Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Nena Karavasiloglou; Anika Huesing; Giovanna Masala; Carla H. van Gils; Renee Turzanski Fortner; Jenny Chang-Claude; Inge Huybrechts; Elisabete Weiderpass; Marc Gunter; Patrick Arveux; Agnes Fournier; Marina Kvaskoff; Anne Tjonneland; Cecilie Kyro; Christina C. Dahm; Helene Tilma Vistisen; Marije F. Bakker; Maria-Jose Sanchez; Maria Dolores Chirlaque Lopez; Carmen Santiuste; Eva Ardanaz; Virginia Menendez; Antonio Agudo; Antonia Trichopoulou; Anna Karakatsani; Carlo La Vecchia; Eleni Peppa; Domenico Palli; Claudia Agnoli; Salvatore Panico; Rosario Tumino; Carlotta Sacerdote; Salma Tuna Butt; Signe Borgquist; Guri Skeie; Matthias Schulze; Timothy Key; Kay-Tee Khaw; Kostantinos K. Tsilidis; Merete Ellingjord-Dale; Elio Riboli; Rudolf Kaaks; Laure Dossus; Sabine Rohrmann; Tilman Kuehn

doi:10.1186/s12916-019-1444-0

Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Nena Karavasiloglou, Anika Huesing, Giovanna Masala, Carla H. van Gils, Renee Turzanski Fortner, Jenny Chang-Claude, Inge Huybrechts, Elisabete Weiderpass, Marc Gunter, Patrick Arveux, Agnes Fournier, Marina Kvaskoff, Anne Tjonneland, Cecilie Kyro, Christina C. Dahm, Helene Tilma Vistisen, Marije F. Bakker, Maria-Jose Sanchez, Maria Dolores Chirlaque Lopez, Carmen SantiusteEva Ardanaz, Virginia Menendez, Antonio Agudo, Antonia Trichopoulou, Anna Karakatsani, Carlo La Vecchia, Eleni Peppa, Domenico Palli, Claudia Agnoli, Salvatore Panico, Rosario Tumino, Carlotta Sacerdote, Salma Tuna Butt, Signe Borgquist, Guri Skeie, Matthias Schulze, Timothy Key, Kay-Tee Khaw, Kostantinos K. Tsilidis, Merete Ellingjord-Dale, Elio Riboli, Rudolf Kaaks, Laure Dossus, Sabine Rohrmann, Tilman Kuehn

Section of Environmental Health

6 Citations (Scopus)

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Abstract

Background: Even though in situ breast cancer (BCIS) accounts for a large proportion of the breast cancers diagnosed, few studies have investigated potential risk factors for BCIS. Their results suggest that some established risk factors for invasive breast cancer have a similar impact on BCIS risk, but large population-based studies on lifestyle factors and BCIS risk are lacking. Thus, we investigated the association between lifestyle and BCIS risk within the European Prospective Investigation into Cancer and Nutrition cohort. Methods: Lifestyle was operationalized by a score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. The recommendations utilized in these analyses were the ones pertinent to healthy body weight, physical activity, consumption of plant-based foods, energy-dense foods, red and processed meat, and sugary drinks and alcohol, as well as the recommendation on breastfeeding. Cox proportional hazards regression was used to assess the association between lifestyle score and BCIS risk. The results were presented as hazard ratios (HR) and corresponding 95% confidence intervals (CI). Results: After an overall median follow-up time of 14.9 years, 1277 BCIS cases were diagnosed. Greater adherence to the WCRF/AICR cancer prevention recommendations was not associated with BCIS risk (HR = 0.98, 95% CI 0.93-1.03; per one unit of increase; multivariable model). An inverse association between the lifestyle score and BCIS risk was observed in study centers, where participants were recruited mainly via mammographic screening and attended additional screening throughout follow-up (HR = 0.85, 95% CI 0.73-0.99), but not in the remaining ones (HR = 0.99, 95% CI 0.94-1.05). Conclusions: While we did not observe an overall association between lifestyle and BCIS risk, our results indicate that lifestyle is associated with BCIS risk among women recruited via screening programs and with regular screening participation. This suggests that a true inverse association between lifestyle habits and BCIS risk in the overall cohort may have been masked by a lack of information on screening attendance. The potential inverse association between lifestyle and BCIS risk in our analyses is consistent with the inverse associations between lifestyle scores and breast cancer risk reported from previous studies.

Original language	English
Article number	221
Journal	BMC Medicine
Volume	17
Issue number	1
Number of pages	11
ISSN	1741-7015
DOIs	https://doi.org/10.1186/s12916-019-1444-0
Publication status	Published - 2 Dec 2019

Keywords

In situ breast cancer
Cohort
Lifestyle
Prevention
Lifestyle Score

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Karavasiloglou, N., Huesing, A., Masala, G., van Gils, C. H., Turzanski Fortner, R., Chang-Claude, J., Huybrechts, I., Weiderpass, E., Gunter, M., Arveux, P., Fournier, A., Kvaskoff, M., Tjonneland, A., Kyro, C., Dahm, C. C., Vistisen, H. T., Bakker, M. F., Sanchez, M.-J., Chirlaque Lopez, M. D., ... Kuehn, T. (2019). Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. BMC Medicine, 17(1), Article 221. https://doi.org/10.1186/s12916-019-1444-0

Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. / Karavasiloglou, Nena; Huesing, Anika; Masala, Giovanna et al.
In: BMC Medicine, Vol. 17, No. 1, 221, 02.12.2019.

Research output: Contribution to journal › Journal article › Research › peer-review

Karavasiloglou, N, Huesing, A, Masala, G, van Gils, CH, Turzanski Fortner, R, Chang-Claude, J, Huybrechts, I, Weiderpass, E, Gunter, M, Arveux, P, Fournier, A, Kvaskoff, M, Tjonneland, A, Kyro, C, Dahm, CC, Vistisen, HT, Bakker, MF, Sanchez, M-J, Chirlaque Lopez, MD, Santiuste, C, Ardanaz, E, Menendez, V, Agudo, A, Trichopoulou, A, Karakatsani, A, La Vecchia, C, Peppa, E, Palli, D, Agnoli, C, Panico, S, Tumino, R, Sacerdote, C, Butt, ST, Borgquist, S, Skeie, G, Schulze, M, Key, T, Khaw, K-T, Tsilidis, KK, Ellingjord-Dale, M, Riboli, E, Kaaks, R, Dossus, L, Rohrmann, S & Kuehn, T 2019, 'Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort', BMC Medicine, vol. 17, no. 1, 221. https://doi.org/10.1186/s12916-019-1444-0

Karavasiloglou N, Huesing A, Masala G, van Gils CH, Turzanski Fortner R, Chang-Claude J et al. Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. BMC Medicine. 2019 Dec 2;17(1):221. doi: 10.1186/s12916-019-1444-0

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title = "Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort",

abstract = "Background: Even though in situ breast cancer (BCIS) accounts for a large proportion of the breast cancers diagnosed, few studies have investigated potential risk factors for BCIS. Their results suggest that some established risk factors for invasive breast cancer have a similar impact on BCIS risk, but large population-based studies on lifestyle factors and BCIS risk are lacking. Thus, we investigated the association between lifestyle and BCIS risk within the European Prospective Investigation into Cancer and Nutrition cohort. Methods: Lifestyle was operationalized by a score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. The recommendations utilized in these analyses were the ones pertinent to healthy body weight, physical activity, consumption of plant-based foods, energy-dense foods, red and processed meat, and sugary drinks and alcohol, as well as the recommendation on breastfeeding. Cox proportional hazards regression was used to assess the association between lifestyle score and BCIS risk. The results were presented as hazard ratios (HR) and corresponding 95% confidence intervals (CI). Results: After an overall median follow-up time of 14.9 years, 1277 BCIS cases were diagnosed. Greater adherence to the WCRF/AICR cancer prevention recommendations was not associated with BCIS risk (HR = 0.98, 95% CI 0.93-1.03; per one unit of increase; multivariable model). An inverse association between the lifestyle score and BCIS risk was observed in study centers, where participants were recruited mainly via mammographic screening and attended additional screening throughout follow-up (HR = 0.85, 95% CI 0.73-0.99), but not in the remaining ones (HR = 0.99, 95% CI 0.94-1.05). Conclusions: While we did not observe an overall association between lifestyle and BCIS risk, our results indicate that lifestyle is associated with BCIS risk among women recruited via screening programs and with regular screening participation. This suggests that a true inverse association between lifestyle habits and BCIS risk in the overall cohort may have been masked by a lack of information on screening attendance. The potential inverse association between lifestyle and BCIS risk in our analyses is consistent with the inverse associations between lifestyle scores and breast cancer risk reported from previous studies.",

keywords = "In situ breast cancer, Cohort, Lifestyle, Prevention, Lifestyle Score",

author = "Nena Karavasiloglou and Anika Huesing and Giovanna Masala and {van Gils}, {Carla H.} and {Turzanski Fortner}, Renee and Jenny Chang-Claude and Inge Huybrechts and Elisabete Weiderpass and Marc Gunter and Patrick Arveux and Agnes Fournier and Marina Kvaskoff and Anne Tjonneland and Cecilie Kyro and Dahm, {Christina C.} and Vistisen, {Helene Tilma} and Bakker, {Marije F.} and Maria-Jose Sanchez and {Chirlaque Lopez}, {Maria Dolores} and Carmen Santiuste and Eva Ardanaz and Virginia Menendez and Antonio Agudo and Antonia Trichopoulou and Anna Karakatsani and {La Vecchia}, Carlo and Eleni Peppa and Domenico Palli and Claudia Agnoli and Salvatore Panico and Rosario Tumino and Carlotta Sacerdote and Butt, {Salma Tuna} and Signe Borgquist and Guri Skeie and Matthias Schulze and Timothy Key and Kay-Tee Khaw and Tsilidis, {Kostantinos K.} and Merete Ellingjord-Dale and Elio Riboli and Rudolf Kaaks and Laure Dossus and Sabine Rohrmann and Tilman Kuehn",

year = "2019",

month = dec,

day = "2",

doi = "10.1186/s12916-019-1444-0",

language = "English",

volume = "17",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central Ltd.",

number = "1",

}

TY - JOUR

T1 - Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

AU - Karavasiloglou, Nena

AU - Huesing, Anika

AU - Masala, Giovanna

AU - van Gils, Carla H.

AU - Turzanski Fortner, Renee

AU - Chang-Claude, Jenny

AU - Huybrechts, Inge

AU - Weiderpass, Elisabete

AU - Gunter, Marc

AU - Arveux, Patrick

AU - Fournier, Agnes

AU - Kvaskoff, Marina

AU - Tjonneland, Anne

AU - Kyro, Cecilie

AU - Dahm, Christina C.

AU - Vistisen, Helene Tilma

AU - Bakker, Marije F.

AU - Sanchez, Maria-Jose

AU - Chirlaque Lopez, Maria Dolores

AU - Santiuste, Carmen

AU - Ardanaz, Eva

AU - Menendez, Virginia

AU - Agudo, Antonio

AU - Trichopoulou, Antonia

AU - Karakatsani, Anna

AU - La Vecchia, Carlo

AU - Peppa, Eleni

AU - Palli, Domenico

AU - Agnoli, Claudia

AU - Panico, Salvatore

AU - Tumino, Rosario

AU - Sacerdote, Carlotta

AU - Butt, Salma Tuna

AU - Borgquist, Signe

AU - Skeie, Guri

AU - Schulze, Matthias

AU - Key, Timothy

AU - Khaw, Kay-Tee

AU - Tsilidis, Kostantinos K.

AU - Ellingjord-Dale, Merete

AU - Riboli, Elio

AU - Kaaks, Rudolf

AU - Dossus, Laure

AU - Rohrmann, Sabine

AU - Kuehn, Tilman

PY - 2019/12/2

Y1 - 2019/12/2

N2 - Background: Even though in situ breast cancer (BCIS) accounts for a large proportion of the breast cancers diagnosed, few studies have investigated potential risk factors for BCIS. Their results suggest that some established risk factors for invasive breast cancer have a similar impact on BCIS risk, but large population-based studies on lifestyle factors and BCIS risk are lacking. Thus, we investigated the association between lifestyle and BCIS risk within the European Prospective Investigation into Cancer and Nutrition cohort. Methods: Lifestyle was operationalized by a score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. The recommendations utilized in these analyses were the ones pertinent to healthy body weight, physical activity, consumption of plant-based foods, energy-dense foods, red and processed meat, and sugary drinks and alcohol, as well as the recommendation on breastfeeding. Cox proportional hazards regression was used to assess the association between lifestyle score and BCIS risk. The results were presented as hazard ratios (HR) and corresponding 95% confidence intervals (CI). Results: After an overall median follow-up time of 14.9 years, 1277 BCIS cases were diagnosed. Greater adherence to the WCRF/AICR cancer prevention recommendations was not associated with BCIS risk (HR = 0.98, 95% CI 0.93-1.03; per one unit of increase; multivariable model). An inverse association between the lifestyle score and BCIS risk was observed in study centers, where participants were recruited mainly via mammographic screening and attended additional screening throughout follow-up (HR = 0.85, 95% CI 0.73-0.99), but not in the remaining ones (HR = 0.99, 95% CI 0.94-1.05). Conclusions: While we did not observe an overall association between lifestyle and BCIS risk, our results indicate that lifestyle is associated with BCIS risk among women recruited via screening programs and with regular screening participation. This suggests that a true inverse association between lifestyle habits and BCIS risk in the overall cohort may have been masked by a lack of information on screening attendance. The potential inverse association between lifestyle and BCIS risk in our analyses is consistent with the inverse associations between lifestyle scores and breast cancer risk reported from previous studies.

AB - Background: Even though in situ breast cancer (BCIS) accounts for a large proportion of the breast cancers diagnosed, few studies have investigated potential risk factors for BCIS. Their results suggest that some established risk factors for invasive breast cancer have a similar impact on BCIS risk, but large population-based studies on lifestyle factors and BCIS risk are lacking. Thus, we investigated the association between lifestyle and BCIS risk within the European Prospective Investigation into Cancer and Nutrition cohort. Methods: Lifestyle was operationalized by a score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. The recommendations utilized in these analyses were the ones pertinent to healthy body weight, physical activity, consumption of plant-based foods, energy-dense foods, red and processed meat, and sugary drinks and alcohol, as well as the recommendation on breastfeeding. Cox proportional hazards regression was used to assess the association between lifestyle score and BCIS risk. The results were presented as hazard ratios (HR) and corresponding 95% confidence intervals (CI). Results: After an overall median follow-up time of 14.9 years, 1277 BCIS cases were diagnosed. Greater adherence to the WCRF/AICR cancer prevention recommendations was not associated with BCIS risk (HR = 0.98, 95% CI 0.93-1.03; per one unit of increase; multivariable model). An inverse association between the lifestyle score and BCIS risk was observed in study centers, where participants were recruited mainly via mammographic screening and attended additional screening throughout follow-up (HR = 0.85, 95% CI 0.73-0.99), but not in the remaining ones (HR = 0.99, 95% CI 0.94-1.05). Conclusions: While we did not observe an overall association between lifestyle and BCIS risk, our results indicate that lifestyle is associated with BCIS risk among women recruited via screening programs and with regular screening participation. This suggests that a true inverse association between lifestyle habits and BCIS risk in the overall cohort may have been masked by a lack of information on screening attendance. The potential inverse association between lifestyle and BCIS risk in our analyses is consistent with the inverse associations between lifestyle scores and breast cancer risk reported from previous studies.

KW - In situ breast cancer

KW - Cohort

KW - Lifestyle

KW - Prevention

KW - Lifestyle Score

U2 - 10.1186/s12916-019-1444-0

DO - 10.1186/s12916-019-1444-0

M3 - Journal article

C2 - 31787099

SN - 1741-7015

VL - 17

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 221

ER -