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Adherence to the American Cancer Society guidelines on nutrition and physical activity for cancer survivors and biomarkers of inflammation among breast cancer survivors
Minji Kang, Sihan Song, Hyun Jeong Cho, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, Jun Won Min, Yoo Seok Kim, Sang-Woon Choi, Jung Eun Lee
Epidemiol Health. 2024;46:e2024026.   Published online January 25, 2024
DOI: https://doi.org/10.4178/epih.e2024026
  • 2,404 View
  • 121 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated whether adherence to the overall lifestyle recommendations in the American Cancer Society (ACS) guidelines on nutrition and physical activity for cancer survivors was associated with inflammation in breast cancer survivors.
METHODS
The study included 409 women who had undergone breast cancer surgery at least 1 year before enrollment. A generalized linear model was used to estimate the least square means and 95% confidence intervals of plasma levels of inflammatory markers according to lifestyle factors defined in terms of adherence to the ACS guidelines.
RESULTS
Higher overall adherence scores were associated with lower levels of high-sensitivity C-reactive protein (hs-CRP) (p for trend=0.015) and higher levels of adiponectin (p for trend=0.009). Similar significant associations of hs-CRP (p for trend= 0.004) and adiponectin (p for trend=0.010) levels were observed with the score for the body mass index (BMI) component of the adherence score. A higher diet component score was associated with a higher adiponectin level (p for trend=0.020), but there was no significant association for the physical activity component score.
CONCLUSIONS
The present study’s findings suggest that maintaining a healthy lifestyle according to the ACS guidelines was associated with beneficial effects on inflammatory marker levels, especially hs-CRP and adiponectin, among breast cancer survivors. Among the 3 components of lifestyle guidelines, the BMI component exhibited the most similar tendency to the overall adherence score in relation to inflammatory indicators. Further prospective and intervention studies are needed to investigate longitudinal associations between lifestyle factors and inflammatory markers among breast cancer survivors.
Summary
Korean summary
- 한국인 유방암 생존자를 대상으로 한 연구에서, 암 생존자를 위한 영양 및 신체 활동에 관한 미국암협회 (American Cancer Society, ACS) 지침을 따라 건강한 생활 습관을 유지하는 것이 혈중 염증 마커 수준, 특히 낮은 hs-CRP와 높은 adiponectin 수준과 관련이 있었습니다. - 체질량지수 (Body Mass Index, BMI)를 적절한 수준 (18.5-23 kg/m²)으로 유지하는 것은 낮은 hs- CRP 수준과 높은 adiponectin 수준과 관련이 있는 것으로 나타났습니다. - 또한, 과일, 야채 및 통곡물이 풍부하고 적색육 및 가공육을 적게 섭취하는 건강한 식단은 혈중 adiponectin 수치가 높은 것과 관련이 있었습니다.
Nutrient intake patterns and breast cancer risk among Jordanian women: a case-control study
Reema Fayez Tayyem, Reema Ibrahim Mahmoud, Muna Hussien Shareef, Lina Salah Marei
Epidemiol Health. 2019;41:e2019010.   Published online March 30, 2019
DOI: https://doi.org/10.4178/epih.e2019010
  • 36,643 View
  • 273 Download
  • 9 Web of Science
  • 11 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Breast cancer (BC) is the most common type of cancer worldwide. Globally, BC is rapidly becoming a major common health problem among women. This study aimed to evaluate the association between nutrient intake patterns and BC risk among Jordanian women.
METHODS
A total of 400 Jordanian women 20-65 years of age were recruited in this case-control study. Two hundred women recently diagnosed with BC were matched in age, income, and marital status to 200 BC-free women. A food frequency questionnaire was used to assess nutrient intake patterns.
RESULTS
In this study, 3 nutrient intake patterns were identified: a high vitamin C and β-carotene nutrient intake pattern; a high calcium, phosphorus, and vitamin D nutrient intake pattern; and a high-fat nutrient intake pattern. A significant increase in BC risk was associated with the high vitamin C and β-carotene nutrient pattern (the highest for the fourth quartile; odds ratio [OR], 5.42; 95% confidence interval [CI], 2.11 to 13.91; ptrend=0.001). In the high calcium, phosphorus, and vitamin D nutrient pattern, a significant inverse trend was detected for the risk of BC. The high-fat nutrient pattern showed a significant direct association with BC risk in the third (OR, 3.88; 95% CI, 1.58 to 9.51) and fourth (OR, 3.87; 95% CI, 1.53 to 9.77) quartiles (ptrend=0.001).
CONCLUSIONS
A significant increase in BC risk was detected for the high vitamin C and β-carotene nutrient intake pattern and the high-fat nutrient intake pattern. However, for the high calcium, phosphorus, and vitamin D nutrient intake pattern, a significant inverse trend was observed.
Summary

Citations

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  • Dietary and Lifestyle Factors and Breast Cancer Risk
    Reema I. Mahmoud, Reema F. Tayyem
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  • The Intake of Some Nutrients is Associated with the Risk of Breast Cancer: Results from Jordanian Case-Control Study
    Reema F. Tayyem, Reema I. Mahmoud, Lina Salah Marei
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  • Association between Grain and Legume Intakes and Breast Cancer Risk among Women
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    Annals of Cancer Research and Therapy.2020; 28(2): 81.     CrossRef
  • Vitamin D promotes the cisplatin sensitivity of oral squamous cell carcinoma by inhibiting LCN2-modulated NF-κB pathway activation through RPS3
    Zixian Huang, Yin Zhang, Haigang Li, Yufeng Zhou, Qianyu Zhang, Rui Chen, Tingting Jin, Kaishun Hu, Shihao Li, Yan Wang, Weiliang Chen, Zhiquan Huang
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Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran
Behjat Marzbani, Javad Nazari, Farid Najafi, Behnaz Marzbani, Sara Shahabadi, Mahin Amini, Mehdi Moradinazar, Yahya Pasdar, Ebrahim Shakiba, Saeed Amini
Epidemiol Health. 2019;41:e2019003.   Published online January 24, 2019
DOI: https://doi.org/10.4178/epih.e2019003
  • 20,737 View
  • 848 Download
  • 34 Web of Science
  • 33 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran.
METHODS
All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata.
RESULTS
The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk.
CONCLUSIONS
Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.
Summary

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Cohort Study of Risk Factors for Breast Cancer in Post Menopausal Women
Arthur J. Hartz, Tao He
Epidemiol Health. 2013;35:e2013003.   Published online April 30, 2013
DOI: https://doi.org/10.4178/epih/e2013003
  • 20,605 View
  • 159 Download
  • 23 Crossref
AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>The present study assessed more than 800 potential risk factors to identify new predictors of breast cancer and compare the independence and relative importance of established risk factors.</p></sec><sec><title>METHODS</title><p>Data were collected by the Women's Health Initiative and included 147,202 women ages 50 to 79 who were enrolled from 1993 to 1998 and followed for 8 years. Analyses performed in 2011 and 2012 used the Cox proportional hazard regression to test the association between more than 800 baseline risk factors and incident breast cancer.</p></sec><sec><title>RESULTS</title><p>Baseline factors independently associated with subsequent breast cancer at the p<0.001 level (in decreasing order of statistical significance) were breast aspiration, family history, age, weight, history of breast biopsies, estrogen and progestin use, fewer live births, greater age at menopause, history of thyroid cancer, breast tenderness, digitalis use, alcohol intake, white race, not restless, no vaginal dryness, relative with prostate cancer, colon polyps, smoking, no breast augmentation, and no osteoporosis. Risk factors previously reported that were not independently associated with breast cancer in the present study included socioeconomic status, months of breast feeding, age at first birth, adiposity measures, adult weight gain, timing of initiation of hormone therapy, and several dietary, psychological, and exercise variables. Family history was not found to alter the risk associated with other factors.</p></sec><sec><title>CONCLUSIONS</title><p>These results suggest that some risk factors not commonly studied may be important for breast cancer and some frequently cited risk factors may be relatively unimportant or secondary.</p></sec>
Summary

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Mortality Trends in Colorectal Cancer and Breast Cancer in Korea: Birth Cohort Effects?.
Jae Kwan Jun, Yeon Ju Kim, Jin Gwack, Yunhee Choi, Yun Chul Hong, Keun Young Yoo
Korean J Epidemiol. 2005;27(1):154-162.
  • 65,535 View
  • 39 Download
AbstractAbstract PDF
Abstract
PURPOSE
Cancer has been the leading cause of deaths since 1980s in Korea. Among them, colorectal cancer and breast cancer shows steadily increasing pattern, being the fourth and the fifth common site of cancer death in Korea, respectively. This analysis aimed to evaluate potential contribution of birth cohort effects to the recent increases in mortality of colorectal cancer and breast cancer since 1983 in Korea.
METHODS
Mortality statistics on deaths of both cancers for the past 20 years of 1983~2002 were obtained from the National Statistical Office. The age-standardized mortality rates were calculated based on the census population of 1992 as a standard.
RESULTS
Age-standardized mortality rate for colorectal cancer increased 4.7-fold in men and 3.6-fold in women, whereas 2.1-fold increase in breast cancer mortality during 1983~2002. Age-specific mortality rates for colorectal cancer were steadily increasing by age before 1991 in both genders. However, the mortality rates showed an exponentially increasing pattern for the age group of 70 and over during 1993~2001, which was more prominent in female. The birth cohort curves showed that there were 2- to 3-fold increases in the mortality rates of people who were born in 1931 for colorectal cancer compared to those of people who were born in 1921. Differences in mortality for breast cancer by birth cohort were 1.7-fold among age group of 45~49 and 50~54 between 1936 and 1946.
CONCLUSIONS
This analysis suggests that recent increases in mortality of colorectal cancer and breast cancer could potentially be due to birth cohort effects, i.e. rapid changes in life-style in younger generation. The quantitative approach using age-period-cohort model should be pursued.
Summary
Development of the Individualized Health Risk Appraisal Model of Breast Cancer Risk in Korean Women.
Sun Ha Jee, Ji Won Song, Chung Mo Nam
Korean J Epidemiol. 2004;26(1):50-58.
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Abstract
OBJECTIVES
The objectives of this study were to develop a health risk appraisal (HRA) model of breast cancer and to evaluate the model's ability to accurately predict ndividual breast cancer risk.
METHOD
The sample data were from a prospective cohort study in Korea with a follow-up period of 8 years in Korea (1995-2002). The cohort was composed of 108,708 Korean women, aged 30 to 64 years, who received health insurance from the Korea Medical Insurance Corporation and who underwent a medical evaluation in 1994. Between 1995 and 2002 (1,138,349 person-year), there were 772 incident cases of breast cancer (67.8/100,000 person-years). First, we developed the HRA based on the Cox proportional hazard models using a prospective cohort data with half-split data (50% random sample). Second, using Cox proportional hazard models, we compared the probability of breast cancer predicted by the model to the actual number of cases observed in the other 50% of the random sample of the study population.
RESULTS
The HRA Cox proportional hazard model of breast cancer developed in the study included age, age2, age at menarche, and lactation. Multivariate Cox proportional hazards models were used to test the HRA model validation. Compared with women in the lowest 10 percentile of subjects, women in the highest 10 percentile had an increased risk of breast cancer (relative risk, 3.701; 95% confidence interval, 2.554 to 5.364).
CONCLUSION
The model's performance was satisfactory for estimating breast cancer risk for individual women aged 30-64 years.
Summary
Review
Food, Nutrient, and the Risk of Breast Cancer.
Myung Hee Shin
Korean J Epidemiol. 2002;24(2):164-170.
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Abstract
Nutrients are the primary dietary component that are of interest in studying the diet-disease relationships because they give us more direct biological mechanisms. However, exploring the associations of the foods or food groups with disease occurrence could also give us an important information in the causal relationships between diet and diseases. When there are no specific nutrient that was shown to be related to a disease, a relationship between a certain food and the disease could provide a new hypothesis for the responsible components. If an association exists with both the overall intake of a nutrient and more than one food source of that nutrient, it is more likely that the association is causal. On the other hand, foods with similar nutrient components could have different effects on our body due to a complex interaction between the nutrients within the food. Epidemiologists should employ both approach (nutrient and food) in order to have an unbiased assessment for the association between diet and diseases. We will take an example of a cohort study which looked at the association between dairy products, calcium, and vitamin D and the risk of breast cancer.
Summary
Original Articles
The Menstrual, Reproductive, and Lactational Factors and the Risk of Breast Cancer in Korea: A Population Based Case-Control Study.
Myung Hee Shin, Jung Hyun Yang, Kuk Jin Choi, Yoon Ok Ahn
Korean J Epidemiol. 2000;22(1):68-68.
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Abstract
This study was conducted to assess the risk of breast cancer by menstrual, reproductive, and lactational factors in Korean women. A total of 210 women living in Seoul aged 30 to 60 with a first diagnosis of breast cancer from 2 teaching hospitals in Seoul, and 249 control subjects, randomly selected from the female pensioners of Korean Medical Insurance Company living in Seoul were interviewed. There was a increasing risk with the decrease of age at menarche, and the adjusted odds ratio(OR) of early menarche(age 14 years or less compared with over 17 years) was 1.61(95% Confidence Interval [CI]: 0.95-2.74). The longer the interval between menarche and regular menstruation, the less risk of breast cancer(OR=0.31, 95% CI: 0.16-0.60). The effect of these menarche factors were more prominent among premenopausal women. The adjusted OR for the second category(25-29 years old) of the age at first pregnancy and the age at the first full term pregnancy, compared to the reference category( 24 years old), were 0.52(95% CI: 0.30-0.92) and 0.58(95% CI: 0.32-1.06), respectively. The late age at the last full term pregnancy had significant protective effect (OR=0.29, 95% CI: 0.10-0.88), and the age itself was important rather than the interval between the first and last full term pregnancy. Factors related to breast feeding(BF) had protective effect consistently. Among parous women, in referent to no BF, women with 1 year of BF had adjusted OR of 0.34(95% CI: 0.17-0.68), while those with 1-3 years of BF had 0.35(95% CI: 0.18-0.67), 3-5 years had 0.29(95% CI: 0.12-0.74), and more than 5 years had 0.06(95% CI: 0.02-0.17). Age at menarche with regular cycle have stronger effect on especially pre-menopausal breast cancer among Korean women. Recent increase in breast cancer incidence in Korea would be explained by delayed age at first pregnancy or delivery, earlier age at menarche and last delivery, and decrease in brest feeding.
Summary
An Analysis on the Factors Associated with Cancer Screening in a City.
Woon Nyung Roh, Won Chul Lee, Young Bok Kim, Yong Mun Park, Hong Jae Lee, Kwang Ho Meng
Korean J Epidemiol. 1999;21(1):81-92.
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Abstract
This study is aimed at preparing basic data required for establishment of a cancer screening program by examining the status of cancer screenings performed by residents in a community and the factors that have an effect on determination for a cancer screening by residents. Cervix, breast and stomach cancers were chosen as target cancers of the study due to the fact that merits of screening for these cancers have been proved by studies done in different countries. In order to find out the status of cancer screening and the factors having an effect on the determination for a cancer screening, 10 Dongs and a total of 1988 people were selected as study area and subjects by a random cluster sampling method, and the subjects were questioned on different aspects by questionnaires. Additionally, in order to find out how cancer screening is performed at medical facilities and how cancer screening is recommended by doctors, medical facilities doing cancer screening were also questioned. The results of the study are as follows: 1. In the case of the screening of the stomach cancer, 16.1% of male subjects and 25.6% of female subjects turned out to have had one or more screening for the cancer. In the cases of the breast and the cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. 2. As to the screening for the stomach cancer, there was a tendency that more of the subjects with lower level education, excepting those without education, had themselves screened for the cancer. Higher screening rates were shown by the subjects in higher ages, those who visited doctors regularly. 3. As to the screening rate by education levels, a high rate of screening was shown by the subjects with above-university education level and there was not a big difference between the screenings done for high school graduates and for those with lower education levels. Regarding the rates of screening by age groups the screening rate turned out to be higher with the higher ages. Screening rates, checked on the basis of the income levels, did not show a big differences between income levels. 4. The highest rate of screening for the breast cancer was shown by the subjects with postgraduate level of education and regarding the rate by income level, a slightly higher level was shown by the subjects with the monthly income of the 2,010,000 won, but the difference between the rates of screening by subjects at different income levels was overall not significant. 5. The rates for selecting the health screening facilities were higher in orders of the reasons that 1) they were close: 2) service was excellent and 3) equipment and facilities were good. Based on the above-mentioned results obtained by the study, it is anticipated that this study will play a vital role as basic data for the development and execution of cancer screening program for a community, and the analysis, done on the basis of the status of the cancer screening, of the factors related to the determination for the cancer screening showed that for the development of a cancer screening program, factors like income levels, education levels, whether people consult doctors regularly and the local government' care for health in a community should be considered, and in addition to which active participation of doctors in the program is also requested.
Summary
Reviews
Methodological Review of Cost Effectiveness Analysis of Cancer Screening.
Ki Taig Jung
Korean J Epidemiol. 1998;20(1):13-31.
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Abstract
The role of economic evaluation for medical services can be summarixed as providing objective criteria for rational bgudget allocation. With medical and epidemiologial studies, cost effectiveness analysis of cancer screening will provide evidence for allocating more financial resources for cancer screening. This study reviewed comprehensive literature of cancer screening for cervical cancer and breast cancer. Through the extensive review of the literature, I suggest crucial issues of cancer screening and checkpoints in designing costeffectiveness analyses of cervical and breast cancers. The issues of cervical and breast cancer screening include ages of starting and terminating mass screening, screening interval and frequency, false positive rate, false negative rate, analytical models, and sensitivity analysis. In addition, cost effectiveness analysis of breast cancer should consider effects of screening methods-self examination, clinical examination, and mammography-that varies across different nations on cost effectiveness ratio. Study results of most issues would be relevant for performing cost effectiveness analysis of cancer screening in Korea. However, difference in incidence rate, medical fees and reimbursement by insurance across nations should be considered in designing cost effectiveness analysis.
Summary
Current Status of Cancer Screening Rate and Epidemiologic Study for Evaluating the Effectiveness of Cancer Screening in Korea.
Won Chul Lee
Korean J Epidemiol. 1998;20(1):1-9.
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Abstract
Current status of cancer screening rate and epidemiologic study for evaluating the effectiveness of cancer screening in Korea are reviewed. There are only few studies for an analysis of the current cancer screening status and associated factors in a community. Among these, a study which were done at Uijongbu city, showed the results on follows ; in the case of the screening of the stomach cancer, 16.1% of male subjects and 25.8% of female subjects turned out to have had one or more screenings for the cancer. In the cases of the breast and cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. The main epidemiologic studies which were for cancer screening effectiveness evaluation were case-control studies for stomach, cervix and breast cancer. According to these studies ; odds ratio was 0.71(95% confidence interval 0.36-1.40) for stomach cancer, 0.53(95% confidence interval 0.33-0.85), cervix cancer and 0.43(95% confidence interval 0.25-0.75) for breast cancer. Establishing cancer screening recommendation to promote national cancer control program and increasing cancer screening rate are needed to reach the goal of reducing cancer mortality and morbidity.
Summary
Original Article
Studies on Risk Factors in Cancers of the Breast, Uterine Cervix and Ovary.
Soon Wha Moon, Soo Yong Choi, Tae Yong Lee, Young Chae Chung
Korean J Epidemiol. 1997;19(2):161-179.
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Abstract
This study presents the comparative pattern of risks for cancers of the breast, uterine cervix and ovary in relation to various risk factors based on the data from a case-control study conducted at the Korea Cancer Center Hospital in Seoul between August in 1996 and March in 1997. Included in the analysis were 128 women of breast cancer, 169 women of uterine cevical cancer and 45 of ovarian cancer confirmed by the historical diagnosis. Person interviews were conducted in all cases through standard questionnaire. Data were analyzed using multiple logistic regression, adjusting for potential confounding factors. In cancers of the uterine cervix and ovary, increasing risks were seen in earlier age at first menarch. Statistically significant associations were found with postmenopausal women in cancers of the breast(OR=2.0) and ovary(OR=8.5). The OR increased with late age at postmenopause in postmenopausal women of uterine cervical cancer(OR=7.0). Increasing number of pregnant and livebirths was associated with a higher risk of uterine cervical cancer(OR=2.7, 2.9). The risk of uterine cervical cancer was decreasing with increasing age at first birth(OR=0.2). Among postmenopausal women, the OR increased with BMI in breast cancer. A positive history of breastfeeding was associated with significantly lower risk of breast cancer(OR=0.4). There were no associations with anthropometric measurements(height, weight, BMI), smoking, alcohol intake, menstrual regularity, age at first marriage, number of marriage and induced abortion, and oral contraceptives in cancers of the breast, uterine cervix and ovary. In cancers of the breast and uterine cervix, decreasing risks were seen in intake of fresh fruits, carrot and cabbage.
Summary

Epidemiol Health : Epidemiology and Health