Association of Family History and Other risk factors with Breast Cancer Risk among Japanese Premenopausal and Postmenopausal Women

Objectives: To determine the impact of family history (FH) on anthropometric and reproductive risk factors for breast cancer, a case-referent study was conducted using data from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC), Japan. Methods: In total, 1584 breast cancer cases were included and 15,331 women, confirmed as free of cancer, were recruited as the referents. Odds ratios and 95% confidence intervals were determined by logistic regression analysis. Separate analyses were performed for premenopausal and postmenopausal women. Results: Height, weight, and current body mass index (BMI) were positively associated with postmenopausal breast cancer regardless of FH, while these anthropometric factors did not alter risk in premenopausal women. The impacts of height and weight on postmenopausal breast cancer were more pronounced among FH women. There was little association with reproductive risk factors for premenopausal or postmenopausal breast cancer in FH cases, in clear contrast to the non-FH cases. Conclusions: These findings suggest some differences in risk impact of common etiologic factors between familial breast cancer and sporadic cases that may give pointers to further analysis of host-specific factors. They imply that avoidance of obesity after menopause may reduce the risk of breast cancer, regardless of FH.     

329例转移性乳腺癌的预后因素及生存分析

目的观察转移性乳腺癌患者的疗效及预后情况,分析影响转移性乳腺癌患者生存的预后因素。方法选取转移性乳腺癌患者329例进行回顾性研究。结果总生存率(OS)1年总生存率为62.9%,2年总生存率为41.9%,3年总生存率为25.8%及5年总生存率11.9%。接受治疗的患者中位生存时间为18.2个月,分别为:骨转移患者23.4个月,淋巴结转移患者31.3个月,肝转移患者17.6个月,肺转移患者15.3个月,脑转移患者7.2个月。通过单因素及多因素分析,获取了同生存获益相关的预后因素。结论对转移性乳腺癌生存有积极影响的独立因素包括:体力状况,年龄≤70岁以及没有内脏的转移。对于此类患者,在解救治疗中应采取较为积极的处理措施,争取更好的生存获益。     

Survival Time and Prognostic Factors for Breast Cancer among Women in North-East Peninsular Malaysia

Background: Breast cancer is the most common malignant disease and the leading cause of cancer death amongwomen globally. This study aimed to determine the median survival time and prognostic factors for breast cancerpatients in a North-East State of Malaysia. Methods: This retrospective cohort study was conducted from January tillApril 2017 using secondary data obtained from the state’s cancer registry. All 549 cases of breast cancer diagnosedfrom 1st January 2007 until 31st December 2011 were selected and retrospectively followed-up until 31st December2016. Sociodemographic and clinical information was collected to determine prognostic factors. Results: The average(SD) age at diagnosis was 50.4 (11.2) years, the majority of patients having Malay ethnicity (85.8%) and a histology ofductal carcinoma (81.5%). Median survival times for those presenting at stages III and IV were 50.8 (95% CI: 25.34,76.19) and 6.9 (95% CI: 3.21, 10.61) months, respectively. Ethnicity (Adj. HR for Malay vs non-Malay ethnicity=2.52;95% CI: 1.54, 4.13; p<0.001), stage at presentation (Adj. HR for Stage III vs Stage I=2.31; 95% CI: 1.57, 3.39; p<0.001and Adj. HR for Stage IV vs Stage I=6.20; 95% CI: 4.45, 8.65; p<0.001), and history of surgical treatment (Adj. HRfor patients with no surgical intervention=1.95; 95% CI: 1.52, 2.52; p<0.001) were observed to be the statisticallysignificant prognostic factors associated with death caused by breast cancer. Conclusion: The median survival timeamong breast cancer patients in North-East State of Malaysia was short as compared to other studies. Primary andsecondary prevention aimed at early diagnosis and surgical management of breast cancer, particularly among the Malayethnic group, could improve treatment outcome.     

Duration of Signs and Survival in Premenopausal Women with Breast Cancer

CONDENSED: Among 550 women reporting a lump as the first sign of breast cancer, those with this sign for 6-29 months compared to those with 1-6 months, had bigger tumors and more frequent axillary node involvement. Overall survival, however, was not significantly different in these two groups. BACKGROUND: The relationship of delay in diagnosis of breast cancer to survival is uncertain. METHODS: We evaluated the relationship of patient-reported duration of signs of breast cancer to survival in participants in a clinical trial of adjuvant hormonal therapy in Vietnam and China. RESULTS: Among 550 women reporting a lump as the first sign of breast cancer and information on when this appeared, the median duration of this sign before diagnosis was 6 months. Comparing two groups of patients with durations of lumps 1-6 months and 6-29 months, the group with longer duration of lumps had larger tumors clinically and pathologically (p = 0.0006, and p = 0.004), more frequent axillary node involvement (p = 0.008), and shorter but not statistically different disease-free and overall survival from the time of diagnosis (p = 0.09 and 0.35, respectively). CONCLUSIONS: Breast cancer evolves slowly in the detectable period of its natural history. The impact of delays in diagnosis of less than 6 months is likely to be very limited; delays more than 6 months appear to have some, but marginal impact on survival.     

Factors Associated with Breast Cancer Awareness in Thai Women

Background: Breast cancer is the most common cancer in women worldwide. In south-east Asia, both the incidenceand mortality rates of breast cancer are on the rise, and the latter is likely due to the limited access to large-scalecommunity screening program in these resource-limited countries. Breast cancer awareness is an important tool whichmay, through increasing breast self-examination and the seeking of clinical examination, reduce breast cancer mortality.Investigating factors associated with breast cancer awareness of women is likely to help identify those at risk, andprovide insights into developing effective health promotion interventions. Objective: To investigate factors associatedwith breast cancer awareness in Thai women. Methods: A cross-sectional sample of Thai women aged 20-64 yearswas collected during August to October, 2015 from two provinces of southern Thailand (Surat Thani and Songkla). Aquestionnaire including the Breast Cancer Awareness Scale along with demographic characteristics was administeredand Proportional Odds Logistic regression was then used to investigate factors associated with breast cancer awareness.Results: In total, 660 Thai women participated in this study. Factors most often associated with the various breastcancer awareness domains were age and rurality. While rural women had poorer knowledge of breast cancer signs andsymptoms, they also had lower levels of perceived barriers and considerably better breast cancer awareness behaviors.Conclusion: Despite lower knowledge of breast cancer risk factors and no evidence of better knowledge of signs andsymptoms, we found rural Thai women had considerably better breast cancer awareness behavior. This may be due tothese women’s lower levels of perceived barriers to breast cancer screening services. Indeed this suggests, at least inThai women, that interventions aimed at lowering perceived barriers rather than enhancing disease knowledge maybe more successful in engaging women with breast cancer screening services and increasing breast self-examination.     

Vascular Invasion as an Independent Prognostic Factor in Lymph Node Negative Invasive Breast Cancer

Introduction: Identification of simple and measurable prognostic factors is an important issue in treatmentevaluation of breast cancer. The present study was conducted to evaluate the prognostic role of vascular invasion inlymph node negative breast cancer patients. Methods: in a retrospective design, we analyzed the recorded profilesof the 1,640 patients treated in the breast cancer department of Motahari clinic affiliated to Shiraz Universityof Medical Sciences, Shiraz, Iran, from January 1999 to December 2012. Overall and adjusted survivals wereevaluated by the Cox proportional hazard model. All the hypotheses were considered two-sided and a p-valueof 0.05 or less was considered as statistically significant. Results: Mean age in lymph node negative and positivepatients was 50.0 and 49.8 respectively. In lymph node negative patients, the number of nodes, tumor size,lymphatic invasion, vascular invasion, progesterone receptor, and nuclear grade were significant predictors.In lymph node and lymphatic negative patients, vascular invasion also played a significant prognostic role inthe survival which was not evident in lymph node negative patients with lymphatic invasion. Discussion: Theresults of our large cohort study, with long term follow up and using multivariate Cox proportional model andcomparative design showed a significant prognostic role of vascular invasion in early breast cancer patients.Vascular invasion as an independent prognostic factor in lymph node negative invasive breast cancer     

Demographic Characteristics,Survival and Prognostic Factors of Early Breast Cancer Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cohort Study

Objective: With increasing prevalence of type 2 diabetes mellitus and breast cancer in Iran, we aimed to search hospital registries of breast cancer patients to investigate type 2 diabetes mellitus association with survival outcomes of early breast cancer after adjustment of confounding factors. Methods: In a retrospective cohort study conducted from July 2003 to Feb 2014 and followed up until death or December 2016, female patients with early breast cancer who have been treated for the first time at the Cancer Institute of Iran, were divided to diabetic and non-diabetic groups. Primary and secondary outcomes were relapse free survival (RFS) and overall survival (OS). SPSS version 23 was used for analysis of data. Other variables included age, tumor stage, hormone receptor status, tumor subtype, and patient’s body mass index (BMI). Result: From a total of 1021 patients, 218 (21.4%) had type 2 diabetes mellitus. Diabetic patients had a higher mean age (53.31 vs 47.00), higher mean BMI (31.13 vs 29.15), lower HER2 expression (20.8% vs 32.1%) and higher frequency of luminal A subtype (61.1% vs 51.0). Overall, after adjustment of other variables, diabetes status did not affect RFS or OS independently. However, in luminal A subgroup, patients with diabetes mellitus had significantly lower survival outcomes of OS (135.277 vs 154.701) and RFS (114.107 vs 133.612) as well as OS higher hazard ratio of 1.830 and RFS hazard ratio of 1.663 compared to non-diabetic patients. BMI, hormone receptor status and tumor stage significantly affected the survival of the patients. Conclusion: In the present study, in addition to known breast cancer risk factors, BMI and type 2 diabetes mellitus had an independent impact on survival of the patients, highlighting the importance of health issues such as obesity and diabetes suboptimal performance in the treatment outcomes of early breast cancer patients in Iran.     

Prognostic Value of Clinicopathological Factors for Indonesian Breast Carcinomas of Different Molecular Subtypes

Background: Breast carcinoma (BC) is a heterogeneous disease due to its different molecular profiles i.e. luminal (luminal A and luminal B) and non-luminal (HER2 positive and triple negative) subtypes. Prognostic value of clinicopathological factors of Indonesian BC of different molecular subtypes has never been reported previously. This study aims to elaborate prognostic impacts on Indonesian BCs focusing on separate molecular subtypes. Methods: A hundred and fifty cases of invasive BC, stage I-IIIA, in Sardjito Hospital, Indonesia, were stained using anti ER, PR, HER2 and Ki-67 antibodies. Survival and prognostic values were statistically analyzed. Results: Compared to the luminal subtypes, the non-luminal subtypes demonstrated higher proportions of intermediate-to-high grade, stage IIIA, positive lymph node infiltration and mortality. The triple negative subtype was typically intermediate-to-high grade, stage IIIA and with a high relative death risk. Luminal A lesions were characteristically low grade, stage I-II and less likely to cause death. Conclusion: In non-luminal BC, staging and lymph node metastasis are independent prognostic factors for survival in HER2 positive and triple negative subtypes, respectively. In luminal BC, clinicopathological factors demonstrated no influence on survival. This study suggests that staging and lymph node metastasis are correlated with survival in non-luminal Indonesian BCs.     

Predictive Factors of Survival Time of Breast Cancer in Kurdistan Province of Iran between 2006-2014: A Cox Regression Approach

Background: Breast cancer is the most common cancer and the second most common cause of cancer-inducedmortalities in Iranian women, following gastric carcinoma. The survival of these patients depends on severalfactors, which are very important to identify in order to understand the natural history of the disease. Materialsand Methods: In this retrospective study, 313 consecutive women with pathologically-proven diagnosis of breastcancer who had been treated during a seven-year period (January 2006 until March 2014) at Towhid hospital,Sanandaj city, Kurdistan province of Iran, were recruited. The Kaplan-Meier method was used for data analysis,and finally those factors that showed significant association on univariate analysis were entered in a Cox regressionmodel. Results: the mean age of patients was 46.10±10.81 years. Based on Kaplan-Meier method median ofsurvival time was 81 months and 5 year survival rate was 75%±0.43. Tumor metastasis (HR=9.06, p=0.0001),relapse (HR=3.20, p=0.001), clinical stage of cancer (HR=2.30, p=0.03) and place of metastasis (p=0.0001) hadsignificant associations with the survival rate variation. Patients with tumor metastasis had the lowest five-yearsurvival rate (37%)and among them patients who had brain metastasis were in the worst condition (5 year survivalrate= 11%±0.10). Conclusions: Our findings support the observation that those women with higher stages ofbreast malignancies (especially with metastatic cancer) have less chance of surviving the disease. Furthermore,screening programs and early detection of breast cancer may help to increase the survival of those women whoare at risk of breast cancer.     

Risk Factor Analysis for Breast Cancer in Premenopausal and Postmenopausal Women of Punjab,India

Objective: Amritsar, the second largest town of agrarian state of Punjab, India reports high number of breast cancer cases every year. The present study investigated the etiology of breast cancer using various obesity indices and other epidemiological factors among breast cancer patients residing in and around Amritsar city. Methods: In this case control study, risk factors for breast cancer were analyzed in 542 female subjects: 271 females with breast cancer patients and 271 unrelated healthy females matched for age as control females. Results: Bivariate analysis for risk factors in cases and controls showed a lower risk (OR=0.65, 95% CI 0.43-0.99, p=0.04) in obese cases with BMI≥25kg/m2 as compared to subjects with normal BMI. Risk factor analysis showed that parameter which provided risk for cancer in postmenopausal women was obesity and in premenopausal women was parity. Postmenopausal women with BMI (overweight: OR=0.39, 95% CI 0.17-0.92, p=0.03; obese: OR= 0.26, 95% CI 0.13-0.52, p=0.00), WC (OR=0.17, 95% CI 0.05-0.52, p=0.00) and WHtR (p=0.02) had highr risk. Premenopausal women with 3 or less than 3 children had a higher risk (OR=5.54, 95 % CI 2.75-11.19, p=0.00) than postmenopausal women when compared to women with more than 3 children. Binary logistic regression analysis revealed that low parity (≤3) substantially increased the risk for breast cancer (OR=4.80, 95% CI 2.34-9.85, p=0.00) in premenopausal women. Conclusion: Obesity, parity associated breast cancer risk and reduced breastfeeding cumulatively predispose the premenopausal women of this region to higher risk of breast cancer.     

Prognostic Value of BCL2 in Women Patients with Invasive Breast Cancer

Background: Breast cancers are heterogeneous, making it essential to recognize several biomarkers for canceroutcome predictions especially in young women where the classical prediction parameters are not suitable. The goalfrom this study is to evaluate the impact of B cell lymphoma 2 (BCL2), P53 and Ki-67 proteins expression on survivalin young women patients with invasive ductal carcinoma. Patients and methods: Samples and clinical data from 238patients were collected between 2003 and 2017. They were selected according to 2 criteria: age ≤40 years old and most ofthem are affected by an Invasive Ductal Carcinoma. We evaluated BCL2, P53 and ki-67 expression by immunochemistrytest, and then we assessed correlations of these biomarkers expression with patient’s clinicopathological characteristicsand survival. Results: Triple negative breast cancer group showed a high frequency among our cohort but we emphasizean almost equitable distribution among all molecular groups. Contrary to other studies which reported that luminal Awas correlated with better prognosis, our analysis demonstrated that luminal A is correlated with the Scarff, Bloomand Richardson (SBR) grading 2 or SBR grading 3. To better investigate the prognosis, we analyze three biomarkersknown by their impact on physiopathology behavior on breast cancer BCL2, ki-67and P53. BCL2 is the more relevantone, it was correlated with molecular subtypes (p=0.0012) and SBR grading (p=0.0016). BCL2 seems to be the goodprognostic biomarker related to survival (p=0.004) with a protective role among patients when endocrine therapyis not provided and Lymph Node (LN) involvement is positive (p=0.021, p=0.000 respectively). Conclusions: Theclassical prognostic parameters based mainly on the molecular classification in breast cancer seem insufficient in thecase of young women. BCL2 protein expression analysis provides a better prognostic value. BCL2 should be clinicallyassociated in current practice when young women specimens are diagnosticated.     

Breast Cancer in Young Women: Prognostic Factors and Clinicopathological Features

Objective:The aim of this study was to determine most significant prognostic factor for overall survival of invasiveduct operable breast cancer from clinical stage, pathological stage, epidemiological, anatomic and cellular andmolecular genetic factors. Materials and Methods: Research design was prospective cohort. Duct invasive operablebreast cancer patients who were diagnosed and treated with standard protocol since 1993, followed prospectivelyuntil November 2003 by clinical stage, pathological stage, age, tumor size, lymph node status, histological grade,mitotic index, ER,PR, c-erbB2, p53 and MIB-1, until revealed outcome (death). Prognostic factor was analyzedunivariately for overall survival with Kaplan Meier method. Difference between two survival group was analyzedwith log- rank test. Independent prognostic factor was analyzed multivariately using proportional hazard (Cox)regression. Results:With univariate analysis, significant prognostic factors for overall survival were clinical stage(p<0.001), pathological stage (p<0.001), tumor size (p<0.001), lymph node status (p<0.001) and adjuvant chemotherapy(p <0.005). Multivariately, most significant prognostic factors for survival were lymph node status (p = 0.001 ; Expβ = 7.775; 95% CI: 2.276 – 26.56) and clinical stage (p = 0.029; Exp β= 2.142; 95% CI: 1.081 – 4.244). Conclusion:Independent prognostic factors for survival are lymph node status and clinical stage.     

Survival Rates of Invasive Breast Cancer among Ethnic Chinese Women Born in East Asia and the United States

Background: Few studies have compared the breast cancer survival rates of US born ethnic Chinese women and ‍the survival rates of Chinese immigrants. The main purpose of this study is to explore the difference of breast cancer ‍survival rates between the two populations and compare the survival rates to those of Caucasians born in the US. ‍Methods: Between 1973 and 2002, 365,215 women who had been diagnosed with primary invasive breast cancer ‍(ICD-O-2 C500:C509) were recorded in the Surveillance, Epidemiology, and End Results (SEER) registries. Of the ‍316,881 breast cancer patients who were white, 180,835 (57%) were born in the United States, 20,983 (7%) were ‍born elsewhere, and 115,063 (36%) had unknown birthplaces. Among the 3,634 breast cancer patients who were ‍ethnically Chinese, 952 (26%) patients were born in the US, 1,356 (37%) were born in East Asia, 146 (4%) were born ‍elsewhere, and 1,180 (33%) had unknown birthplaces. We compared the survival rates and estimated the risk ratios ‍(RRs) by the Kaplan-Meier estimates and the Cox proportional hazards models. Results: A lower 5-year overall ‍survival rate of breast cancer was observed among Chinese women born in East Asia (0.74, 95% CI=0.72-0.77) than ‍those born in the U.S. (0.79, 95% CI=0.76-0.81), with an adjusted hazards ratio of 1.22 (95% CI=1.06-1.40). The 5- ‍year survival rates for SEER stage were higher among Chinese women born in the U.S. (localized: 0.90, 95% CI=0.87- ‍0.93; regional: 0.71, 95% CI=66-0.77; distant: 0.16, 95% CI=0.06-0.25) than that among Chinese women born in ‍East Asia (localized: 0.86, 95% CI=0.83-0.89; regional: 0.68, 95% CI=0.63-0.73; distant: 0.16, 95% CI=0.07-0.25). ‍Higher 5-year survival rates among Chinese women born in the U.S. in comparison to Chinese women born in East ‍Asia were also observed in different calendar years (1973-1980, 1981-1990, 1991-2002), in surgery and radiation ‍therapy. Conclusions: Our analysis showed that among the Chinese breast cancer patients, women born in East Asia ‍had lower 5-year survival rates than women born in the United States. SEER stage, grade, and tumor size appear to ‍be important prognostic factors. The poor 5-year survival rates among Chinese women born in East Asia indicate ‍potential problems of accessing medical facilities for early detection, diagnosis and treatment because of potential ‍language and culture barriers, lower education level, as well as stress of the first generation of migrant Chinese ‍women in the United States.     

Survival Time and Molecular Subtypes of Breast Cancer after Radiotherapy in Thailand

Background: Breast cancer is an important cause of death among women. One way of classifying differentforms of breast cancer is by molecular features, usually in terms of the four subtypes: luminal A, luminalB, HER2-enriched, and triple negative. Objectives: This study aimed to investigate the association betweenmolecular subtypes and survival among breast cancer patients treated with radiotherapy. Materials and Methods:A retrospective cohort study was conducted. The subjects were 272 breast cancer patients who had receivedtreatment in the radiotherapy unit at Srinagarind Hospital, Thailand, between 1 January, 1999, and 31 May,2009. The end of the study was 1 June, 2014. Overall survival was defined as the time elapsing between initialregistration at the radiotherapy unit and death or the end of the study. Survival curves were estimated by theKaplan-Meier method, and a multivariate analysis was performed using Cox’s proportional hazard regressionmodel. Results: The patient mean age was 47.5±10.4 at the time of diagnosis. Of the 272 patients, 146 (53.7%)were classified as luminal A, 12 (4.4%) as luminal B, 30 (11.0%) as HER2-enriched, and 84 (30.9%) as triplenegative. The overall survival rates at 1, 3 and 5 years were 87.1%, 68.4% and 59.2%, respectively. According tomolecular subtypes, HER2-enriched patients had the lowest 5-year survival rate (30.0 %, 95%CI: 15.02-46.55).The median follow-up time was 8.37 years. In the Cox model analysis a higher risk of death was found for patientswith HER2-enriched (HRadj=3.34, 95%CI:1.96-5.67), triple negative (HRadj=2.17, 95%CI: 1.44-3.27), and stageIIlB (HRadj=2.20, 95%CI: 1.16-4.17) cancers. Conclusions: The worst survival rates were among patients classifiedas HER2-enriched, triple negative and at stage IIIB. Early detection and an advanced treatment modality areneeded to help these patients.     

DNA Repair Gene Patterns as Prognostic and Predictive Factors in Molecular Breast Cancer Subtypes

DNA repair pathways can enable tumor cells to survive DNA damage induced by chemotherapy and thus provide prognostic and/or predictive value. We evaluated Affymetrix gene expression profiles for 145 DNA repair genes in untreated breast cancer (BC) patients (n = 684) and BC patients treated with regimens containing neoadjuvant taxane/anthracycline (n = 294) or anthracycline (n = 210). We independently assessed estrogen receptor (ER)‐positive/HER2‐negative, HER2‐positive, and ER‐negative/HER2‐negative subgroups for differential expression, bimodal distribution, and the prognostic and predictive value of DNA repair gene expression. Twenty‐two genes were consistently overexpressed in ER‐negative tumors, and five genes were overexpressed in ER‐positive tumors, but no differences in expression were associated with HER2 status. In ER‐positive/HER2‐negative tumors, the expression of nine genes (BUB1, FANCI, MNAT1, PARP2, PCNA, POLQ, RPA3, TOP2A, and UBE2V2) was associated with poor prognosis, and the expression of one gene (ATM) was associated with good prognosis. Furthermore, the prognostic value of specific genes did not correlate with proliferation. A few genes were associated with chemotherapy response in BC subtypes and treatment‐specific manner. In ER‐negative/HER2‐negative tumors, the MSH2, MSH6, and FAN1 (previously MTMR15) genes were associated with pathological complete response and residual invasive cancer in taxane/anthracycline‐treated patients. Conversely, PMS2 expression was associated with residual invasive cancer in treatments using anthracycline as a single agent. In HER2‐positive tumors, TOP2A was associated with patient response to anthracyclines but not to taxane/anthracycline regimens. In genes expressed in a bimodal fashion, RECQL4 was significantly associated with clinical outcome. In vitro studies showed that defects in RECQL4 impair homologous recombination, sensitizing BC cells to DNA‐damaging agents.     

Association of Lifestyle and Other Risk Factors with Breast Cancer According to Menopausal Status: A Case-Control Study in the Region of WesternPomerania (Poland).

Purposes: The purpose of this study was to examine the association between family history, reproductive, anthropometric, lifestyle factors and risk of breast cancer according to menopausal status, using data from a case-control study conducted in the Region of Western Pomerania (Poland). Methods: A total, 858 women with histological confirmed breast cancer and 1085 controls, free of any cancer diagnosis, aged 28-78 years, were included in the study. The study was based on a self-administered questionnaire. Logistic regression was used to compute odds ratios and 95% confidence intervals and a broad range of potential confounders was included in analysis. Results: Protective effect of a late age at menarche, a longer period of breast-feeding, increased levels of: recreational physical activity, total vegetables or fruits intake, and intake of vitamins on the risk of breast cancer was observed among both pre- and post-menopausal women. Familial history of breast cancer, active or passive smoking, experience of a crude psychological stress were positively associated with breast cancer regardless menopausal status. Current body weight, current body mass index, increased alcohol intake elevated breast cancer risk in postmenopausal women, while these factors did not alter risk among premenopausal women. Increased consumption of red meat or animal fats elevated the risk in premenopausal women. More educated premenopausal women had lower breast cancer than those graduated from elementary school. Low family income increased the risk in premenopausal women. Conclusion: There is evidence for a dose-response relationship between several lifestyle factors and breast cancer risk. The results also suggest that some different mechanisms may operate in breast cancer etiology in pre-and post-menopausal women. A multifactorial process of breast cancer development, the complex interaction between physical activity, diet, energy intake and body weight, inconsistent and inconclusive data on breast cancer risk factors coming even from well-designed epidemiological studies are the case for continual update knowledge on primary prevention and identification of changes in behavior that will reduce the risk.