, Via Dante 109, 97100, Ragusa, Italy.
Rosario
R
Tumino
Cancer Registry, ASP Ragusa, Via Dante 109, 97100, Ragusa, Italy.
Graziella
G
Frasca
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori" Via delle Oblate 4, 50141, Florence, Italy.
Calogero
C
Saieva
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori" Via delle Oblate 4, 50141, Florence, Italy.
Domenico
D
Palli
D000328:Adult; D000428:Alcohol Drinking; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006184:Habits; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008019:Life Style; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D012307:Risk Factors; D057185:Sedentary Behavior
Alcohol; Body mass index; Physical activity; Population attributable risk; Post-menopausal breast cancer; Prospective study