Prevalence of Established Nutritional

and Behavioral Risk Factors of Breast

Cancer among Apparently Healthy

Women

R.Shobana

Department of Applied Nutrition

Faculty of Livestock, Fisheries and Nutrition

Wayamba University of Sri Lanka

Background

25.4%

7.7%

5.8%5.7%

4.4%

50.9%

Breast

Ovary

Lip,mouth

Colon, rectum

Uterus

Others

Figure 1: Leading Cancer sites among Sri Lankan women

(National Cancer Control Program – 2009)

The most common gynecological cancer in the world

The most common among Sri Lankan women

Over 508,000 women died worldwide due to breast cancer in 2011 – (WHO, 2013)

Identification of risk factors, their distribution among population and risk assessment in healthy women promote screening

Number of deaths due to breast cancer is increasing

majority of cases are diagnosed at late stage

Routine screening is important for early detection

reduce the burden of breast cancer

Risk factors of breast

cancer

Heredity

Reproduction

Behavior

Diet

Diet and behavior can be modified to reduce the risk of breast cancer

Objectives

To determine the prevalence of established risk factors

of breast cancer among apparently healthy women

To identify the difference in the presence of risk factors

between two geographical locations

To estimate the lifetime breast cancer risk of apparently

healthy women in two geographical locations

Methodology

Sample selection

Data collection

100 individuals from Kandy

and 150 from Jaffna

Interviewer administered

general questionnaire

Interviewer administered

food frequency questionnaire

Data analysis Physical Activity Level (PAL) –

General Practice Physical Activity Questionnaire

Statistical analysis Descriptive statistics Chi-square tests and independent t-

tests – identify the difference in the presence of risk factors in selected two geographical locations

Breast cancer risk assessment

– Gail breast cancer risk

assessment tool

ResultsTable 1: Reproductive and anthropometric characteristics of individuals in Kandy and Jaffna

*significantly different at 95% confident

Reproductive characteristics Kandy Jaffna p value

Mean SD Mean SD

Age at menarche 12.7 ±1.2 13.8 ±1.6 0.030*

Parity 2.27 ±0.9 2.82 ±1.3 0.000*

Cumulative time duration of breast feeding (months)

69.9 ±35.8 47.5 ±28.3 0.003*

Mean time duration of breast feeding (months)

31.3 ±13.0 17.6 ±8.1 0.000*

BMI (kgm-2) 24.9 ±3.7 24.0 ±4.8 0.040*

Table 2: Dietary and behavioral factors affecting breast cancer

*significantly different at 95% confident

Dietary risk factors Dietary protective factors Behavioral factors

Consumption of Processed meat Cheese Butter/margarine Coconut oil Carbonated beverage

High frequencyconsumption of Egg Milk

Consumption of Sesame oil

High Frequency consumption of Fish Soya meat Cruciferous vegetables

Night shift workingPassive smokingPhysical Activity Level

Difference in distribution of dietary risk factors

33.0

94.0

22.0

0.7

22.0

36.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Processed meat Coconut oil CarbonatedBeverage

Freq

uen

cy (

%)

Food items

Kandy

Jaffna

Figure 2: Consumption of food items that increase the risk of breast cancer

Frequency consumption of egg and milk

Figure 3: Frequency consumption of egg

22.0

74.0

4.0

28.7

52.0

19.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

< 4times/week

≥ 4 times/week

Nonconsumers

Fre

qu

en

cy (

%)

Frequency consumption of egg

Kandy

Jaffna

5.0

32.0

10.0

53.0

5.2

13.4

33.4

48.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

≤ 3 times/month

1-6times/week

≥ once a day Nonconsumers

Fre

qu

en

cy (

%)

Frequency consumption of milk

Kandy

Jaffna

Figure 4: Frequency consumption of milk

Frequency consumption of protective dietary factors

29.0

39.0 40.0 41.0 41.0

58.0

18.0

56.060.7

26.0

50.0

40.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

≤ 4 times/week

> 4times/week

< 4times/week

≥ 4 times/week

≤ 4 times/week

4times/week

Fre

qu

en

cy (

%)

Food consumption frequency

Kandy

Jaffna

>

Figure 5: Frequency consumption of food items that reduce the risk of breast cancer

Fish Cruciferous vegetablesSoya meat

Life time risk of breast cancer in study sample (determined by Gail risk assessment tool)

28.3%

71.7%

High risk

Low risk

0 20 40 60 80 100

Kandy

Jaffna 66.9%

79.1%

0 20 40

Kandy

Jaffna 33.1%

20.9%

Figure 7: Distribution of low risk group

Figure 6: Distribution of life time risk of breast cancer

Figure 8: Distribution of high risk group

Conclusion

Risk factors Kandy Jaffna

Dietary risk factors

High consumption of

Processed meat

Coconut oil

Cheese

Butter/margarine

Egg

Low consumption of

Cruciferous vegetables

Soya meat

Reproductive risk

factors

Young age at menarche

Low parity

Higher BMI

Short duration of breast

feeding

Majority of the study sample in both locations under low risk

Among the high risk group, high proportion represented by

subjects in Jaffna (Based on Gail risk assessment tool)

Table 3: Dietary and reproductive risk factors common in Kandy and Jaffna

Acknowledgement

I would like to extend my sincere gratitude to

my principal supervisor and co-supervisor

all study participants in Kandy and Jaffna

all my colleagues

References

National Cancer Control Program. (2009) Cancer Incidence Data: Sri Lanka year 2001-2005. Cancer Registry, 7th publication. Colombo: National Cancer Control program.

World Health Organization (2013) Breast cancer: prevention and control [online] Available from: http://www.who.int/cancer/detection/breastcancer/en/index1.html [accessed on 02/04/2016].

Thiebaut, A. C. M., Kipnis, V., Chang, S.-C., Subar, A. F., Thompson, F. E., Rosenberg, P. S., … Schatzkin, A. (2007). Dietary fat and postmenopausal invasive breast cancer in the National Institutes of Health-AARP Diet and Health Study cohort. Journal of the National Cancer Institute, 99(6), 451–62. http://doi.org/10.1093/jnci/djk094 [accessed on 10/04/2016].

Friedenreich, C. M., Courneya, K. S., & Bryant, H. E. (2001). Influence of physical activity in different age and life periods on the risk of breast cancer. Epidemiology (Cambridge, Mass.), 12(6), 604–12. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11679785[accessed on 11/04/2016].

CharacteristicsKandy (%) Jaffna (%)

p value

Educational level

Primary 2.0 4.7

Secondary 8.0 22.7

G.C.E O/L 40.0 36.0 0.01*

G.C.E A/L 40.0 32.0

Higher 10.0 4.7

Employment status

Yes 33.0 22.0

No 67.0 78.0 0.050

Table 3: Distribution of selected demographic characteristics in study sample

*significantly different at 95% confident interval

Characteristics Kandy (%) Jaffna (%) p valueNight shift workingYes 6.0 0.7No 94.0 99.3 0.012*Night shift frequencyNone 94.0 99.3Once a week 3.0 0.72/more times per week 3.0 0.0 0.350Passive smokingYes 21.0 10.0No 79.0 90.0 0.009*Duration of exposure to passive smoking per dayNone 79.0 90.0< 2 hours 16.0 7.3≥ 2 hours 5.0 2.7 0.845Physical Activity LevelInactive 77.0 67.3Moderately inactive 12.0 24.0Moderately active 9.0 4.0 0.030*Active 2.0 4.7

Table 4: Distribution of selected lifestyle characteristics in study sample

Table 5: Distribution of selected reproductive characteristics in study sample

Characteristics Kandy (%) Jaffna (%) p valueOverweight/obese at adolescentYes 33.0 29.3No 67.0 70.7 0.534 Irregular periodsAmenorrhoea 6.0 5.3 0.822Polymenorrhoea 6.0 4.7 0.642Pregnant historyEver become pregnant 90.0 89.3Never become pregnant 10.0 10.7 0.866Abortion historyYes 14.0 14.7No 86.0 85.3 0.883 Contraceptive usageYes 35.0 27.3No 65.0 72.7 0.197

Table 6: Distribution of selected disease history in study sample

Diseases Kandy (%) Jaffna (%) p value

Diabetes

Yes 13.0 16.7

No 87.0 83.3 0.429

Gestational diabetes

Yes 2.0 4.0

No 98.0 96.0 0.379

Hypertension

Yes 21.0 17.3

No 79.0 82.7 0.467

Gestational hypertension

Yes 8.0 4.7

No 92.0 95.3 0.277

Characteristics Kandy (%) Jaffna (%) p valueCumulative time duration of breast cancer (months)0-12 months 12.0 16.013-24 months 8.0 12.025-36 months 5.0 13.337-48 months 14.0 22.7≥ 49 months 61.0 36.0 0.003*cumulative time duration of breast feeding≥ 24 monthsYes 80.0 72.0No 10.0 17.3 0.151Mean time duration of breast feeding < 24 months 33.0 78.0≥ 24 months 67.0 22.0 0.000*

Table 7:Distribution of characteristic of breast feeding time duration in study sample

*significantly different at 95% confident interval

Characteristics Kandy (%) Jaffna (%) p value

Pork 5.0 0.0 0.006*

Mutton 12.0 30.0 0.001*

Sausages

Consumers 33.0 0.7

Non consumers 67.0 99.3 0.000*

Meat balls

Consumers 9.0 0.0

Non consumers 91.0 100.0 0.000*

Meat an processed meat

84.0

33.0

9.0

76.0

0.7 0.00.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Meat Sausages Meat balls

Fre

qu

en

cy (

%)

Meat and processed meat

Kandy

Jaffna

84.0

3.0 5.0

12.0

76.0

2.0 0.0

30.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Poultry Beef Pork Mutton

Fre

qu

en

cy (

%)

Types of meat

Kandy

Jaffna

Figure 1: Frequency distribution of meat

and processed meat among individuals in

Kandy and Jaffna

Figure 2: Frequency distribution of different

types of meat among individuals in Kandy

and Jaffna

Distribution of meat and processed meat among

individuals in Kandy and Jaffna

47.0

84.0

77.0

68.0

30.0

52.0

32.0

76.0

70.0

5.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Milk Yogurt Ice cream Curd Cheese

Fre

qu

en

cy (

%)

Milk and milk products

Kandy

Jaffna33.0

25.0

92.0

29.0

11.0

96.0

81.0

63.3

38.0

60.764.0

58.7

81.386.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Shark Salmon Dried fish Prawns Crabs Egg (Hen) Soya meat

Fre

qu

en

cy (

%)

Protein sources

Kandy

Jaffna

Distribution of protein sources among individuals in

Kandy and Jaffna

Figure 3: Protein source consumption frequency among individuals in

Kandy and Jaffna

Figure 4: Milk and milk products consumption frequency among

individuals in Kandy and Jaffna

Distribution of milk and milk products among

individuals in Kandy and Jaffna

94.0

40.0

75.0

22.0

81.3

28.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Coconut oil Vegetable oil Butter/Margarine

Fre

qu

en

cy (

%)

Types of fat

Kandy

Jaffna

Figure 5 : Different types of fat consumption frequency among

individuals in Kandy and Jaffna

Distribution of different types of oil among individuals

in Kandy and Jaffna

Characteristics Kandy Jaffna p value

Mean SD Mean SD

Age at interview 48.7 ±10.7 53.2 ±10.5 0.960

Age at menarche 12.7 ±1.2 13.8 ±1.6 0.030*

Age at menopause 48.7 ±3.5 48.6 ±3.9 0.196

Age at first live birth 25.9 ±4.1 26.9 ±4.7 0.137

Age at last child birth 30.6 ±4.3 32.2 ±4.3 0.867

Parity 2.27 ±0.9 2.82 ±1.3 0.000*

Number of abortion 1.29 ±0.6 1.19 ±0.4 0.205

Cumulative time duration of breast feeding (months) 69.9 ±35.8 47.5 ±28.3 0.003*

Mean time duration of breast feeding (months) 31.3 ±13.0 17.6 ±8.1 0.000*

BMI (kgm-2) 24.9 ±3.7 24 ±4.8 0.040*

*significantly different at 95% confident interval

Table 1: Descriptive characteristics of apparently healthy

women participated in the study

Distribution of frequency consumption of significantly different dietary risk factors

22.0

74.0

28.7

52.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

< 4 times/week ≥ 4 times/week

Fre

qu

en

cy (

%)

Egg consumption frequency

Kandy

Jaffna

5.0

32.0

10.0

3.2

13.3

33.3

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

≤ 3 times/month

1-6 times/week ≥ Once a day

Fre

qu

en

cy (

%)

Milk consumption frequency

Kandy

Jaffna

Distribution of life time risk of breast cancer in study sample

54.1%45.9% low risk

High risk

40 45 50 55 60

Kandy

Jaffna 57.8%

48.4%

0 10 20 30 40 50 60

Kandy

Jaffna 42.2%

51.6%

Figure 5: Distribution of risk category

Figure 6: Distribution of high risk category

Figure 7: Distribution of low risk category