|Year : 2016 | Volume
| Issue : 2 | Page : 493-497
Exploring the role of dietary factors in the development of breast cancer
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India
|Date of Web Publication||25-Jul-2016|
Saurabh RamBihariLal Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute,Ammapettai Village, Thiruporur- Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
Source of Support: None, Conflict of Interest: None
The aim of the current review is to assess the magnitude of the breast cancer, and to explore the contribution of different dietary constituents in both the causation and the prevention of the disease. An exhaustive search for all materials related to the topic was made in different search engines, including PubMed, World Health Organization Web site, and Google scholar, for a duration of 30 days (June 2014). Relevant documents, systematic reviews, technical publication series, research articles, books, and guidelines focusing on the association of dietary factors and breast cancer, published in 1998-2014 were included in the review. Overall, 56 articles were selected based on the suitability with the current review objectives and analyzed. Although specific foods and nutrients have been attributed to the causation of breast cancer, the association of the same with overall diet is still inconsistent and unexplored. As the etiology of breast cancer is multifactorial and because contribution of each factor in the development of the disease is still unclear, early detection of the disease remains the crucial factor in breast cancer control. To conclude, a definite direct or inverse association has been observed in the development of breast cancer with the dietary nutrients, and thus there is an urgent need to develop cost-effective and readily available approach for the early detection and treatment of breast cancer, especially among women from low-resource settings.
Keywords: Breast cancer, diet, screening
|How to cite this article:|
Shrivastava SR, Shrivastava PS, Ramasamy J. Exploring the role of dietary factors in the development of breast cancer. J Can Res Ther 2016;12:493-7
| > Introduction|| |
The World Health Organization has estimated that globally, 14.1 million new cases of cancer and 8.2 million cancer-associated deaths have been reported in 2012. Worldwide, breast cancer has been ranked as the most common cancer among women, accounting for 11.7 million new cases in 2012 alone. Furthermore, it is also the leading cause of death among women, resulting subsequent to a cancerous growth. In fact, a significant increase has been observed in both breast cancer incidence and associated mortality in comparison with the estimates of the year 2008. Breast cancer has been acknowledged as one of the biggest public health concern across the world owing to the high incidence prevalence, over-burdened health system, and associated medical expenditure., Current estimates suggest that of every four women across the globe who are diagnosed with any type of cancer, one is a case of breast cancer.
However, the most distressing part is that a major proportion of deaths attributed to breast cancer are occurring in developing countries and in low-resource settings, mainly because of the adoption of harmful lifestyles and weak public health care delivery system (namely, lack of comprehensive screening programs and treatment facilities).,, Findings of studies have revealed that breast cancer-associated morbidity and mortality can be significantly reduced with the help of effective screening programs, as it not only enhances the probability of a successful outcome , but also minimizes the need of invasive treatment.
The objective of the current review is to assess the magnitude of the breast cancer, and to explore the contribution of different dietary constituents in both the causation and the prevention of the disease. Furthermore, the next objective is to suggest feasible, cost-effective population-based measures, which, if implemented globally, will reduce the magnitude of the disease.
| > Materials and Methods|| |
An exhaustive search for all materials related to the topic was made in different search engines, including PubMed, World Health Organization Web site, and Google scholar, for a duration of 30 days. Relevant documents, systematic reviews, technical publication series, research articles, books, and guidelines focusing on the association of dietary factors and breast cancer, published in 1998-2014, were included in the review. A total of 76 studies were identified initially, of which 14 were excluded on account of irrelevance to the present study and because of the unavailability of the complete version of the articles. Overall, 62 articles were selected on the basis of the suitability with the current review objectives and were analyzed. The selected articles and documents were then categorized into different sections, namely, risk factors in the causation of breast cancer; dietary constituents: augmenting the risk of breast cancers; dietary constituents: reducing the risk of breast cancers; suggested interventions; and implications for practice and research. Keywords used in the search included breast cancer, prevention, and diet.
Potential risk factors
Research work has revealed that the etiology of breast cancer is multifactorial and there is a considerable interaction between the environmental factors and the individual's genetic predisposition., Other factors including women's age; parity; practice of late initiation of breastfeeding;, oral contraceptives and hormone replacement therapy;,,, positive family history; lack of exercise;, disturbances in the circadian rhythm; high percentage of total body fat and tall height in adulthood; teenage obesity; age at menarche, menopausal status, age at first live birth, genetic mutations and benign breast disease;,,,,,, and positive history of contra-lateral breast cancer  have also been cited.
Dietary factors: Increasing the risk of breast cancers
Although specific foods and nutrients have been attributed in the causation of breast cancer, the association of the same with overall diet is still inconsistent and unexplored. However, it has been documented that diet is an environmental factor with a significant potential to influence the onset of cancer by modifying the epigenome. In a population-based case-control study performed in China, it was observed that high consumption of animal-source foods had a direct association with the development of breast cancer. In an another study to assess the association between dietary folate and the development of breast cancer, a positive association between intake of synthetic folate and development of breast cancer among the European American women was observed. In addition, factors like alcohol intake and excess of calorie intake have also shown a positive association with the development of the breast cancer in different settings.,
Dietary factors: Decreasing the risk of breast cancers
In contrast to the most of the non-modifiable risk factors, diet- and nutrition-related parameters can be easily modified, thereby reducing the incidence of the breast cancer. In the past decade or so, specific food components have been identified, which are considered beneficial in mitigating the risk of breast cancer subtypes, namely
- frequent miso soup and isoflavone consumption;
- high soy intake;,,
- beverages containing Lactobacillus casei Shirota;
- green tea;
- natural food folate intake;,
- conjugated linoleic acid;
- citrus fruits;
- diet rich in fruit and vegetables;,,,
- milk and egg;
- plant sterols;
- omega-3 fatty acids;
- vitamin-D;,, and
- vitamin-B, carotenoids, phytoestrogens, and fiber.
Furthermore, compliance with a modified type of Mediterranean diet has also shown a reduction in the risk of breast cancer in the postmenopausal women., In a cohort study conducted among Swedish women, it was concluded that the intake of vitamin-C before detection of breast cancer can improve the survival rate. Researchers have even advocated for the formulation of a disease-specific local index-based dietary pattern for predicting the risk of the breast cancer in the future.
Furthermore, in case of post-menopausal women, dietary factors are not only associated with the development of the disease but they also determine the survival rates after treatment.,, In addition, high vegetable intake or reducing fats/calorie intake is shown to be effective in reducing both breast cancer relapse after surgery and mortality associated with the disease.,,,,
Breast cancer can be distinguished from other cancers by the fact that it occurs at a site that can be easily noticed, and thus liable for early detection and treatment. As the etiology of breast cancer is multifactorial and because contribution of each factor in the development of the disease is still unclear, early detection of the disease remains the crucial factor in breast cancer control., Furthermore, owing to the complex natural history of breast cancer, the policy to combat it should be multipronged based on the potential factors prevalent in different settings. Currently, the need is to formulate a comprehensive and integrated approach to facilitate early detection in both high-risk and the general population, and thus improve the survival rate.
The World Health Organization and the International Agency for Research on Cancer has proposed a range of strategies to improve the level of care for the benefit of the community. The proposed recommendation includes
- more commitment from the policy makers in the area of cancer prevention and control;
- formulating specific strategies based on the prevalence and the predisposing factors;
- encouraging research activities to identify the etiological agents and to understand the natural history of the disease;
- developing mechanisms to disseminate all recent guidelines to the health care professionals;
- building linkages with local agencies, non-governmental organizations, and international agencies to provide technical assistance and to increase the coverage of services in remote and inaccessible areas;
- scaling-up the quality of health care delivery system (namely, training of the health care workers, capacity building, strengthening of infrastructure) at local and national levels to deliver care for breast cancer patients;
- creating an environment for increasing awareness community about risk factors;
- implementing uniform breast cancer screening services in the entire country;
- extending targeted interventions toward high-risk group patients;
- orienting private practitioners through a health professional education program; and
- advocating lifestyle modification measures such as weight control, increased physical activity, limited alcohol intake, reduced fat intake.,,,,,,,,
The Government can plan to implement the aforementioned suggested measures in collaboration with the local health sector and different stakeholders in a flexible manner for the benefit of both the general population and the high-risk groups.
Implications for practice
The findings of the current review clearly reflect the necessity for a comprehensive national program for cancer well supported by intensive health awareness campaigns to spread information about the potential risk factors and breast self-examination. All the physicians from the public health sector and the private sector, including practitioners from other disciplines, should be trained to detect early signs of breast cancer. The outreach health workers should also be motivated to spread awareness about screening centers working for detecting breast cancer. In addition, a strong political will is the most indispensable element, especially in low-resource settings, desired for establishing a linkage between different agencies to ensure external supervision and monitoring.
Implications for research
The need of the hour is to conduct community-based cohort studies to explore the role of different dietary nutrient either in the causation or in the prevention of the breast cancer. In addition, there is a need to perform quantitative and qualitative studies to assess the level of awareness among the community about potential risk factors and breast cancer screening services. All such studies should look out for different factors that are preventing people from using health care services. Case-control studies or randomized controlled trials are desired in the areas to estimate the cutoff levels of dietary constituents, which are safe for human consumption and thus will not lead to the development of breast cancer.
| > Conclusion|| |
In conclusion, a definite direct or inverse association has been observed in the development of breast cancer with the dietary nutrients. However, the currently available evidence cannot be generalized in different settings and requires further research. In addition, there is an urgent need to develop cost-effective and readily available approach for the early detection and treatment of breast cancer, especially among women from low-resource settings.
| > References|| |
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.
Rastgoi M. Increase in cancer death by the year 2020. Geneva: World Health Organization; 2004.
EMRO Technical Publications Series In: 30 WHO: Guidelines for the early detection and screening of breast cancer. In: Khatib O, Modjtabai A, editors. Cairo: World health organization regional office for the Eastern Mediterranean; 2006.
Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 2013;132:1133-45.
Althuis MD, Dozier JM, Anderson WF, Devesa SS, Brinton LA. Global trends in breast cancer incidence and mortality 1973-1997. Int J Epidemiol 2005;34:405-12.
Austoker J, Bankhead C, Forbes LJ, Atkins L, Martin F, Robb K, et al
. Interventions to promote cancer awareness and early presentation: Systematic review. Br J Cancer 2009;101:S31-9.
Chong PN, Krishnan M, Hong CY, Swah TS. Knowledge and practice of breast cancer screening amongst public health nurses in Singapore. Singapore Med J 2002;43:509-16.
Harmer V. Breast Cancer Nursing: Care and Management. Breast Cancer Nursing Care and Management ed,. Oxford, Wiley-Blackwell; 2011. p. 1-18.
Seradour B, Allioux C, Ancelle-Park R, Asad SM, Barreau B, De Wold C, et al
. The screening for breast cancer: An issue of public health. 2nd
ed,. Paris, Fr: Springer; 2007. p. 71-85.
Wiseman M. The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: A global perspective. Proc Nutr Soc 2008;67:253-6.
Kahlenborn C, Modugno F, Potter DM, Severs WB. Oral contraceptive use as a risk factor for premenopausal breast cancer: A meta-analysis. Mayo Clin Proc 2006;81:1290-302.
Downs-Holmes C, Silverman, P. Breast cancer: Overview and updates. Nurse Pract 2011;36:20-6.
Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 2002;360:187-95.
Puri S, Mangat C, Bhatia V, Kalia M, Sehgal A, Kaur AP. Awareness of risk factors and aspects of breast cancer among north Indian women. Internet J Health 2009;8:2.
Somdatta P, Baridalyne N. Awareness of breast cancer in women of an urban resettlement colony. Indian J Cancer 2008;45:149-53.
Hankinson TaH. Textbooks of Cancer Epidemiology. Breast Cancer. 2nd
Fioretti F, Tavani A, Bosetti C, La Vecchia C, Negri E, Barbone F, et al
. Risk factors for breast cancer in nulliparous women. Br J Cancer 1999;79:1923-8.
Friedenreich CM. Physical activity and breast cancer: Review of the epidemiologic evidence and biologic mechanisms. Recent Results Cancer Res 2011;188:125-39.
Parkin DM, Boyd L, Walker LC. 16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer 2011;105 Suppl 2:S77-81.
Hansen J, Stevens RG. Case-control study of shift-work and breast cancer risk in Danish nurses: Impact of shift systems. Eur J Cancer 2012;48:1722-9.
Ahlgren M, Melbye M, Wohlfahrt J, Sorensen TI. Growth patterns and the risk of breast cancer in women. N Engl J Med 2004;351:1619-26.
Stoll BA. Teenage obesity in relation to breast cancer risk. Int J Obes Relat Metab Disord 1998;22:1035-40.
Veronesi U, Boyle P, Goldhirsch A, Orecchia R, Viale G. Breast cancer. Lancet 2005;365:1727-41.
Lee SM, Park JH, Park HJ. Breast cancer risk factors in Korean women: A literature review. Int Nurs Rev 2008;55:355-9.
Thomsen A, Kolesar JM. Chemoprevention of breast cancer. Am J Health Syst Pharm 2008;65:2221-8.
Dandash KF, Al-Mohaimeed A. Knowledge, attitudes, and practices surrounding breast cancer and screening in female teachers of Buraidah, Saudi Arabia. Int J Health Sci (Qassim) 2007;1:61-71.
Pratt MA. Paradoxical roles for FOXA1 in anti-estrogen resistance and as a luminal differentiation factor in breast cancer. Gland Surg 2012;1:9-11.
Harvey SL, Khasraw M. Alternative targeted therapy for early Her2 positive breast cancer. Gland Surg 2013;2:42-5.
Akinyemiju TF. Risk of asynchronous contralateral breast cancer: Multiple approaches for a complex issue. Gland Surg 2013;2:110-3.
Link LB, Canchola AJ, Bernstein L, Clarke CA, Stram DO, Ursin G, et al
. Dietary patterns and breast cancer risk in the California teachers study cohort. Am J Clin Nutr 2013;98:1524-32.
Lelievre SA, Weaver CM. Global nutrition research: Nutrition and breast cancer prevention as a model. Nutr Rev 2013;71:742-52.
Bao PP, Shu XO, Zheng Y, Cai H, Ruan ZX, Gu K, et al
. Fruit, vegetable, and animal food intake and breast cancer risk by hormone receptor status. Nutr Cancer 2012;64:806-19.
Gong Z, Ambrosone CB, McCann SE, Zirpoli G, Chandran U, Hong CC, et al
. Associations of dietary folate, Vitamins B6 and B12 and methionine intake with risk of breast cancer among African American and European American women. Int J Cancer 2014;134:1422-35.
Li CI, Chlebowski RT, Freiberg M, Johnson KC, Kuller L, Lane D, et al
. Alcohol consumption and risk of postmenopausal breast cancer by subtype: The women's health initiative observational study. J Natl Cancer Inst 2010;102:1422-31.
Song JK, Bae JM. Citrus fruit intake and breast cancer risk: A quantitative systematic review. J Breast Cancer 2013;16:72-6.
Yamamoto S, Sobue T, Kobayashi M, Sasaki S, Tsugane S. Japan public health center-based prospective study on cancer cardiovascular diseases group. Soy, isoflavones, and breast cancer risk in Japan. J Natl Cancer Inst 2003;95:906-13.
Iwasaki M, Hamada GS, Nishimoto IN, Netto MM, Motola J Jr, Laginha FM, et al
. Dietary isoflavone intake and breast cancer risk in case-control studies in Japanese, Japanese Brazilians, and non-Japanese Brazilians. Breast Cancer Res Treat 2009;116:401-11.
Wu AH, Yu MC, Tseng CC, Pike MC. Epidemiology of soy exposures and breast cancer risk. Br J Cancer 2008;98:9-14.
Ko KP, Kim SW, Ma SH, Park B, Ahn Y, Lee JW, et al
. Dietary intake and breast cancer among carriers and noncarriers of BRCA mutations in the Korean Hereditary Breast Cancer Study. Am J Clin Nutr 2013;98:1493-501.
Toi M, Hirota S, Tomotaki A, Sato N, Hozumi Y, Anan K, et al
. Probiotic beverage with soy isoflavone consumption for breast cancer prevention: A case-control study. Curr Nutr Food Sci 2013;9:194-200.
Wu AH, Yu MC, Tseng CC, Hankin J, Pike MC. Green tea and risk of breast cancer in Asian Americans. Int J Cancer 2003;106:574-9.
Kotsopoulos J, Kim YI, Narod SA. Folate and breast cancer: What about high-risk women? Cancer Causes Control 2012;23:1405-20.
Białek A, Tokarz A. Conjugated linoleic acid as a potential protective factor in prevention of breast cancer. Postepy Hig Med Dosw (Online) 2013;67:6-14.
Jung S, Spiegelman D, Baglietto L, Bernstein L, Boggs DA, van den Brandt PA, et al
. Fruit and vegetable intake and risk of breast cancer by hormone receptor status. J Natl Cancer Inst 2013;105:219-36.
Cade JE, Burley VJ, Greenwood DC. Dietary fibre and risk of breast cancer in the UK Women's Cohort Study. Int J Epidemiol 2007;36:431-8.
Ferrari P, Rinaldi S, Jenab M, Lukanova A, Olsen A, Tjonneland A, et al
. Dietary fiber intake and risk of hormonal receptor-defined breast cancer in the European Prospective Investigation into Cancer and Nutrition study. Am J Clin Nutr 2013;97:344-53.
Grattan BJ Jr. Plant sterols as anticancer nutrients: Evidence for their role in breast cancer. Nutrients 2013;5:359-87.
Iyengar NM, Hudis CA, Gucalp A. Omega-3 fatty acids for the prevention of breast cancer: an update and state of the science. Curr Breast Cancer Rep 2013;5:247-54.
Stoll F, Akladios CY, Mathelin C. Vitamin D and breast cancer: Is there a link? Gynecol Obstet Fertil 2013;41:242-50.
Yousef FM, Jacobs ET, Kang PT, Hakim IA, Going S, Yousef JM, et al
. Vitamin D status and breast cancer in Saudi Arabian women: Case-control study. Am J Clin Nutr 2013;98:105-10.
Chajes V, Romieu I. Nutrition and breast cancer. Maturitas 2014;77:7-11.
Buckland G, Travier N, Cottet V, González CA, Luján-Barroso L, Agudo A, et al
. Adherence to the Mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study. Int J Cancer 2013;132:2918-27.
Couto E, Sandin S, Lof M, Ursin G, Adami HO, Weiderpass E. Mediterranean dietary pattern and risk of breast cancer. PLoS One 2013;8:e55374.
Harris HR, Bergkvist L, Wolk A. Vitamin C intake and breast cancer mortality in a cohort of Swedish women. Br J Cancer 2013;109:257-64.
Shahril MR, Sulaiman S, Shaharudin SH, Akmal SN. Healthy eating index and breast cancer risk among Malaysian women. Eur J Cancer Prev 2013;22:342-7.
Thomson CA. Diet and breast cancer: Understanding risks and benefits. Nutr Clin Pract 2012;27:636-50.
Griffith KA, Royak-Schaler R, Nesbitt K, Zhan M, Kozlovsky A, Hurley K, et al
. A culturally specific dietary plan to manage weight gain among African American breast cancer survivors: A feasibility study. Nutr Health 2012;21:97-105.
Spark LC, Reeves MM, Fjeldsoe BS, Eakin EG. Physical activity and/or dietary interventions in breast cancer survivors: A systematic review of the maintenance of outcomes. J Cancer Surviv 2013;7:74-82.
Li CI, Daling JR, Porter PL, Tang MT, Malone KE. Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor-positive invasive breast cancer. J Clin Oncol 2009;27:5312-8.
Ewertz M, Jensen MB, Gunnarsdottir KA, Hojris I, Jakobsen EH, Nielsen D, et al
. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 2011;29:25-31.
Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: Systematic review and meta-analysis. Breast Cancer Res Treat 2010;123:627-35.
Chaudhry ZW, Brown RV, Fawole OA, Wilson R, Gudzune KA, Maruthur NM, et al
. Comparative effectiveness of strategies to prevent weight gain among women with and at risk for breast cancer: A systematic review. Springerplus 2013;2:277.
Tasci A, Usta YY. Comparison of knowledge and practices of breast self examination: A pilot study in Turkey. Asian Pac J Cancer Prev 2010;11:1417-20.