This study evaluates the risk of cardiovascular disease (CVD) following breast cancer, accounting for baseline CVD risk.n = 4328) were selected matched for age, year, and time since cohort enrollment. Based on CVD risk factors at cohort enrollment, 10-year risk of CVD was calculated and categorized: low (< 10%), intermediate (10–20%), high (> 20%). Cox proportional hazard models assessed the risk of CVD events  and CVD mortality of women with versus without breast cancer, adjusted for baseline CVD risk.Within the EPIC-NL (Dutch part of the European Prospective Investigation into Nutrition and Cancer) cohort, 1103 women were diagnosed with breast cancer. For every breast cancer patient, 3–4 women without breast cancer  and 325 (7.5%) CVD events occurred in women with and without breast cancer, respectively. In the low CVD risk group, women with breast cancer had 1.44 (95% CI 1.00–2.06) times higher risk of CVD events than women without breast cancer. In the intermediate and high CVD risk categories, risk of CVD events was similar in women with and without breast cancer. Overall, women with breast cancer had 1.77 (95% CI 1.10–2.86) times higher risk of CVD mortality than women without breast cancer.Among women with low CVD risk, women with breast cancer have a higher risk of CVD event than women without breast cancer. Overall, women with breast cancer have a higher risk of CVD mortality than women without breast cancer.The online version of this article (10.1007/s10549-018-4723-0) contains supplementary material, which is available to authorized users. Breast cancer incidence and survival are high in developed countries . SurvivaBreast cancer patients may have a higher CVD risk compared to the general population. Although cancer treatments such as anthracycline-based regimens, trastuzumab, and radiotherapy reduce the risk of cancer recurrence and death, they have been associated with an increased risk of CVD –16. AnthExcept for a few studies , 22, 23,The current study included women participating in the Dutch contribution to the European Prospective Investigation into Cancer and Nutrition (EPIC-NL), which consists of the MORGEN and Prospect cohorts . Detailst0) were not eligible for the current study. Furthermore, women were not included if they had not given consent for linkage with vital status or morbidity registries (n = 2717) or had missing information on hospital admission or cause of death (n = 55). The current study included all women diagnosed with a first in situ or invasive breast cancer during follow-up in the EPIC-NL cohort until December 31, 2010 (referred to as ‘exposed’ in the current study). Subsequently four women without breast cancer during follow-up were matched to the exposed women on age at breast cancer diagnosis (t1), year of breast cancer diagnosis (t1), and time between EPIC-NL enrolment (t0) and breast cancer diagnosis (t1) (the ‘unexposed’ group). We would like to stress that this is not a matched case–control study, but rather a prospective follow-up study, matched on the exposure status (breast cancer).Women with prevalent cancer at EPIC-NL enrolment  and other . Diabetes was present if participants were diagnosed with diabetes according to the general questionnaire. Physical activity was assessed by questions on occupational and recreational physical activity during the past year at t0  and medians [interquartile range (IQR)] were used to describe continuous variables with and without normally distributed data, respectively. Time at risk started at d models  were used models  was perft1, i.e., the stratification by Framingham risk created new groups and therefore women within these groups were no longer age-matched, and body mass. The analysis on the risk of death from CVD was performed only for the total study population and adjusted for Framingham risk score; the low number of deaths did not allow for stratification by Framingham risk category. In addition, a sensitivity analysis was performed excluding women with a history of CVD to test the hypothesis that women with a known risk of CVD at breast cancer diagnosis receive less cardiac toxic breast cancer treatments.The analyses on the risk of a CVD event  were performed for the total study population and stratified by low (< 10%), intermediate (10–20%), or high (> 20%) Framingham risk category. The analysis including the total study population was adjusted for Framingham risk score and body mass index. The analysis stratified by Framingham risk category was adjusted for age at Statistical analyses were conducted using IBM SPSS statistics version 23, except for the competing risk analyses which were conducted with SAS version 9.4.t0), median age of the study population was 54 years (IQR = 50–60) for women with breast cancer and women without breast cancer  than for women who would not develop breast cancer  (Table t0 was comparable for women with and without breast cancer in the low Framingham risk category: 25.2 (SD = 3.7) and 25.1 (SD = 3.8), respectively . In the intermediate and high Framingham risk categories, the mean body index was also comparable between women with breast cancer (27.3 (SD = 4.2) and 28.5 (SD = 3.8), respectively) and without breast cancer (27.2 (SD = 4.2) and 28.1 (SD = 4.5), respectively).At EPIC-NL cohort enrolment  and this was 6 years (IQR = 3–10) for women without breast cancer .Breast cancer patients had 5 years IQR = 2–9) median follow-up since t and this–9 medianThe risk of a CVD event  did not differ between women with breast cancer and women without breast cancer: adjusted HR = 1.16 (95% CI 0.92–1.47) Table . HoweverThe results of this study indicate that the risk of a CVD event  among women with a low Framingham risk (< 10%) is 44% higher in women with breast cancer compared to women without breast cancer. No difference was observed in the total study population. We did find that women with breast cancer have an adjusted 77% higher risk of death from CVD than women without breast cancer.Although breast cancer is the main cause of death in women with breast cancer, CVD is increasingly recognized as an important contributor to mortality in breast cancer survivors –41. CVD Several CVD disorders may contribute to a higher CVD risk following breast cancer. Women with breast cancer in the low Framingham risk category were more often hospitalized with heart failure or acute pulmonary heart disease than low-risk women without breast cancer. Heart failure is a known complication induced by anthracycline-based chemotherapies, trastuzumab, and radiotherapy-induced cardiomyopathy due to coronary artery calcifications caused by high radiotherapy heart dose –47. AcutA study that stratified women by CVD risk at breast cancer diagnosis showed that in the low CVD risk group, women treated with radiotherapy were not at increased risk of CVD . HoweverThere is also a suggestive clarification for the observations in our study. The sensitivity analysis shows that the risk of a CVD event in women with breast cancer with a low Framingham risk score was higher when women with a history of CVD were excluded. This may indicate that in clinical practice women with a higher CVD risk, i.e., history of CVD, receive less cardiac toxic cancer treatments than women without a higher CVD risk . As sucht1) and thereafter. However, CVD risk factors may have changed between t0 and t1 (median time of 8 years) and after t0. This would result in women shifting to another Framingham risk category. It Is unclear how this would affect our results. Another concern is that we likely have missed women with CVD. The use of hospital discharge registry underestimates the true incidence rates, especially for coronary heart disease and heart failure [We were not able to account for changes in CVD risk factors after EPIC enrolment. We assume that these factors used for calculating the Framingham risk score remained more or less similar until time of breast cancer diagnosis  than women without breast cancer. Overall, women with breast cancer have a higher risk of death from CVD than women without breast cancer adjusted for Framingham risk score. Future research may investigate an individualized approach for breast cancer patients to optimize the balance between high breast cancer tumor control and minimal cancer treatment-induced CVD risk.Supplementary material 1 (DOCX 31 kb)Below is the link to the electronic supplementary material.


To investigate the awareness and knowledge level of breast cancer among Chinese participants.Case–control study.This study was based on the database of the minister-affiliated hospital key project of the Ministry of Health of the People’s Republic of China that included 21 Chinese hospitals between April 2012 and April 2013.Matched study was designed among 2978 participants with Han ethnicity aged between 25 and 70.2 test, reliability analysis, exploratory factor analysis, and univariate and multivariate logistic regression analyses were performed to know the level of breast cancer knowledge and find the breast cancer awareness-associated factors.Student’s t-test, Pearson’s χ80.0% (2383/2978) of the participants had poor awareness level of breast cancer. In-depth knowledge of breast cancer such as early symptoms and risk factors was poorly found among them. Television broadcast and relatives or friends with breast cancers were the main sources of information about breast cancer. Of all participants, 72.8% (2167/2978) had heard about breast cancer as a frequent cancer affecting women, and 63.3% (1884/2978) knew that family history of breast cancer was a risk factor for breast cancer. Over half of them were aware that a breast lump could be a symptom of breast cancer. Multivariate analysis identified the following variables that predicted awareness of breast cancer: young age , occupation  , high household social status , breast hyperplasia history , high behavioural prevention score .Most women were aware of breast cancer as a disease, but their in-depth knowledge of it was poor. More publicity and education programmes to increase breast cancer awareness are necessary and urgent, especially for the ageing women and agricultural workers. This was a multicentre, matched case–control study designed to investigate the breast cancer awareness of women in 21 hospitals in Northern and Eastern China.We designed this hospital-based study to investigate the level of knowledge of breast cancer in female patients with breast cancer. Meanwhile, we compared the results with our previous community-based study.Although we used the same questionnaire in these two studies, we still did not have uniform standards and methods for measuring knowledge evaluation. Hence a standard measurement of breast cancer-related knowledge should be developed.Breast cancer (BC) is one of the most common cancers and the leading cause of cancer-related death among women worldwide.4et al reported that more than 70% of women with BC in developed countries had disease stage I or II, compared with 20%–60% in low/middle-income countries.Many studies have shown that the early detection of BC plays a vital role in patient survival. Further, a delay in the diagnosis and subsequent treatment can lead to worsening of morbidity and mortality.To promote BC awareness among Chinese women and build education programmes to prevent delays in diagnosis and treatment, healthcare specialists must know their current level of understanding. Thus, we performed this cross-sectional survey in China to assess the level of awareness and knowledge of BC-related symptoms and risk factors, and identify awareness-related factors.We designed a multicentre, case–control, hospital-based study to investigate the awareness of women in 21 hospitals located in 11 provinces in Northern and Eastern China. This study was conducted between April 2012 and April 2013 and was funded by the Ministry of Health of the People’s Republic of China.All participants were of the Han ethnic group. Cases and controls were matched 1:1 for age (±3 years), diagnosis hospital  and timing of examination (within 2 months). The inclusion criteria for BC group were as follows: (1) newly diagnosed and histologically confirmed BC and (2) women aged between 25 and 70 years old. Women who had recurrent or metastatic BC and/or complications of other malignant tumours confirmed by clinical or pathological diagnosis were excluded from this group. The members of control group were all from the regular physical examination centre in cooperation hospitals. The inclusion criteria for the control group were as follows: (1) negative physical examination results; (2) negative ultrasound scans of breast and/or mammographic screening results; and (3) no evidence or history of cancer. The exclusion criteria for the control group were as follows: a neoplastic disease at any other site, history of cancer or other major chronic diseases. We collected data strictly according to the inclusion and exclusion criteria, and then excluded subjects whose data were incomplete or lacking. Finally, a total of 1489 case–control sets were involved.A self-designed structured questionnaire was previously developed to record information through person-to-person interviews. The theoretical basis of this interview questionnaire was numerous published articles and the opinions of a variety of experts in breast surgery, epidemiology, statistics, nutrition and molecular biology. Several similar questions were asked in different sections of the questionnaire to minimise recall bias. Previously, we conducted an investigation to assess the practicality and effectiveness of the survey and by which we validated the questionnaire.Awareness and knowledge of BC were assessed through 15 items on risk factors and early symptoms of BC included in the questionnaire . For eacInterviewers were selected by medical professionals and medical postgraduate students. All interviewers had completed standardised training and were certified to conduct surveys independently. The questionnaires and forms were coded twice and were entered twice by different clerks. If there were inconsistent records, professionals would manually check and correct these. We also used computer software to check the logic and reasonable range of responses throughout the questionnaire to identify contradictory responses.2 test, reliability analyses, exploratory factor analysis, and univariate and multivariate logistic regression analyses, were used to identify factors related to the knowledge of BC. ORs with 95% CIs were also calculated. All data analyses were performed using SPSS V.21.0.EpiData V.3.1 was used to create the database. Statistical methods, including Student’s t-test, Pearson’s χIn this survey, 2978 women were included in our final analysis. The demographic characteristics are shown in Responses to questions about BC among the population are summarised in Regarding the subjects’ BC behavioural prevention, 1109 (37.2%) women had performed BSE at least once, 1020 of the 2978 women (37.2%) had undergone CBE, 35.9% had received breast ultrasound and 22.2% had undergone a radiographic breast examination. We set a 3-point cut-off value to distinguish high and low awareness of breast examination, and we found that more than half of the women  had high awareness of behavioural prevention.Most of the subjects obtained their information on BC from television (TV) broadcast and relatives or friends with BC, which accounted for 30.6% and 29.6% of all women, respectively .Results for univariate analysis indicated that awareness and knowledge of BC were related to history of BC, age, location, education status, occupation, household monthly income, social status, history of breast hyperplasia, family history of BC, drinking, smoking, physical training execution, waist-hip ratio, present life satisfaction and behavioural prevention score. All significant variables were included in multivariate analysis. Multivariate analysis identified that age , occupation , social status , history of breast hyperplasia  and behavioural prevention score  were independently correlated with BC awareness and knowledge  through Reliability and construct validity and internal consistency reliability estimates of the 15-item scale of awareness and knowledge of BC were calculated using Cronbach’s alpha. The α-coefficient for the total scale was 0.902, which was considered acceptable for internal consistency reliability.14In this hospital-based study, we evaluated the level of BC awareness among Chinese women. Results showed that most participants had poor awareness regarding BC (80.0%), which is similar to our previous community-based study (81.4% of subjects had poor awareness). This seems to be a common phenomenon both in the low/middle-income countries and the developed countries, although the proportion of women with high awareness in developed countries was reportedly higher than that in low/middle-income countries or regions.15 16It has also been published that different approaches for obtaining cancer-related knowledge influenced the level of awareness of BC.In our study, more than two-thirds (72.8%) of the participants knew or had heard about BC, but their in-depth knowledge of the early symptoms of BC and risk factors was insufficient. Although more than half (52.7%) of them knew that the presence of a lump in the breast was a BC symptom and family history was an important risk factor for BC, the proportion of women who knew other BC symptoms and BC risk factors was low . These results were consistent with our previous studyet al revealed that the level of knowledge of BC decreased as the age of responders increased.et al showed that older women were more interested in BC knowledge than younger women. Okobia et al also arrived at the same conclusion among Nigerian women.Many studies found a close relationship between age and awareness and knowledge of BC.The relationship between occupation and the level of awareness and knowledge of BC was also demonstrated in this study. Workers and medical staff tended to be more aware of the symptoms and risk factors for BC, while the awareness of agricultural workers was significantly poorer. Similar results were observed in many other studies including our community-based population survey.et alet al.Many studies demonstrated that education level was a major determinant of BC awareness and increased awareness was associated with higher levels of education. Terzioğlu et al,Women with a history of breast hyperplasia tended to know more about BC in our study . In some cases, the symptoms of breast hyperplasia may be similar to those of cancer; thus, women who had been diagnosed with breast hyperplasia were likely to pay more attention to breast health and to take better precautions. Breast hyperplasia may cause breast tenderness and other symptoms, but it may also serve as a forewarning for increased self-health awareness. This result was consistent with the research by Kosgeroglu et alet alRegarding behavioural prevention of BC, our study showed that 61.2% of women adequately and consciously performed breast examination. Among the women with high awareness of BC, most had accepted breast-related examinations and 61.2% of them obtained a high behavioural prevention score. However, the proportions of women who accepted BSE, CBE, breast ultrasound or breast radiograph were still low (less than 40%). Rates of BSE practices, clinical examination and radiographic screening were lower than those reported in the studies of Whitman We compared the results with our earlier study.41In this study, the result of the reliability index was 0.902 and the validity was 0.883, while the results in our previous study were 0.910 and 0.870, respectively. We used the same questionnaire in these two studies, but we still did not have uniform standards and methods for measuring BC-related knowledge evaluation. Thus, we consider that a standard measurement of BC-related knowledge should be developed, which will be a part of important content of our further study. Additionally, the reality and validity of our 5-item questionnaire for assessing levels of behavioural prevention was not good enough for this assessment , which limited the results of the study in terms of BC practices.Combined with our previous study, we concluded that most women were aware of BC as a disease entity, but their in-depth knowledge of the disease was poor. BC awareness, increased publicity and education programmes are necessary and urgent, especially for older women and agricultural workers.


Retinol binding protein 4 (RBP4) is a recently identified adipokine that is elevated in patients with obesity or type 2 diabetes. A growing body of research has shown that RBP4 is associated with several types of cancer. However, no studies have investigated the relationship between serum RBP4 levels and breast cancer risk. We performed a case-control study to evaluate the association between serum RBP4 levels and the risk of breast cancer.From August 2012 to December 2013, four-hundred subjects including 200 patients diagnosed with primary breast cancer and 200 matched healthy women were consecutively enrolled from Affiliated Hospital of Qingdao University Medical College. Blood samples were collected from healthy controls and breast cancer patients before commencement of treatment. Enzyme-linked immunosorbent assay was used to evaluate the serum RBP4 levels in separated serum samples. Meanwhile, the characteristics of breast cancer cases and controls were collected from medical records and pathological data.The serum levels of RBP4 were significantly higher in patients with breast cancer than that in the healthy control group . Compared to the subjects in the lowest quartile of serum RBP4 level, the adjusted ORs (95% CIs) is 2.16(1.01–4.61) and 2.07 (1.07–4.00) for women in the second and highest RBP4 tertile, respectively. For breast cancer patients, patients with PR or ER negative displayed significantly higher serum RBP4 levels than those with PR or ER positive.Our results for the first time suggested serum RBP4 levels could be associated with the risk of breast cancer. However, further prospective studies are essential to confirm these observed results. Breast cancer is the most common malignancy tumor and is the main cause of cancer deaths among women worldwide, with an estimated 1.67 million new cases in 2012 .The occurrence and development of breast cancer is a complicated dynamic process with many reported risk factors, and one of the established risk factors for breast cancer developments is obesity, 5. AdipRBP4, a novel adipokine, belongs to the lipocalin family of proteins that transport small hydrophobic molecules. RBP4 is a 21-KDa protein and the protein encoder gene is located on chromosome 10 10q23.33). Previou.33. PrevTo the best of our knowledge, no studies have investigated the relationship between RBP4 and the risk of breast cancer. Hence, the purpose of the present study was to determine whether high levels of serum RBP4 are associated with an increased risk of breast cancer using a case–control study. In addition, we also investigated the association between serum RBP4 levels and clinicopathological features of breast cancer.From August 2012 to December 2013, a case-control study was conducted at Affiliated Hospital of Qingdao University Medical College. Four-hundred patients including 200 cases and 200 matched controls were consecutively enrolled in our study. Each subject signed standard consent statement before being recruited into this study. The study protocol was approved by Qingdao university medical college ethics committee. Cases were women with a diagnosis of primary breast cancer recruited consecutively from individuals visiting breast surgeon of Affiliated Hospital of Qingdao University Medical College. The inclusion criteria for cases were as follows: 1) diagnosing with primary breast cancer within six months, 2) confirmed by histopathology, 3) no receiving chemotherapy, radiotherapy, surgery, or blood transfusions, 4) having complete pathological data and medical records. Diagnosed patients who suffered from serious complications or other types of cancer were not included. Then, the pathology report from each case was reviewed to confirm the diagnosis. In the same period, 200 female subjects (controls) without any clinical signs, symptoms or suspicion of any type of cancer in their medical history were was randomly selected from physical examination center of Affiliated Hospital of Qingdao University Medical College. Efforts were made to frequency match the cases and controls by age .Subjects’ characteristics including age, BMI, age at menarche, menopausal status and history of abortion were collected from medical records. Tumor size, pathological type, metastasis status and the status of p53, estrogen receptor (ER) and progesterone receptor (PR) of 200 breast cancer specimens were obtained from pathological data. The pathological tumor stage was defined according to the 7th edition of the tumor-node-metastasis (TNM) classification of the American Joint Committee on Cancer (AJCC).Blood samples of patients were drawn before initiating chemo (radio)therapy and/or surgical resection of tumor. After at least 12 hours fasting, blood samples were collected from breast cancer patients and healthy controls. To separate serum from blood cells, samples were centrifuged at 3,000g for 10 min at 4°C following 30-min clotting. Freshly separated serum was employed for determination of lipid profile and blood glucose, and the remaining aliquots of serum were stored at −80°C until they were assessed for serum RBP4 levels. The assay of triglycerides (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and fasting blood glucose (FBG) were carried out in an automated analyzer . Serum RBP4 was estimated by an enzyme-linked immunosorbent assay (ELISA) (R&D Systems China Co. Ltd) with the lower detection limit of 0.048 mM/l. The inter- and intra-assay coefficients of variation were 7.2% and 6.9% respectively.All the data were statistically analyzed using the SPSS 17.0 software and the significance level was set at p ≤ 0.05. Data are presented as means±SD as the data was normally distributed. To compare variables between two groups or subgroups, Chi-square tests for categorical variables and Student’s t-test or one-way ANOVA for continuous variables were used. Multivariate logistic regression models were used to assess the risk of breast cancer according to the tertiles of serum RBP4 level. Multivariate linear regression analysis were used to determine the relationships between BMI, TC, TG, HDL, LDL, FBG and serum RBP4.Characteristics of cancer patients and healthy controls are summarized in P <0.05). Subjects in the second RBP4 tertile also revealed increased risk of breast cancer and the OR is 2.03(P <0.05). When the model was further adjusted for potential risk factors of breast cancer, the results were similar, with ORs (95% CIs) of 2.16(1.01–4.61) and 2.07(1.07–4.00) for women in the second and highest RBP4 tertile, respectively, when compared to those in the lowest tertile(P <0.05).P < 0.05), while circulating RBP4 levels were significantly correlate with BMI and TG in control group. Both in two groups, we fail to found significant relationship between RBP4 and TC, HDL, LDL or FBG.2), serum RBP4 levels was not significantly associated with the risk of breast cancer. Whereas, serum RBP4 levels were positively associated with breast cancer risk among subjects with lower BMI (<25 kg/m2) .To further evaluate the association of likelihood of breast cancer risk with serum RBP4 levels, we performed a stratified analysis by BMI .In the sIn this current case-control study, we observed a positive correlation between the levels of serum RBP4 and breast cancer risk, especially among patients with lower BMI. These associations were largely independent of established breast cancer risk factors, including age, menarche age and BMI and blood-lipoid indexes. Among breast cancer patients, serum RBP4 levels were significant higher in patients with ER or PR negative than those in patients with ER or PR positive.Most of the adipokines have been linked to the risk of various kinds of cancer such as gastric malignancy, hepatocSeveral studies have showed that RBP4 has a role in some types of cancers such as lung, pancreaPrevious studies revealed a correlation between serum RBP4 levels and obesity, dyslipidemia and FPG. Two studies in Chinese population have reported that RBP4 levels are positively associated with BMI, TG, TC, LDL and FBG while negatively related to HDL, 39. How2). In the higher BMI (≥25kg/m2) subgroup, there is no significant association of serum RBP4 with the risk of breast cancer. This result is agreement with the previous study on RBP4 and risk of colon adenoma [Obesity have been closely related to occurrence and development of breast cancer, 42, whi adenoma , they alSeveral epidemiological studies have reported that serum lipid abnormalities, including elevated total cholesterol, LDL-cholesterol and triglycerides and reduced HDL-cholesterol, increase the risk of breast cancer–46. In tIn this study, we also analyzed the association between serum RBP4 levels and clinical characteristics among breast cancer patients. The results showed that the high levels of serum RBP4 is associated with negative ER and PR status, but not with histopathological subtype, TNM stage, metastasis and P53 status. ER and PR are hormone receptors on breast cell that receive hormone signals informing the cell to grow. The expression status of these hormone receptors in breast cancer is associated with clinical and biological heterogeneity. Many stDietary pattern have been closely related to the risk of breast cancer, while dIn summary, the results from this study show that higher circulating levels of RBP4 are associated, independent of BMI, lipids, FBG and other potential risk factors, with an increased risk of breast cancer. We infer that serum RBP4 level may be correlated with breast cancer prognosis. Further investigation is merited to corroborate our findings and to elucidate the underlying molecular mechanism between RBP4 and breast cancer.S1 Table(XLSX)Click here for additional data file.


To determine the risk factors of obesity and diet on breast cancer in Ankara, Turkey.A case-controlled study was carried out on newly diagnosed 40 breast cancer patients [patient group (PC)] and 40 volunteer individuals [control group (CG)] with no diagnosis of cancer and history of cancer in the family with similar characteristics to the age and gender-matched patient group between March and July 2016. All the individuals were administered a questionnaire by face-to-face interview method.2 in PG and 30.1±6.18 kg/m2 in CG (p>0.05). It was determined that intake of vitamin C and fiber decreases the risk of breast cancer. Also, eating quickly and smoking were risk factors for breast cancer (p<0.05).The mean menarche age, age at first birth and menopause age were 13.0±1.17, 22.6±3.78 and 44.33±2.39 years in PG and 12.3±0.95, 21.6±2.99, 46.71±2.41 years in CG, respectively. The mean BMI values were determined as 28.1±6.75 kg/mThis study indicated that there are relationships between menarche age, menopause age, and age at first birth, eating quickly, smoking and breast cancer. Conversely, there are significant negative relationships between dietary fiber, vitamin C intake and breast cancer. As a result, it can be said that there is a link between breast cancer and lifestyle factors and a reduction in the risk of developing breast cancer can be achieved through changes in diet, one of the lifestyle factors. Breast cancer is known to be the most commonly observed cancer type in Turkey and in the world.7The influence of dietary factors on breast cancer risk have been investigated extensively. Up to now, however, the findings have been mostly inconclusive and inconsistent.This case-controlled study was carried out on newly diagnosed 40 breast cancer patients aged 18 years and over who applied to Hacettepe University Faculty of Medicine Oncology Hospital Medical Oncology Unit [patient group (PC)], and 40 volunteer individuals with no diagnosis of cancer and no cancer history in the family, who had similar characteristics to the age and gender-matched patient group and who applied to Hacettepe University Department of Internal Medicine [control group (CG)] between March and July 2016. All the individuals included in the scope of the study were provided a questionnaire composed of three parts  by face-to-face interview method. The cases and controls were patients who visited hospital for the study. All the patients who came to the hospital and volunteered were taken into the sample since the number of patients involved in the study was limited. Maximum number of patients that can be reached within the permitted duration of the study was achieved. The study was approved by the Institutional Review Board and Ethics Committee of Baskent University (Project No: KA15/22) and all subjects gave written consent.The nutritional status of the participants was determined by food frequency questionnaire. The portion sizes of the food items were determined by means of a picture booklet consisting of 120 food images. The energy and nutrition values were assessed using the Nutrient Base program (BEBIS).102).Body weight of the participants was measured with light clothes on, but without socks and shoes by Tanita Body Composition Analyzer UM-073. Height was measured in a standing position with head at Frankfort plane using the Seca 206 mechanical measuring tape, which is a commercial stadiometer. The following formula was used in order to calculate the Body Mass Index (BMI): weight (kg)/height (m2) test was used to compare the demographic characteristics of the participants. In the cases when there were dichotomous dependent variables, unconditional logistic regression analyses were performed in order to identify statistical differences across the groups. The relative risks were calculated as odds ratio (OR) with 95% confidence intervals (CIs). The differences that had a probability value of p<0.05 were deemed significant.The SPSS version 20.0 for Windows was used in order to perform the statistical analysis. The results were displayed as mean±standard deviations (±SD), frequencies and percentages. Pearson chi-square .Logistic regression analyses of dietary energy and some nutrients intakes, BMI and breast cancer are shown in Eating, general habits and breast cancer risk are presented in Breast cancer is a complex and multifactorial disease in which both environmental and genetic factors interact closely, and it also presents serious problems for public health.15It is known that menarche age, age at first birth and menopause age are the risk factors for breast cancer.18It has been hypothesized that diets with high amounts of fiber or which have a small fraction of fiber provide protection against breast cancer by means of certain mechanisms. Such mechanisms include the inhibition of intestinal reabsorption of estrogen excreted through the biliary system, reduction in the synthesis of estrogen by inhibition of human estrogen synthetase and a decrease in the glycemic index.Cigarette is among significant risk factors in carcinogenesis. Smoke contains thousands of compounds including numerous mutagens such as polycyclic aromatic hydrocarbons (PAH) and nitrosamines.It is predicted in a projection of the future health and the economic burden obesity will impose in 2030 that there will be approximately 500,000 additional cancer cases will appear in the United States by 2030 if the current trends in obesity continues. Another finding of this analysis is that if the BMI of every adult was decreased by one percent, which corresponds to an approximate weight loss of 1 kg (or 2.2 lbs) for an average-height adult, the increase in the number of cancer cases would be prevented and about 100,000 new cancer cases would be avoided.6The results of this study showed that the mean BMI was similar in groups and there was no statistically significant effect of BMI on breast cancer (p>0.05). This situation suggests that it depends on the fact that the educational levels of individuals with breast cancer are higher than the individuals in the control, they pay greater attention to their nutritional status, and they have just received a diagnosis.This study has a small sample size due to the difficulty of finding individuals recently diagnosed with breast cancer during the study. Furthermore, since it was carried out in one single hospital, no generalization might be made for the obtained results. Stronger results would be obtained by enlarging the sample size provided that more patients with recent breast cancer diagnosis could be reached.In this study, it was found that there is a significant positive relationship between breast cancer and menarche age, age at first birth, menopause age, eating quickly and smoking; on the other hand, a significant negative relationship between intake of dietary fiber and vitamin C and breast cancer. It could be said that the risk of breast cancer development might be decreased through changes in lifestyle and with a healthy and balanced diet. There is need for further studies to confirm the observations made in the present study.


P = 0.19). Apart from albumin, none of the serum markers of inflammation studied showed a link with the risk of developing thyroid cancer–suggesting that the role of inflammation may be more complicated and requires assessment of more specialised measurements of inflammation.Chronic inflammation is one of the underlying risks associated with thyroid cancer. We ascertained the association between commonly measured serum biomarkers of inflammation and the risk of thyroid cancer in Swedish Apolipoprotein-related MORtality RISk (AMORIS) study. 226,212 subjects had baseline measurements of C-reactive protein, albumin and haptoglobin. Leukocytes were measured in a subgroup of 63,845 subjects. Associations between quartiles and dichotomized values of inflammatory markers and risk of thyroid cancer were analysed using multivariate Cox proportional hazard models. 202 individuals were diagnosed with thyroid cancer during a mean follow-up of 19.6 years. There was a positive association between lower albumin levels and risk of developing thyroid cancer [Hazard Ratio for albumin ≤ 40 g/L: 1.50 ]. When stratified by a metabolic score, we observed similar association for albumin with higher HR among those with metabolic score ≥ 1, as compared to those with metabolic score of 0 [HR 1.98 (95% CI = 1.11-3.54) vs 1.17 (95% CI = 0.72–1.89)] ( Thyroid cancer is the most common endocrine malignancy . There hNevertheless, there are only a few observational studies exploring the link between inflammation and the risk of developing a thyroid cancer using systemic inflammatory markers. A recent study based on the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort showed that insulin-like growth factor-I concentrations may be positively associated with the risk of developing differentiated thyroid carcinoma . In a caThis study aimed to further evaluate this association. We explored the risk of developing a thyroid cancer by assessing serum biomarkers that are commonly measured in clinical practice and are indicative of inflammation  in a large Swedish cohort study .Characteristics of study participants are shown in Table Lower values of serum albumin were associated with the risk of developing a thyroid cancer [HR for albumin ≤ 40 g/L: 1.50 (95% CI = 1.04–2.16)] in a multivariate model (Table P = 0.19) by metabolic score (Table When stratified by a proxy variable for obesity (metabolic score), we observed a similar positive association between albumin and the risk of developing a thyroid cancer in both groups, with a slightly higher HR for those with a metabolic score ≥ 1 [HR 1.98 (95% CI = 1.11–3.54)]) vs those with a metabolic score of 0 (1.17 (95% CI = 0.72–1.89)]. However, there was no statistically significant interaction .In the AMORIS study, we found evidence for an inverse association between serum albumin levels and the risk of developing a thyroid cancer. This inverse association became stronger when measured in a subgroup of subjects with serum triglycerides and total cholesterol above normal. No associations with the risk of developing a thyroid cancer were observed for CRP, haptoglobin, or leukocytes.Molecular pathways linking inflammation and development of a thyroid cancer have been increasingly studied. For instance, increased expression of autotaxin, lysophosphatidate and inflammatory mediators has been found in malignant thyroid disease. It has been postulated that autotaxin is an integral component of tumorigenesis in thyroid follicular cells leading to tumour growth and promoting markers of more aggressive tumour phenotypes including proliferation, vascularity, metastasis, immune evasion, and treatment resistance , 19. MorThe observed association between albumin and the risk of developing a thyroid cancer may support the well-established concept of low serum albumin as a marker of poor health status , 25. OurThis is to our knowledge the largest prospective study assessing common serum markers of inflammation with the risk of developing a thyroid cancer. The strength of this study lies in the prospective evaluation of exposures and complete follow-up of study participants through national health registers. All analyses were performed at CALAB using internationally accredited and calibrated methods . The popIt is a limitation that high-sensitive CRP was not available at the time measurements were conducted. Any CRP levels < 10 mg/L were unquantifiable, which may have resulted in an underestimation of the association with risk of developing a thyroid cancer. Information on BMI was not available for a large proportion in the current subset of AMORIS participants, so we used a metabolic score as an obesity proxy. Another limitation is the lack of data on histological variants of thyroid cancer , as wellThe Swedish Apolipoprotein-related MORtality RISk data-base (AMORIS) includes blood samples from 812,073 Swedish men and women, ranging in age from < 20 to 80 years old and over undergoing occupational health screening or primary care. The cohort is based on a linkage between data from laboratory examinations performed in the Central Automation Laboratory (CALAB) in Sweden and information recorded in Swedish National Registers using a 10-digit personal identifier number, which is unique to every Swedish resident. AMORIS is a large prospective cohort with information on serum biomarkers, cancer diagnosis, co-morbidities, vital status, socioeconomic status, and emigration. This study complied with the Declaration of Helsinki and was approved by the Ethics Review Board of the Karolinska Institute.n = 226, 212). Leukocytes were measured for a subgroup of the study population . The choice of biomarkers was guided by recommendations from similar studies done using data from the AMORIS study [We restricted our study population to individuals aged 20 years or older who did not have a previous diagnosis of cancer. Furthermore, all subjects were required to have baseline measurements of CRP, albumin, and haptoglobin available from the same health examination (IS study –38. The IS study .Serum CRP (mg/L), albumin (g/L), haptoglobin (g/L), leukocytes (10 × 109/L), triglycerides (mmol/L), total cholesterol (mmol/L) and glucose (mmol/L) were measured at baseline with standard laboratory methods as described elsewhere . High seSerum glucose, total cholesterol, and triglycerides levels were dichotomised using clinical cut-offs in accordance with the American Diabetes Association and National Cholesterol Education Programme (NCEP) guidelines  . ObesityWe estimated the risk of developing a thyroid cancer with multivariate Cox proportional hazards regression, comparing people with high to low levels of CRP, albumin, haptoglobin and leukocytes respectively. Cox regression models were adjusted for age, sex, education, and CCI, as well as triglycerides (continuous), glucose (continuous), total cholesterol (continuous), and fasting status. The assumption of proportional hazards was evaluated by adding time dependent covariates into the models as well as by assessment of the Schoenfeld Residuals.We performed stratified analyses based on the values of the above-described metabolic score (0 vs ≥ 1) to evaluate effect modification by metabolic abnormalities. In addition, stratification by sex was performed.Based on current evidence, the World Trade Center Program Administrator under Centers for Disease Control and Prevention (CDC) sets the minimum latency for developing a thyroid cancer as 2.5 years, which is well covered within our follow up time . NeverthFor those biomarkers in which we observed an association based on the hazard ratios, we used the Restrictive Cubic Spline (RCS) function to graphically display the hazard ratios representing the dose-response association. We used knots located at the 5th, 25th, 75th and 95th percentiles as well as the medical reference value  in a mulAll analyses were conducted with Statistical Analysis Systems (SAS) software release 9.4  .The observation of an association between low levels of albumin and the risk of developing a thyroid cancer suggests the importance of inflammation as one of the mechanisms underlying carcinogenic development. The lack of an association with other commonly measured markers of inflammation indicates that the role of inflammation in the development of a thyroid cancer may be more complicated and would require more detailed data on markers of inflammation such as interleukins or gamma-delta T-cells. Future studies should entail temporality of associations between inflammation and development of thyroid cancers to further identify their clinical or public health importance.