Modifiable Lifestyle Factors: Opportunities for (Hereditary) Breast Cancer Prevention - a Narrative Review

Abstract

Increasing rates of obesity, lack of physical activity, sedentary behavior, and frequent alcohol consumption are major lifestyle-related risk factors for breast cancer. In fact, it has been estimated that about one-third of breast cancer cases are attributable to factors women can change. Most research has focused on examining the impact of one single exposure on breast cancer risk while adjusting for other risk modifiers. Capitalizing on big data, major efforts have been made to evaluate the combined impact of well-established lifestyle factors on overall breast cancer risk. At the individual level, data indicate that even simple behavior modifications could have a considerable impact on breast cancer prevention. Moreover, there is emerging new evidence that adopting a healthy lifestyle may be particularly relevant for women with hereditary susceptibility to breast cancer. On the absolute risk scale, studies suggest that the presence of certain risk factors, such as excessive body weight, had a substantially higher impact on breast cancer risk if women had a hereditary predisposition to cancer. The existing body of knowledge gives the medical professionals guidance as to which factors to focus on when counseling patients. However, well-designed randomized controlled trials utilizing objective methods are crucial to providing concrete recommendations.

Peroxisome proliferator-activated receptor gamma and BRCA1

“…BRCA1, DNA repair-associated gene (BRCA1), is one of the most highly associated cancer susceptibility genes, principally with breast and ovarian cancer (Turnbull et al 2018). Currently recommended preventive strategies are primarily surgical (Ludwig et al 2016, Andrews & Mutch 2017 with evaluation of the relative effectiveness of the lifestyle-driven (Lammert et al 2018) and hormonal approaches used, more generally, for reduction of breast cancer risk (Pujol et al 2012, Phillips et al 2013, Dabydeen et al 2015, Alothman et al 2017) considered more investigational.…”

Responses of smoking and nonsmoking cancer patients to drug treatment

“…While genetic factors are difficult to alter, environmental factors have been the main targets of cancer prevention. [ 3 , 4 ]…”

Outcomes of women at high familial risk for breast cancer: An 8‐year single‐center experience

“…From late 2015, referral criteria were defined as a lifetime risk of developing breast cancer of at least 25% based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) and/or MRI eligibility as per category 3 of the FRA‐BOC. The clinic provides regular breast screening and clinical breast examinations (CBEs), and informs patients about risk‐reducing strategies including bilateral prophylactic mastectomy (BPM), bilateral risk‐reducing salpingo‐oophorectomy, endocrine preventive strategies, and lifestyle recommendations …”

“…The clinic provides regular breast screening and clinical breast examinations (CBEs), and informs patients about risk-reducing strategies including bilateral prophylactic mastectomy (BPM), 12 bilateral risk-reducing salpingooophorectomy, 1 endocrine preventive strategies, 1,13 and lifestyle recommendations. 14 The aim of this study was to evaluate the current approach to patient selection in the BOCRMC, and to investigate whether the reference criteria should be restricted to mutation carriers only, or should remain more broad. Therefore, we assessed the clinical outcomes of high-risk women attending the BOCRMC with regard to breast malignancies detected through the screening services provided and their uptake rate of preventive options, and described these outcomes in both mutation carriers and noncarriers.…”