Prevalence of healthy lifestyles against cancer in Spanish women

Modifying behavior towards healthier lifestyles could prevent a significant number of malignant tumors. We evaluated the prevalence of healthy habits against cancer in Spanish women free of this disease, taking as a reference the recommendations for cancer prevention included in the European Code Against Cancer (ECAC), and we explored the characteristics associated with it. Our population comprised 3,584 women recruited in a population-based cross-sectional study carried out in 7 breast cancer screening programs. Information was directly surveyed and used to calculate a score based on ECAC recommendations referred to bodyweight, physical activity, diet, breastfeeding, tobacco, alcohol and hormone replacement therapy use. The degree of adherence was estimated with a score that evaluated null (0 points), partial (0.5 points) and full adherence (1 point) of each specific recommendation. Associations were explored using binary and ordinal logistic regression models. The median score was 5.7 out of 9 points. Recommendations with lower adherence were those related to intake of red/processed meat and foods high in salt (23% of total adherence), physical activity (24%) and body weight (29%), and recommendations with greater adherence where those related to hormone replacement therapy use (91%), vegetable intake (84%), alcohol (83%) and tobacco (61%). Overall adherence was better among older women, parous women, and in those living in rural areas, and worse among women with higher caloric intake. These recommendations should be evaluated periodically. Screening programs can be an appropriate place to disseminate this information.This study was supported by the Spanish Public Health Research Fund (FIS PI060386 & PS09/0790); by the Spanish Ministry of Health, Social Policy and Equality (EC11-273), by the Carlos III Institute of Health (ISCIII) (AESI PI15CIII/00013); by the Spanish Ministry of Economy and Competitiveness, Juan de la Cierva de Incorporación grant (IJCI-2014-20900); by the EPY 1306/06 Collaboration Agreement between Astra-Zeneca and the Carlos III Institute of Health; and a grant from the Spanish Federation of Breast Cancer patients (FECMA EPY 1169/10). The authors wish to thank the participants in the DDM-Spain study for their contribution to breast cancer research.S

Association Between Western and Mediterranean Dietary Patterns and Mammographic Density

OBJECTIVE: To examine the association between two dietary patterns (Western and Mediterranean), previously linked to breast cancer risk, and mammographic density. METHODS: This cross-sectional study included 3,584 women attending population-based breast cancer screening programs and recruited between October 7, 2007, and July 14, 2008 (participation rate 74.5%). Collected data included anthropometric measurements; demographic, obstetric, and gynecologic characteristics; family and personal health history; and diet in the preceding year. Mammographic density was blindly assessed by a single radiologist and classified into four categories: less than 10%, 10-25%, 25-50%, and greater than 50%. The association between adherence to either a Western or a Mediterranean dietary pattern and mammographic density was explored using multivariable ordinal logistic regression models with random center-specific intercepts. Models were adjusted for age, body mass index, parity, menopause, smoking, family history, hormonal treatment, and calorie and alcohol intake. Differences according to women's characteristics were tested including interaction terms. RESULTS: Women with a higher adherence to the Western dietary pattern were more likely to have high mammographic density (n=242 [27%]) than women with low adherence (n=169 [19%]) with a fully adjusted odds ratio (ORQ4vsQ1) of 1.25 (95% confidence interval [CI] 1.03-1.52). This association was confined to overweight-obese women (adjusted ORQ4vsQ1 [95% CI] 1.41 [1.13-1.76]). No association between Mediterranean dietary pattern and mammographic density was observed. CONCLUSION: The Western dietary pattern was associated with increased mammographic density among overweight-obese women. Our results might inform specific dietary recommendations for women with high mammographic density.S

Reproducibility of data-driven dietary patterns in two groups of adult Spanish women from different studies

The objective of the present study was to assess the reproducibility of data-driven dietary patterns in different samples extracted from similar populations. Dietary patterns were extracted by applying principal component analyses to the dietary information collected from a sample of 3550 women recruited from seven screening centres belonging to the Spanish breast cancer (BC) screening network (Determinants of Mammographic Density in Spain (DDM-Spain) study). The resulting patterns were compared with three dietary patterns obtained from a previous Spanish case-control study on female BC (Epidemiological study of the Spanish group for breast cancer research (GEICAM: grupo Español de investigación en cáncer de mama)) using the dietary intake data of 973 healthy participants. The level of agreement between patterns was determined using both the congruence coefficient (CC) between the pattern loadings (considering patterns with a CC≥0·85 as fairly similar) and the linear correlation between patterns scores (considering as fairly similar those patterns with a statistically significant correlation). The conclusions reached with both methods were compared. This is the first study exploring the reproducibility of data-driven patterns from two studies and the first using the CC to determine pattern similarity. We were able to reproduce the EpiGEICAM Western pattern in the DDM-Spain sample (CC=0·90). However, the reproducibility of the Prudent (CC=0·76) and Mediterranean (CC=0·77) patterns was not as good. The linear correlation between pattern scores was statistically significant in all cases, highlighting its arbitrariness for determining pattern similarity. We conclude that the reproducibility of widely prevalent dietary patterns is better than the reproducibility of more population-specific patterns. More methodological studies are needed to establish an objective measurement and threshold to determine pattern similarity.This study was supported by Carlos III Institute of Health FIS(Spanish Public Health Research Fund: PI060386 FIS; PS09/00790 and PI15CIII/0029 research grants), the Spanish Ministryof Health (EC11-273), the Spanish Ministry of Economyand Competitiveness (IJCI-2014-20900), the Spanish Federationof Breast Cancer Patients (FECMA: EPY 1169-10) and theAssociation of Women with Breast Cancer from Elche (AMAC-MEC: EPY 1394/15). None of the funders had any role in thedesign, analysis or writing of this article.V.L.,N.A.,B.P.-G.andM.P.designedthestudy;A.C.,J.V.,C.S.,C.P.-P.,S.A.,M.E.,D.S.-T.,C.V.andC.S.-C.collectedthedataand/or prepared the database. A. C. performed statistical analysisand wrote the initial version of the manuscript that M. P. revised andcorrected in its different versions. All the authors have read andapproved thefinal version of the manuscript.The authors declare that there are no conflicts of interest.S

Sleep patterns, sleep disorders and mammographic density in spanish women: The DDM-Spain/Var-DDM study

[EN] We explored the relationship between sleep patterns and sleep disorders and mammographic density (MD), a marker of breast cancer risk. Participants in the DDM-Spain/var-DDM study, which included 2878 middle-aged Spanish women, were interviewed via telephone and asked questions on sleep characteristics. Two radiologists assessed MD in their left craneo-caudal mammogram, assisted by a validated semiautomatic-computer tool (DM-scan). We used log-transformed percentage MD as the dependent variable and fitted mixed linear regression models, including known confounding variables. Our results showed that neither sleeping patterns nor sleep disorders were associated with MD. However, women with frequent changes in their bedtime due to anxiety or depression had higher MD (e¿:1.53;95%CI:1.04¿2.26).This work was supported by grants from the Spanish Ministry of Economy and Competitiveness - Carlos III Institute of Health (ISCIII) (FI14CIII/00013, FIS PI060386 & PS09/0790), from the Spanish Federation of Breast Cancer Patients (FECMA 485 EPY 1170-10), Gent per Gent Fund (EDEMAC Project), the EPY1306/06 collaboration agreement between Astra-Zeneca and the ISCIII and partially funded by the European Regional Development Fund (FEDER)Pedraza-Flechas, AM.; Lope, V.; Moreo, P.; Ascunce, N.; Miranda-García, J.; Vidal, C.; Sánchez-Contador, C.... (2017). Sleep patterns, sleep disorders and mammographic density in spanish women: The DDM-Spain/Var-DDM study. Maturitas. 99:105-108. https://doi.org/10.1016/j.maturitas.2017.02.015S1051089

Overeating, caloric restriction and mammographic density in Spanish women. DDM-Spain study

[EN] Objectives: Mammographic density (MD) is a strong risk factor for breast cancer. The present study evaluates the association between relative caloric intake and MD in Spanish women. Study design: We conducted a cross-sectional study in which 3517 women were recruited from seven breast cancer screening centers. MD was measured by an experienced radiologist using craniocaudal mammography and Boyd's semi-quantitative scale. Information was collected through an epidemiological survey. Predicted calories were calculated using linear regression models, including the basal metabolic rate and physical activity as explanatory variables. Overeating and caloric restriction were defined taking into account the 99% confidence interval of the predicted value. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using center-specific mixed ordinal logistic regression models, adjusted for age, menopausal status, body mass index, parity, tobacco use, family history of breast cancer, previous biopsies, age at menarche and adherence to a Western diet. Main outcome measure: Mammographic density. Results: Those women with an excessive caloric intake ( > 40% above predicted) presented higher MD (OR = 1.41, 95%CI = 0.97-2.03; p = 0.070). For every 20% increase in relative caloric consumption the probability of having higher MD increased by 5% (OR = 1.05, 95%CI = 0.98-1.14; p = 0.178), not observing differences between the categories of explanatory variables. Caloric restriction was not associated with MD in our study. Conclusions: This is the first study exploring the association between MD and the effect of caloric deficit or excessive caloric consumption according to the energy requirements of each woman. Although caloric restriction does not seem to affect breast density, a caloric intake above predicted levels seems to increase this phenotypeThis study was supported by the Research Grant FIS PI060386 from Spanish Public Health Research Fund (Fondo de Investigacion Sanitaria); the Carlos III Institute of Health (Institute de Salud Carlos III)PI15CIII/0029 and PI15CIII/00013; the EPY 1306/06Collaboration Agreement between Astra-Zeneca and the Carlos III Institute of Health; and a grant from the Spanish Federation of Breast Cancer Patients (FECMA EPY 1169/10).Del Pozo, MDP.; Castelló, A.; Vidal, C.; Salas -Trejo, D.; Sanchez Contador, C.; Pedraz-Pingarrón, C.; Moreno, MP.... (2018). Overeating, caloric restriction and mammographic density in Spanish women. DDM-Spain study. Maturitas. 117:57-63. https://doi.org/10.1016/j.maturitas.2018.09.006S576311

Calorie intake, olive oil consumption and mammographic density among Spanish women

High mammographic density (MD) is one of the main risk factors for development of breast cancer. To date, however, relatively few studies have evaluated the association between MD and diet. In this cross-sectional study, we assessed the association between MD (measured using Boyd's semiquantitative scale with five categories: 75%) and diet (measured using a food frequency questionnaire validated in a Spanish population) among 3,548 peri- and postmenopausal women drawn from seven breast cancer screening programs in Spain. Multivariate ordinal logistic regression models, adjusted for age, body mass index (BMI), energy intake and protein consumption as well as other confounders, showed an association between greater calorie intake and greater MD [odds ratio (OR) = 1.23; 95% confidence interval (CI) = 1.10-1.38, for every increase of 500 cal/day], yet high consumption of olive oil was nevertheless found to reduce the prevalence of high MD (OR = 0.86;95% CI = 0.76-0.96, for every increase of 22 g/day in olive oil consumption); and, while greater intake of whole milk was likewise associated with higher MD (OR = 1.10; 95%CI 1.00-1.20, for every increase of 200 g/day), higher consumption of protein (OR = 0.89; 95% CI 0.80-1.00, for every increase of 30 g/day) and white meat (p for trend 0.041) was found to be inversely associated with MD. Our study, the largest to date to assess the association between diet and MD, suggests that MD is associated with modifiable dietary factors, such as calorie intake and olive oil consumption. These foods could thus modulate the prevalence of high MD, and important risk marker for breast cancer.Grant sponsor: Spain’s Health Research Fund (Fondo de Investigación Sanitaria);Grant numbers:FIS PI060386 & FIS PIS09/01006; Collaboration Agreement between Astra-Zeneca and the Carlos III Institute of Health (Instituto de Salud Carlos III);Grant number: EPY 1306/06; Spanish Federation of Breast Cancer patients; Grant number: FECMA 485 EPY 1170-10S

Evaluation of mammographic density patterns: reproducibility and concordance among scales

<p>Abstract</p> <p>Background</p> <p>Increased mammographic breast density is a moderate risk factor for breast cancer. Different scales have been proposed for classifying mammographic density. This study sought to assess intra-rater agreement for the most widely used scales (Wolfe, Tabár, BI-RADS and Boyd) and compare them in terms of classifying mammograms as high- or low-density.</p> <p>Methods</p> <p>The study covered 3572 mammograms drawn from women included in the DDM-Spain study, carried-out in seven Spanish Autonomous Regions. Each mammogram was read by an expert radiologist and classified using the Wolfe, Tabár, BI-RADS and Boyd scales. In addition, 375 mammograms randomly selected were read a second time to estimate intra-rater agreement for each scale using the kappa statistic. Owing to the ordinal nature of the scales, weighted kappa was computed. The entire set of mammograms (3572) was used to calculate agreement among the different scales in classifying high/low-density patterns, with the kappa statistic being computed on a pair-wise basis. High density was defined as follows: percentage of dense tissue greater than 50% for the Boyd, "heterogeneously dense and extremely dense" categories for the BI-RADS, categories P2 and DY for the Wolfe, and categories IV and V for the Tabár scales.</p> <p>Results</p> <p>There was good agreement between the first and second reading, with weighted kappa values of 0.84 for Wolfe, 0.71 for Tabár, 0.90 for BI-RADS, and 0.92 for Boyd scale. Furthermore, there was substantial agreement among the different scales in classifying high- versus low-density patterns. Agreement was almost perfect between the quantitative scales, Boyd and BI-RADS, and good for those based on the observed pattern, i.e., Tabár and Wolfe (kappa 0.81). Agreement was lower when comparing a pattern-based (Wolfe or Tabár) versus a quantitative-based (BI-RADS or Boyd) scale. Moreover, the Wolfe and Tabár scales classified more mammograms in the high-risk group, 46.61 and 37.32% respectively, while this percentage was lower for the quantitative scales (21.89% for BI-RADS and 21.86% for Boyd).</p> <p>Conclusions</p> <p>Visual scales of mammographic density show a high reproducibility when appropriate training is provided. Their ability to distinguish between high and low risk render them useful for routine use by breast cancer screening programs. Quantitative-based scales are more specific than pattern-based scales in classifying populations in the high-risk group.</p

Obstetric history and mammographic density: a population-based cross-sectional study in Spain (DDM-Spain)

High mammographic density (MD) is used as a phenotype risk marker for developing breast cancer. During pregnancy and lactation the breast attains full development, with a cellular-proliferation followed by a lobular-differentiation stage. This study investigates the influence of obstetric factors on MD among pre- and post-menopausal women. We enrolled 3,574 women aged 45–68 years who were participating in breast cancer screening programmes in seven screening centers. To measure MD, blind anonymous readings were taken by an experienced radiologist, using craniocaudal mammography and Boyd’s semiquantitative scale. Demographic and reproductive data were directly surveyed by purpose-trained staff at the date of screening. The association between MD and obstetric variables was quantified by ordinal logistic regression, with screening centre introduced as a random effect term. We adjusted for age, number of children and body mass index, and stratified by menopausal status. Parity was inversely associated with density, the probability of having high MD decreased by 16% for each new birth (P value < 0.001). Among parous women, a positive association was detected with duration of lactation [>9 months: odds ratio (OR) = 1.33; 95% confidence interval (CI) = 1.02–1.72] and weight of first child (>3,500 g: OR = 1.32; 95% CI = 1.12–1.54). Age at first birth showed a different effect in pre- and post-menopausal women (P value for interaction = 0.030). No association was found among pre-menopausal women. However, in post-menopausal women the probability of having high MD increased in women who had their first child after the age of 30 (OR = 1.53; 95% CI = 1.17–2.00). A higher risk associated with birth of twins was also mainly observed in post-menopausal women (OR = 2.02; 95% CI = 1.18–3.46). Our study shows a greater prevalence of high MD in mothers of advanced age at first birth, those who had twins, those who have breastfed for longer periods, and mothers whose first child had an elevated birth weight. These results suggest the influence of hormones and growth factors over the proliferative activity of the mammary gland

Compliance with current dietary recommendations and geographical variability of diet in women participating in 7 screening programs for breast cancer in Spain.

[ES] Introducción:Una dieta saludable es especialmenteimportante durante la menopausia, periodo en el queaumenta el riesgo de varios problemas de salud. Analiza-mos la dieta de mujeres peri y postmenopáusicas españo-las y el grado de cumplimiento de las recomendacionesactuales. Material y métodos:Estudio transversal en 3.574 muje-res de 45-68 años que acuden al cribado de cáncer demama en 7 centros (A Coruña, Barcelona, Burgos, Palmade Mallorca, Pamplona, Valencia y Zaragoza). Se recogióla dieta mediante un cuestionario de frecuencia de ali-mentos validado para población española. Para la valora-ción del cumplimiento de las recomendaciones actuales seutilizaron los rangos recomendados por la SociedadEspañola de Nutrición Comunitaria para ingesta de gru-pos de alimentos y las Ingestas Diarias Recomendadas(IDR) para energía, vitaminas y minerales de la Federa-ción Española de Nutrición, Alimentación y Dietética. Resultados:El 29% de las mujeres eran obesas y un42% tenía sobrepeso. El aporte calórico medio fue de2.053 kcal (DE: 480). El perfil calórico general fue de: 43% de la energía aportada por lo carbohidratos, 36%por las grasas, 20% por las proteínas. Se evidenció unaingesta deficiente de vitamina D en todos los nodos delestudio, con una ingesta media general de 2,14 μg/día. Sedetectó a su vez una ingesta deficitaria de vitamina E en ACoruña y Burgos. Todos los centros presentaron unaingesta elevada de productos lácteos y de legumbres. Elconsumo de frutas y verduras fue muy heterogéneosiendo especialmente elevada su ingesta en Mallorca yValencia mientras que fue baja para ambos grupos de ali-mentos en A Coruña. La ingesta de aceite de oliva fue ele-vada en todos los centros exceptuando Burgos con un74,3% de las mujeres estudiadas por debajo de las 3raciones al día recomendadas. Conclusiones:Una dieta con menos grasas y proteínasy más rica en vegetales, frutos secos y alimentos ricos enhidratos de carbono equilibraría el balance energético ymejoraría la calidad de la dieta corrigiendo las bajasingestas de vitaminas D y E. Estas recomendaciones sonespecialmente importantes en las ciudades más alejadasde la costa mediterránea donde se han detectado mayoresincumplimientos de las recomendaciones vigentes y unadieta más alejada de la dieta mediterránea. [EN] A healthy diet is especially important during menopause, a period which increases the risk of various health problems. We analyzed the diet of periand postmenopausal Spanish women and the degree of compliance with current recommendations. We studied 3574 women 45-68 years old who attended breast cancer screening programmes in 7 centres (A Coruña, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia and Zaragoza). Diet information was collected using a food frequency questionnaire validated for the Spanish population. For the assessment of compliance with current guidelines we used the recommendations by the Spanish Society of Community Nutrition for food groups intake and by the Spanish Federation of Nutrition, Food and Dietetics for energy, vitamins and minerals intake. The 29% of women were obese and 42% overweight. The average caloric intake was 2.053 kcal (SD 480). The general energy profile was: 43% of the energy from the carbohydrates, 36% from fats, and 20% from proteins. There was a low vitamin D intake in all centres of the study, with an overall mean intake of 2.14 mg/day. A deficit of vitamin E intake in A Coruña and Burgos was also detected. Intake of dairy products and vegetables was high in all the study centers. The consumption of fruits and vegetables was very heterogeneous, with high intakes observed in Mallorca and Valencia and low for both food groups in A Coruña. The olive oil intake was high in all centers except Burgos with 74.3% of the women studied below the recommended 3 servings per day. A diet with less fat and protein and a higher consumption of vegetables, nuts and foods rich in carbohydrate might balance the energy intake and improve the quality of the diet correcting the low intakes of vitamins D and E. These recommendations are especially important in cities far from the Mediterranean coast where more breaches have been detected over the current recommendations with a lower adherence to the Mediterranean diet.Este estudio ha recibido financiación del Fondo deInvestigación Ssanitaria (proyecto PI060386) y de Astra-Zéneca (convenio de colaboración entre Astra-Zeneca y el Instituto de salud Carlos III 1306-1306EPY).S