A healthy lifestyle index and its association with risk of breast, endometrial, and ovarian cancer among Canadian women
Several modifiable risk factors have been associated with risk of female cancers, but there is limited data regarding their combined effect on risk among Canadian women. Therefore, we assessed the joint association of modifiable risk factors, using a healthy lifestyle index (HLI) score, with risk of specific reproductive cancers.
This study included a subcohort of 3,185 of the 39,618 women, who participated in the Canadian Study of Diet, Lifestyle, and Health, and in whom 410, 177, and 100 postmenopausal breast, endometrial, and ovarian cancers, respectively, were ascertained. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards regression models modified for the case-cohort design.
Each unit increase in the HLI score was associated with 3% and 5% reductions in risk of postmenopausal breast cancer and endometrial cancer, respectively (HR 0.97; 95% CI 0.94–0.99 and HR 0.95; 95% CI 0.90–0.99, respectively). Compared to those with HLI score in the lowest category, those in the highest category had 30% and 46% reductions in risk of these cancers, respectively. The HLI score was not associated with altered risk of ovarian cancer.
Our findings suggest that promoting a healthy lifestyle may aid in the primary prevention of postmenopausal breast and endometrial cancers.
KeywordsHealthy lifestyle index score Breast cancer Endometrial cancer Ovarian cancer
Drs. Arthur and Rohan are supported by a grant from the Breast Cancer Research Foundation (BCRF-16-137).
Compliance with ethical standards
Conflict of interest
The author(s) declare that they have no competing interests.
- 3.World Cancer Research Fund/American Institute for Cancer Research (2014) Continuous update project report. Food, nutrition, physical activity, and the prevention of ovarian cancer 2014. Available at: http://www.dietandcancerreport.org/cup/cup_resources.php. Accessed 4 May 2017
- 8.World Cancer Research Fund/American Institute for Cancer Research. (2017) Continuous update project report. Food, nutrition, physical activity, and the prevention of breast cancer. Available at: http://www.wcrf.org/breast-cancer-2017. Accessed 31 May 2017
- 9.World Cancer Research Fund/American Institute for Cancer Research. (2013) Continuous update project report. Food, nutrition, physical activity, and the prevention of endometrial cancer. Available at: http://www.wcrf.org/sites/default/files/Endometrial-Cancer-2013-Report.pdf. Accessed 4 May 2017
- 12.Makarem N, Lin Y, Bandera EV, Jacques PF, Parekh N (2015) Concordance with world cancer research fund/American institute for cancer research (WCRF/AICR) guidelines for cancer prevention and obesity-related cancer risk in the Framingham offspring cohort (1991–2008). Cancer Causes Control 26(2):277–286CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Statistics Canada (2013) Annual migration estimates by census division/census metropolitan area. Available at: http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=4101. Accessed May 8 2017
- 35.Castelló A, Martin M, Ruiz A, Casas AM, Baena-Cañada J,M, Lope V et al (2015) Lower breast cancer risk among women following the world cancer research fund and american institute for cancer research lifestyle recommendations: EpiGEICAM case–control study. PLoS ONE 10:e0126096CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Romaguera D, Vergnaud A, Peeters PH, van Gils CH, Chan DS, Ferrari P et al (2012) Is concordance with world cancer research fund/American institute for cancer research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr 96:150–163CrossRefPubMedGoogle Scholar
- 39.Slattery ML, Lundgreen A, Torres-Mejia G, Wolff RK, Hines L, Baumgartner K et al (2014) Diet and lifestyle factors modify immune/inflammation response genes to alter breast cancer risk and prognosis: the breast cancer health disparities study. Mutat Res 770:19–28CrossRefPubMedPubMedCentralGoogle Scholar