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Obesity is associated with an increased risk of breast cancer in post-menopausal women, the mechanisms of which may be hormonal. It has been demonstrated that obese women metabolise androstenedione (from the adrenal gland) into oestrogen in the adipocytes. The circulating levels of oestrone are higher in obese post-menopausal women than non-obese individuals. In pre-menopausal women obesity may be associated with a reduced risk of breast cancer, although the reasons for this difference are unclear.


Attention has focused on the role of dietary fat in the pathogenesis of breast cancer. Animal studies have shown that the total fat consumption, and more importantly, the composition of fats in the diet are important in the development of breast cancer. In studies in man, close correlations between the per capita consumption of fat and breast cancer mortality rates have been demonstrated. However, when individuals are considered the association is lacking. There is no well-established relationship between dietary fat consumption and an individual persons risk of developing breast cancer.

Anti-oxidant nutrients (e.g. fruit, greens) may be important in protecting against the development of breast cancer. These molecules protect against reactive oxygen species which can damage DNA within the cell. Examples of these substances are vitamins A, C and E, and selenium. Other dietary substances which may be important in causing breast cancer are the heterocyclic amines (found in char-broiled foods) and plant oestrogens (soy products).


Physical activity, especially in the teenage and young adult years, may protect against breast cancer in both pre- and post-menopausal women. One explanation for this has been the exercise-induced delay in the onset of the menarche and the reduction in the number of menstrual cycles.


Alcohol consumption increases the risk of breast cancer. An intake of more than 15 g of alcohol per day has been found to be associated with a significant increase in the risk of breast cancer, when compared with people who do not consume alcohol. This may be because of a hormonal effect - alcohol consumption results in increased circulating levels of oestrone and oestradiol.

Figure 17.20. An example of DCIS: high-grade DCIS with comedo necrosis distending and filling terminal ducts. Note the cellular pleomorphism and well-defined cell borders (x150).

Cigarette smoking

There is controversy regarding the role of smoking in the aetiology of breast cancer. Although some studies have suggested there is an increased risk (possibly due to carcinogens in smoke) others have shown a reduced risk (possibly due to decreased circulating levels of oestrogens). There is no convincing evidence that smoking causes breast cancer although a small number of studies have indicated there may be a very weak link.

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