Adherence to the South African Food Based Dietary Guidelines may reduce breast cancer risk in black South African women: The SABC study

Objective: To determine the level of adherence, and to assess the association between higher adherence to the South African Food Based Dietary Guidelines (SAFBDGs) and breast cancer risk. Design: Population-based, case-control study (the South African Breast Cancer study), matched on age and demographic settings. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to the SAFBDGs, a 9-point adherence score (out of 11 guidelines) was developed, using suggested adherence cut-points for scoring each recommendation (0 and 1). When the association between higher adherence to the SAFBDGs and breast cancer risk were assessed, data driven tertiles among controls were used as cut-points for scoring each recommendation (0, 0.5 and 1). Odds ratios and 95% confidence intervals were estimated using multivariate logistic regression models. Setting: Soweto, South Africa Population: Black urban women, 396 breast cancer cases and 396 controls. Results: After adjusting for potential confounders, higher adherence (>5.0) to the SAFBDGs vs. lower adherence (<3.5), was statistically significantly inversely associated with breast cancer risk overall (OR=0.56, 95%CI:0.38-0.85), among postmenopausal women (OR=0.64, 95%CI:0.40-0.97) as well as for oestrogen positive breast cancers (OR=0.51, 95%CI:0.32-0.89). Only 32.3% of cases and 39.1% of controls adhered to at least half (a score >4.5) of the SAFBDGs. Conclusions: Higher adherence to the SAFBDGs may reduce breast cancer risk in this population. The concerning low levels of adherence to the SAFBDGs emphasize the need for education campaigns and to create healthy food environments in South Africa to increase adherence to the SAFBDGs.

Risk of Breast Cancer in Women with Mastitis: A Retrospective Population-Based Cohort Study

Background and objectives: Breast cancer is a common cancer in women and has been the fourth leading cause of death in Taiwanese women. Risk factors for breast cancer include family history of breast cancer, genetic factors, and not breastfeeding. Several studies have reported an association between repeated inflammation at a young age, especially among lactating women, and cancer; however, the number of studies about the association of mastitis and breast cancer in nonlactating women is still limited. Therefore, the aim of this study was to determine the relationship between mastitis in women aged ≥40 years and breast cancer. Materials and Methods: This was a retrospective cohort study design. The data source was the Longitudinal Health Insurance Database 2010 (LHID 2010), comprising data collected by Taiwan’s National Health Insurance program. Cases of newly diagnosed mastitis in women aged ≥40 years (ICD-9-CM code = 611.0) were selected from the years 2010 to 2012. Women not diagnosed with mastitis were selected as the control group, and their data for the years 2009 to 2013 were obtained through the database. In addition, the non-mastitis group was matched 1:10 by age. Results: A total of 8634 participants were selected from the LHID 2010, which included 734 cases with mastitis and 7900 cases without mastitis. After adjustment for age, hypertension, hyperlipidemia, diabetes, hypothyroidism, and autoimmune diseases, the Cox proportional hazard model showed that patients with mastitis had a higher risk of breast cancer (aHR = 3.71, 95% CI = 1.9–7.02) compared with the non-mastitis group. The Kaplan–Meier curve also showed that women with mastitis had a higher risk of developing breast cancer. Conclusions: This study confirmed that women with mastitis have a higher risk of developing breast cancer. Therefore, women aged ≥40 years could reduce breast cancer risk by taking precautions to prevent mammary gland infection and mastitis.

Progestogens are the problem in hormone replacement therapy: Time to reappraise their use

Combined (estrogen and a progestogen) hormone replacement therapy (cHRT) is associated with an increased risk of breast cancer, while estrogen replacement therapy is not. Whatever the underlying mechanism, it is the progestogen in cHRT that seems to increase the risk. Fear of breast cancer is a major limiting factor in the use of hormone replacement therapy, and when women discontinue cHRT because of side effects, the latter are often attributable to the progestogen component. cHRT is given to women with an intact uterus to protect against the effects of un-opposed estrogen such as an increased risk of endometrial cancer. Estrogen replacement therapy suffices for women with a prior hysterectomy. There is a clear distinction in risk and side effect profile between cHRT and estrogen replacement therapy. Apart from being the most effective treatment for menopausal symptoms, estrogen prevents osteoporosis, and may also have a potential role in prevention of Alzheimer’s Dementia, now the biggest killer of women in the United Kingdom. Evidence also suggests that progestogens could compromise the dementia-preventative effect of estrogen. Given the immense therapeutic and preventative potential of estrogen, the use of progestogens in cHRT needs re-appraisal. The levonorgestrel intrauterine system (LNg-IUS) could reduce breast cancer risk while protecting the endometrium. Other approaches to the safe use of progestogens await research.

Environmental Influences on Mammographic Breast Density in California: A Strategy to Reduce Breast Cancer Risk

State legislation in many U.S. states, including California, mandates informing women if they have dense breasts on screening mammography, meaning over half of their breast tissue is comprised of non-adipose tissue. Breast density is important to interpret screening sensitivity and is an established breast cancer risk factor. Environmental chemical exposures may play an important role in this, especially during key windows of susceptibility for breast development: in utero, during puberty, pregnancy, lactation, and the peri-menopause. There is a paucity of research, however, examining whether environmental chemical exposures are associated with mammographic breast density, and even less is known about environmental exposures during windows of susceptibility. Now, with clinical breast density scoring being reported routinely for mammograms, it is possible to find out, especially in California, where there are large study populations that can link environmental exposures during windows of susceptibility to breast density. Density scores are now available throughout the state through electronic medical records. We can link these with environmental chemical exposures via state-wide monitoring. Studying the effects of environmental exposure on breast density may provide valuable monitoring and etiologic data to inform strategies to reduce breast cancer risk.

Role of Vitamin D in Breast Cancer Prevention and Therapy: Recent Findings

Vitamin D, a fat-soluble vitamin, is produced in the skin exposed to the sunlight or provided by dietary intake. In addition to its role in the regulation of calcium and phosphorus metabolism, vitamin D has been correlated with several ailments such as depression, osteoporosis and cancer. Since vitamin D deficiency has been demonstrated to be linked to higher breast cancer risk, importance has been given to study its possible use in the prevention or even treatment of breast cancer. Herein, we review recent publications studying the vitamin D effects and breast cancer. Role of vitamin D as a preventive agent, its involvement in therapies and the effects of vitamin D supplementation are discussed. Accumulative findings support that vitamin D supplementation might reduce breast cancer risk, enhance effectiveness of chemotherapeutics and improve cancer survival. J MEDICINE JAN 2020; 21 (1) : 46-50