Risk Factors of

Breast Cancer
Dr- Zainab A. Al-Dubisi
Contents
 Introduction.
 Epidemiology.
 Risk Factors.
 Recommendations.
 References.
 Introduction

 Breast cancer is the commonest female cancer.

 The 2ndmost common cancer death in women.

 The main cause of death in women ages 45- 55.

 1/2cases can be explained by known risk factors.

 15% are associated with +ve family history.

…Cont
Understanding the risk factors for
breast cancer permits us to identify
women at increased risk and intervene
to modify risk, both individually and
socially.
 Epidemiology in KSA
 The recent data collected was in 2004 that by
Saudi Cancer Registry (SCR)
“Cancer Incidence Report in Saudi Arabia 2004”

 It constitutes 11.5% of all cancers in Saudi.

 Breast cancer in female accounts for 22.4% of all newly
diagnosed cancer in female
 The ASR was 15.4/100,000 for female population.
The five regions with the
highest ASR

 Eastern region at 22.6/100,000.

 Riyadh region at 19.4/100,000.
 Makkah region at 19.1/100,000.
 Jouf region at 17.5/100,000
 Qassim region at 12.6/100,000.
Epidemiology in U.S
 The incidence of breast cancer
increased during the 1980s but leveled
off in the 1990s and declined between
2001 and 2003.

 The current incidence is estimated at

around 120/100,000 women.
…Cont
Annually:
 approximately 182,460 American

women are diagnosed with breast

cancer.

 40,480 die from the disease .

…Cont
 The incidence of breast cancer is
highest in developed countries:
North America & Western Europe.

 Lowest incidences seen in:

South America, Africa and parts of Asia.
Survival rate
 The 5-year breast cancer survival rate 98%
for stage I cancer
16% for stage IV cancer
 85% after 5 years
 71% after 10 years
 57% after 15 years

 52% after 20 years

www.emedicine.com
Risk Factors of Breast Cancer
 Endogenous factors:
produced within or caused by the
organism…

 Exogenous factors:
Produced out side the body…
Endogenous factors
 Age and gender.
 Family history and genetic factors .
 Race and ethnicity.
 Benign breast disease.
 Personal history of breast cancer.
 Hormonal & reproductive Factors.
 Bone & breast Density
 Age & Gender
 They are the strongest risk factors.

 It is 100x > in female than male.

 Annually, in U.S 182,460 women

diagnosed with invasive breast cancers
versus1900 in men.
Age

 Breast cancer is rare in women< 25 y.

 Incidence increases with age, with a

plateau in women aged 50-55 y.

 At age 75-80, the incidence decreases.

Family History
 +ve family History is seen in 15-20 % of
women with breast cancer.

 The risk associated with having an

affected 1st or 2nd degree maternal or
paternal relative .
…Cont
 The lifetime risk is up to 4 times higher if
a mother or sister are affected.

The risk increased if:

 1st degree relative affected by 1.80 fold.
 2 affected 1st degree relatives, the risk
is increased 2.93 fold.
…Cont
The risk ratios were highest for women
with young affected relatives.
Risk increased
 2.9 fold for a woman whose relative was
diagnosed before age 30.
 1.5 fold increased if the affected relative
was diagnosed after age 60.
Medline ® Abstracts for References 188
of 'Epidemiology and risk factors for breast cancer
…Genetics
 BRCA1, BRCA2,p53, ATM, and PTEN
mutations are associated with higher
risk.

 Ataxia telangiectasia heterozygotes are

at 4-times increased risk

Medline ® Abstracts for References.19, 189

of 'Epidemiology and risk factors for breast cancer
Race and ethnicity
Compared with US women:

 Individuals of Ashkenazi Jewish

descent have a 2x greater risk.

 Japanese and Taiwanese woman have

1/5 the risk.
…Cont
 The highest rates occur in whites; that is
133 /100,000
 The rate in blacks is 118/ 100,000
 Asian Americans/Pacific Islanders is
89/100,000
 American Indians/Alaska natives is
70/ 100,000 Medline ® Abstracts for References
of 'Epidemiology and risk factors for breast cancer
...Cont
 Benign breast disease
:Proliferative lesion

without atypia (complex fibroadenoma,-1

moderate or florid hyperplasia, sclerosing
adenosis, intraductal papillomas) relative risk
. )1.3 to 2

with atypia (atypical lobular hyperplasia,-2

atypical ductal hyperplasia) (relative risk 4 to 6)
…Cont
:Nonproliferative lesions

Single (fibrocystic change, solitary papilloma,-1

simple fibroadenoma) are not associated with an
.increased risk for breast cancer
Muliple may increase the risk for breast cancer-2
.modestly (1.8% at 10y-one cohort study)

 Medline ® Abstract for Reference 25

of 'Epidemiology and risk factors for breast cancer'
 PERSONAL HISTORY OF BREAST
 CANCER
 In Pt with personal Hx of:

 Invasive breast cancer the risk of developing

invasive breast cancer in the contralateral
breast is 1.5% yearly.
 In situ lesions the 10-year risk of developing a
contralateral invasive breast cancer is 5%
Medline ® Abstract for Reference 27
of 'Epidemiology and risk factors for breast cancer'
Other Pathology
 Risk is increased with Hx of ovarian
cancer, endometrial cancer,

 Risk is decreased with cervical cancer.

 Hormonal/Reproductive Factors
 Factors increasing the number of
menstrual cycles increase the risk,
probably due to increased endogenous
estrogen exposure..
(1) Menarche < 13 years.
(1) Nulliparity
(2) 1st pregnancy > 30 years.
(4) No breastfeeding.
(5) Menopause > 50 years.
Breastfeeding
…Breast feeding
 protective effect has been shown in
multiple case-control and cohort
studies.
 The magnitude of which is dependent
on the duration of breastfeeding, and on
the confounding factor of parity.

Medline ® Abstracts for References 69

of 'Epidemiology and risk factors for breast cancer
 Bone & Breast density
 Bone density: In multiple studies,
women with higher bone density had a
higher breast cancer risk.

 Breast density: dense breast tissue is

independently associated with an
increased risk of breast cancer.
Medline ® Abstracts for References
of 'Epidemiology and risk factors for breast cancer
Exogenous factors

 Exogenous hormones .
 Weight.
 Socioeconomic Status.
 Exposure to ionizing radiation.
 Environment factors .
Hormonal Therapy
 Long-term use of HT is associated with the
highest risk. In contrast, short-term HT
appears not to increase the risk of breast
cancer significantly
 The use of combined estrogen plus
progesterone is associated with an increased
relative risk of breast cancer
Weight
 Obesity: Increased risk is probably due
to adipose conversion of androgens to
estrogens.
..Cont
 Women> 80 kg have 25 % higher risk
compared to those weighing< 60 kg , after
adjusting for height .

 BMI >33 kg/m2 has a 27% increased breast

cancer risk compared to those with a BMI
<21 kg/m2.
Dose the height considerer factor for
?breast cancer

Yes, it dose
 …Cont
 Increased height has been associated with a
higher risk.

 Women > 175 cm tall were 20% more likely to

develop breast cancer than those < 160 cm.

Medline ® Abstracts for References 33,34,45

of 'Epidemiology and risk factors for breast cancer
Seven prospective cohort studies 2000-sep-15
Socioeconomic class
 Women of higher socioeconomic
status are at greater risk for breast
cancer.
 It is independent factors that may
reflect differing reproductive patterns

Medline ® Abstract for Reference 28

'of 'Epidemiology and risk factors for breast cancer
lifestyle  
Physical Activity
Regular physical exercise appears to
provide modest protection against breast
cancer particularly in premenopausal
women

Medline ® Abstracts for References 46-48

'Epidemiology and risk of breast cancer
…Cont
Dietary

Red meat  An association between intake of

(>5 servings per week) and premenopausal
breast cancer .
…Cont

Fat intake has significant impact on

breast cancer risk that was suggested
in a meta-analysis of studies of both
premenopausal and postmenopausal
women
…Cont
Alcohol intake
It is associated with an increased risk of
hormone receptor-positive breast.

Medline ® Abstracts for References

'Epidemiology and risk of breast cancer
Antioxidants

There is no strong evidence for an effect of

intake of vitamin E, C or beta-carotene on
breast cancer risk
The data are conflicting on vitamin A and
breast cancer.

Medline ® Abstracts for References 203,204f

Epidemiology and risk factors for breast cancer '
Environmental Factors
 Organochlorines include polychlorinated
biphenyls (PCB's), dioxins, and
organochlorine pesticides such as DDT
are persisting in body tissues for years

Medline ® Abstracts for References 203,204f

Epidemiology and risk factors for breast cancer '
Ionizing radiation
 Ionizing radiation on the chest at a young
age.10-14 yrs

 Risk is seen up to 45 years & no risk after

that.

Medline ® Abstracts for References 203,204f

Epidemiology and risk factors for breast cancer '
 Recommendations
Primary cancer prevention evidence

1-Maintain a healthy weight throughout life

A - Consistent (Level 1) evidence that

overweight and obesity are significant risk
factors for cancers of the breast
.Contd
2-Adopt a physically active lifestyle

A - Consistent (Level 1) evidence indicates

that physical activity offers significant
protection for cancers of the breast
3-Consume a healthy diet, with an emphasis
on plant source

B-Limited-quality evidence suggests that

plant-based diets that have high amounts of
fruits, vegetables and whole grains are
protective for some cancers
4-Limit consumption of alcohol

A - Consistent (Level 1) evidence exists that

high alcohol intake is associated with
significantly and linearly increased risk of
breast cancer.
References
www.emedicine.com
ww.medline.com
www.cochrane.com
www.pubmed.com
www.uptodate.com
.www.AAFP.com
.Swanson’s Family Medicine Textbook