An estrogen-related lifestyle score is associated with risk of postmenopausal breast cancer in the PLCO cohort
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Healthy or unhealthy lifestyle behaviors are often adopted together. We aimed to investigate the combined effect of estrogen-related lifestyle factors on postmenopausal breast cancer risk.
Data from 27,153 women enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial were used. We created an estrogen-related lifestyle score (ERLS) by incorporating a previously developed measure of estrogenic diet, alcohol intake, body mass index (BMI), and physical activity. The scores ranged from 0 to 6 with alcohol and BMI accounting for higher weights than the other factors. To evaluate the preventive possibilities of a low estrogen-related lifestyle and to be consistent with other published lifestyle scores, higher scores were set to correspond with potentially lower estrogenic lifestyle. The association between the ERLS and incident breast cancer was examined using Cox proportional hazards models.
Participants with an ERLS of 4 or ≥ 5 had a 23% (HR 0.77; 95% CI 0.67–0.89) and 34% (HR 0.66; 95% CI 0.56–0.78) lower risk of breast cancer, respectively, compared to those with an ERLS ≤ 2 after multivariable adjustment. Estimates were similar when restricting to invasive cases or estrogen receptor-positive subtypes. No single lifestyle component appeared to drive the association.
Our findings suggest that the combined effect of a lifestyle characterized by a low estrogenic diet, low alcohol consumption, low body weight, and high levels of physical activity are associated with a reduction in postmenopausal breast cancer risk, possibly through an influence on estrogen metabolism.
KeywordsBreast cancer Lifestyle score Estrogen metabolism Behavior Epidemiology Prospective cohort study
Ratio of 2- to 16-hydroxylated estrogen metabolites
American Institute for Cancer Research
Body mass index
Continuous Update Project
European Prospective Investigation into Cancer and Nutrition
Estrogen-related dietary pattern
Estrogen-related lifestyle score
Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
United States Department of Agriculture
World Cancer Research Fund
This work was made possible in part by Grant Number T32-GM081740 from NIH-NIGMS. DPS is supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01 ES-044005 l). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIGMS or NIH.
Compliance with ethical standards
Conflict of interest
The authors do not declare any conflicts of interest.
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