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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
  • 33,541 View
  • 253 Download
  • 10 Citations
AbstractAbstract PDF
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.
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.
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).
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.


Citations to this article as recorded by  
  • Technological readiness of commercial microalgae species for foods
    Shufang Yang, Yuwei Fan, Yue Cao, Yuxin Wang, Haijin Mou, Han Sun
    Critical Reviews in Food Science and Nutrition.2023; : 1.     CrossRef
  • Is There an Association between β-Carotene and Breast Cancer? A Systematic Review on Breast Cancer Risk
    Isabel Peraita-Costa, Paula Carrillo Garcia, María Morales-Suárez-Varela
    Nutrition and Cancer.2022; 74(1): 39.     CrossRef
  • Adherence to the DASH Diet and Risk of Breast Cancer
    Fatemeh Toorang, Bahareh Sasanfar, Ahmad Esmaillzadeh, Kazem Zendehdel
    Clinical Breast Cancer.2022; 22(3): 244.     CrossRef
  • Vitamin D, Th17 Lymphocytes, and Breast Cancer
    Beata Filip-Psurska, Honorata Zachary, Aleksandra Strzykalska, Joanna Wietrzyk
    Cancers.2022; 14(15): 3649.     CrossRef
  • A Prospective Analysis of Plasma Phospholipid Fatty Acids and Breast Cancer Risk in 2 Provinces in Canada
    Marnie Newell, Sunita Ghosh, Susan Goruk, Mohammedreza Pakseresht, Jennifer E Vena, Trevor J B Dummer, Catherine J Field
    Current Developments in Nutrition.2021; 5(4): nzab022.     CrossRef
  • Anti-Inflammatory and Anticancer Effects of Microalgal Carotenoids
    Javier Ávila-Román, Sara García-Gil, Azahara Rodríguez-Luna, Virginia Motilva, Elena Talero
    Marine Drugs.2021; 19(10): 531.     CrossRef
  • Dietary and Lifestyle Factors and Breast Cancer Risk
    Reema I. Mahmoud, Reema F. Tayyem
    Current Nutrition & Food Science.2020; 16(3): 251.     CrossRef
  • 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
    Current Research in Nutrition and Food Science Journal.2020; 8(1): 12.     CrossRef
  • Association between Grain and Legume Intakes and Breast Cancer Risk among Women
    Shatha S. Hammad, Reema Mahmoud, Lina Marie, Dana Abdelrahim, Reema F. Tayyem
    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
    Cell Death & Disease.2019;[Epub]     CrossRef
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
  • 15,434 View
  • 717 Download
  • 22 Citations
AbstractAbstract PDF
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.
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.
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.
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.


Citations to this article as recorded by  
  • Association of food groups and dietary pattern with breast cancer risk: A systematic review and meta-analysis
    Sangah Shin, Jialei Fu, Woo-Kyoung Shin, Dan Huang, Sukhong Min, Daehee Kang
    Clinical Nutrition.2023; 42(3): 282.     CrossRef
  • Dietary patterns and breast cancer risk, prognosis, and quality of life: A systematic review
    Yuan Bu, Junchao Qu, Siqi Ji, Jingxin Zhou, Mengxin Xue, Jiling Qu, Huiping Sun, Yongbing Liu
    Frontiers in Nutrition.2023;[Epub]     CrossRef
  • Dietary Heat-Treatment Contaminants Exposure and Cancer: A Case Study from Turkey
    Hilal Pekmezci, Burhan Basaran
    Foods.2023; 12(12): 2320.     CrossRef
  • The importance of SOCS1 − 1478 CA/del polymorphism and expression in breast cancer: a case–control study in the north of Iran
    Habibbullah Paeiz, Zivar Salehi, Farhad Mashayekhi, Hamid Saeidi Saedi, Laleh Mirzanejad
    Breast Cancer Research and Treatment.2023; 202(2): 389.     CrossRef
  • Caffeic Acid Phenethyl Ester (CAPE) Synergistically Enhances Paclitaxel Activity in Ovarian Cancer Cells
    Anna Kleczka, Radosław Dzik, Agata Kabała-Dzik
    Molecules.2023; 28(15): 5813.     CrossRef
  • Investigation of Breast Cancer Risk Factors in the Imam Hossein and Shohada-E Tajrish Hospitals of Tehran in 2019–2022: A case–control study
    Hanieh Bayat, Sima Nazarpour, Robab Anbiaee
    SN Comprehensive Clinical Medicine.2023;[Epub]     CrossRef
  • The Application of Whole-Process Case Management in Patients with Triple-Negative Breast Cancer
    Yunyan Zhao, Ran Zhu, Jie Bai, Jie Li, Xue Jia, Peng Wang, Lijun Jin, Wei long Zhong
    Journal of Oncology.2022; 2022: 1.     CrossRef
  • Dietary patterns, cooking methods and breast cancer risk in Mexico: An exploratory case-control study
    Elisa Pineda, María I. Ortega-Vélez, Martin Preciado-Rodríguez, Socorro Saucedo-Tamayo, Graciela Caire-Juvera
    Nutrition and Health.2022; : 026010602211192.     CrossRef
  • Age-specific incidence rates of breast cancer among Japanese women increasing in a conspicuous bimodal distribution pattern
    Nanami Tokutake, Riona Ushiyama, Kyoka Matsubayashi, Yuji Aoki
    Proceedings of Singapore Healthcare.2021; 30(2): 166.     CrossRef
  • Consumption of Sweet Beverages and Cancer Risk. A Systematic Review and Meta-Analysis of Observational Studies
    Fjorida Llaha, Mercedes Gil-Lespinard, Pelin Unal, Izar de Villasante, Jazmín Castañeda, Raul Zamora-Ros
    Nutrients.2021; 13(2): 516.     CrossRef
  • The association between plant-based dietary patterns and risk of breast cancer: a case–control study
    Somaye Rigi, Seyed Mohammad Mousavi, Sanaz Benisi-Kohansal, Leila Azadbakht, Ahmad Esmaillzadeh
    Scientific Reports.2021;[Epub]     CrossRef
  • Preventive measures against development of breast cancer
    Yu. V. Vykhristyuk, G. E. Roitberg, J. V. Dorosh, N. V. Karaseva, R. A. Akobova
    South Russian Journal of Cancer.2021; 2(1): 50.     CrossRef
  • Association between dietary phytochemical index and breast cancer: a case–control study
    Seyed Mojtaba Ghoreishy, Azadeh Aminianfar, Sanaz Benisi-Kohansal, Leila Azadbakht, Ahmad Esmaillzadeh
    Breast Cancer.2021; 28(6): 1283.     CrossRef
  • The Benefit of Enhanced Daycare of Traditional Chinese Medicine for Cancer Treatment Related Adverse Events: A Retrospective Study of Medical Records
    Hsiu-An Wu, Chien-Hung Chen, Ming-Hsien Hsieh, Yung-Chang Wu, Jung-Peng Chiu, Chien-Jung Huang, Chung-Hua Hsu
    Integrative Cancer Therapies.2021; 20: 153473542110256.     CrossRef
  • Differential effects of phenolic extracts from red‐fleshed apple peels and flesh induced G1 cell cycle arrest and apoptosis in human breast cancer MDA‐MB‐231 cells
    Cui Xia Li, Zhen Xian Lin, Xian Hua Zhao, Wei Fang Zuo, Nan Wang, Zong Ying Zhang, Xue Sen Chen
    Journal of Food Science.2021; 86(9): 4209.     CrossRef
  • Evaluation of the Effects of Different Dietary Patterns on Breast Cancer: Monitoring Circulating Tumor Cells
    Xiuxiu Wang, Xiaoyu Liu, Zhenzhen Jia, Yilun Zhang, Shuo Wang, Hongyan Zhang
    Foods.2021; 10(9): 2223.     CrossRef
  • The association between adherence to MIND diet and risk of breast cancer: A case–control study
    Fatemeh Sheikhhossein, Hossein Imani, Mohammad Reza Amini, Fatemeh Hosseini, Sakineh Shab‐Bidar
    International Journal of Clinical Practice.2021;[Epub]     CrossRef
  • Factors affecting health services strategic purchasing for breast cancer patients: a mixed study in Iran
    Samereh Yaghoubian, Mohammad Ali Jahani, Zeynab Farhadi, Ghahraman Mahmoudi
    Cost Effectiveness and Resource Allocation.2021;[Epub]     CrossRef
  • Effect of Consumption of Whole-Wheat Breads on FBS, HbA1c, and Blood Lipids in Patients with Type 2 Diabetes
    Javad Nazari, Nasrin Yadegari, Sousan Khodam, Amir Almasi-Hashian, Saeed Amini
    Preventive Nutrition and Food Science.2021; 26(3): 269.     CrossRef
  • Dietary Patterns and Risk of Invasive Ductal and Lobular Breast Carcinomas: A Systematic Review and Meta-analysis
    Mostafa Dianatinasab, Marjan Rezaian, Elmira HaghighatNezad, Zahra Bagheri-Hosseinabadi, Sasan Amanat, Shahab Rezaeian, Alireza Masoudi, Reza Ghiasvand
    Clinical Breast Cancer.2020; 20(4): e516.     CrossRef
  • Preprocessing Breast Cancer Data to Improve the Data Quality, Diagnosis Procedure, and Medical Care Services
    Zeinab Sajjadnia, Raof Khayami, Mohammad Reza Moosavi
    Cancer Informatics.2020; 19: 117693512091795.     CrossRef
  • Breast cancer risk factors in Iran: a systematic review & meta-analysis
    Amir Shamshirian, Keyvan Heydari, Zahra Shams, Amir Reza Aref, Danial Shamshirian, Omid Reza Tamtaji, Zatollah Asemi, Layla Shojaie, Hamed Mirzaei, Neda Mohammadi, Behdad Zibaee, Keyvan Karimifar, Bahman Zarandi, Akbar Hedayatizadeh-Omran, Reza Alizadeh-N
    Hormone Molecular Biology and Clinical Investigation.2020;[Epub]     CrossRef
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
  • 17,950 View
  • 152 Download
  • 23 Citations
AbstractAbstract PDF

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.


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.


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.


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.



Citations to this article as recorded by  
  • Number of lifetime menses increases breast cancer occurrence in postmenopausal women at high familial risk
    Margaux Bieuville, Dominique Faugère, Virginie Galibert, Morgane Henard, Antoine M. Dujon, Beata Ujvari, Pascal Pujol, Benjamin Roche, Frédéric Thomas
    Frontiers in Ecology and Evolution.2023;[Epub]     CrossRef
  • Short Breastfeeding Duration is Associated With Premature Onset of Female Breast Cancer
    Ángel Fernández-Aparicio, Jacqueline Schmidt-RioValle, Pedro A. García, Emilio González-Jiménez
    Clinical Nursing Research.2022; 31(5): 901.     CrossRef
  • World Cancer Research Fund International: Continuous Update Project—systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk
    Doris S. M. Chan, Leila Abar, Margarita Cariolou, Neesha Nanu, Darren C. Greenwood, Elisa V. Bandera, Anne McTiernan, Teresa Norat
    Cancer Causes & Control.2019; 30(11): 1183.     CrossRef
  • Physical Activity and Weight Loss Reduce the Risk of Breast Cancer: A Meta-analysis of 139 Prospective and Retrospective Studies
    Prue J. Hardefeldt, Ross Penninkilampi, Senarath Edirimanne, Guy D. Eslick
    Clinical Breast Cancer.2018; 18(4): e601.     CrossRef
  • Connecting the dots between breast cancer, obesity and alcohol consumption in middle-aged women: ecological and case control studies
    E. R. Miller, C. Wilson, J. Chapman, I. Flight, A.-M. Nguyen, C. Fletcher, Ij Ramsey
    BMC Public Health.2018;[Epub]     CrossRef
  • Cardiac glycosides and breast cancer risk: A systematic review and meta-analysis of observational studies
    Reema A. Karasneh, Liam J. Murray, Chris R. Cardwell
    International Journal of Cancer.2017; 140(5): 1035.     CrossRef
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    Chen Zhang, Shao-Hua Xie, Bingfei Xu, Shi Lu, Pian Liu
    Drug Safety.2017; 40(4): 285.     CrossRef
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    Mohamed Hosny Osman, Eman Farrag, Mai Selim, Mohamed Samy Osman, Arwa Hasanine, Azza Selim, Luis Eduardo M. Quintas
    PLOS ONE.2017; 12(6): e0178611.     CrossRef
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    Lenora Ann Pluchino, Amethyst Kar-Yin Liu, Hwa-Chain Robert Wang
    Free Radical Biology and Medicine.2015; 80: 12.     CrossRef
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    Eline C. Noels, Oren Lapid, Jan H.N. Lindeman, Esther Bastiaannet
    Aesthetic Surgery Journal.2015; 35(1): 55.     CrossRef
  • Obesity and male breast cancer: provocative parallels?
    Matthew P. Humphries, V. Craig Jordan, Valerie Speirs
    BMC Medicine.2015;[Epub]     CrossRef
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    A.O. Mueck, H. Seeger
    Gynäkologische Endokrinologie.2015; 13(3): 156.     CrossRef
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    X. Ruan, A. O. Mueck
    Climacteric.2015; 18(1): 38.     CrossRef
  • Reproductive Risk Factors Differ Among Breast Cancer Patients and Controls in a Public Hospital of Paraiba, Northeast Brazil
    Gibran Sarmento de Almeida, Layze Amanda Leal Almeida, Gilmara Marques Rodrigues Araujo, Mathias Weller
    Asian Pacific Journal of Cancer Prevention.2015; 16(7): 2959.     CrossRef
  • Recent trends in incidence of five common cancers in 26 European countries since 1988: Analysis of the European Cancer Observatory
    Melina Arnold, Henrike E. Karim-Kos, Jan Willem Coebergh, Graham Byrnes, Ahti Antilla, Jacques Ferlay, Andrew G. Renehan, David Forman, Isabelle Soerjomataram
    European Journal of Cancer.2015; 51(9): 1164.     CrossRef
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    Amos Pines
    Climacteric.2014; 17(1): 98.     CrossRef
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    E Kreiter, A Richardson, J Potter, Y Yasui
    British Journal of Cancer.2014; 110(7): 1891.     CrossRef
  • Cardiac glycosides and the risk of breast cancer in women with chronic heart failure and supraventricular arrhythmia
    Sébastien Couraud, Sophie Dell’Aniello, Nathaniel Bouganim, Laurent Azoulay
    Breast Cancer Research and Treatment.2014; 146(3): 619.     CrossRef
  • Colorectal Cancer Incidence Rates in the Louisiana Acadian Parishes Demonstrated to be Among the Highest in the United States
    Jordan J Karlitz, Christine Blanton, Patricia Andrews, Vivien W Chen, Xiao-Cheng Wu, Elizabeth Fontham
    Clinical and Translational Gastroenterology.2014; 5(10): e60.     CrossRef
  • Family History Attributes and Risk Factors for Breast Cancer in Turkey
    Ozden Gokdemir-Yazar, Seval Yaprak, Muhteber Colak, Ediz Yildirim, Dilek Guldal
    Asian Pacific Journal of Cancer Prevention.2014; 15(6): 2841.     CrossRef
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    Sébastien Couraud, Laurent Azoulay, Sophie Dell’Aniello, Samy Suissa
    BMC Cancer.2014;[Epub]     CrossRef
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    Lenora Ann Pluchino, Hwa-Chain Robert Wang, Sharon A. Glynn
    PLoS ONE.2014; 9(11): e108698.     CrossRef
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    Milena Ilic, Hristina Vlajinac, Jelena Marinkovic
    Asian Pacific Journal of Cancer Prevention.2013; 14(11): 6643.     CrossRef
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
  • 34 Download
AbstractAbstract PDF
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.
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.
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.
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.
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.
  • 4,919 View
  • 22 Download
AbstractAbstract PDF
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.
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.
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).
The model's performance was satisfactory for estimating breast cancer risk for individual women aged 30-64 years.
Food, Nutrient, and the Risk of Breast Cancer.
Myung Hee Shin
Korean J Epidemiol. 2002;24(2):164-170.
  • 4,418 View
  • 11 Download
AbstractAbstract PDF
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.
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.
  • 4,939 View
  • 23 Download
AbstractAbstract PDF
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.
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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  • 10 Download
AbstractAbstract PDF
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.
Methodological Review of Cost Effectiveness Analysis of Cancer Screening.
Ki Taig Jung
Korean J Epidemiol. 1998;20(1):13-31.
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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.
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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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.
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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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.

Epidemiol Health : Epidemiology and Health