Association between the Adherence to the International Guidelines for Cancer Prevention and Mammographic Density

<div><p>Introduction</p><p>Mammographic density (MD) is considered a strong predictor of Breast Cancer (BC). The objective of the present study is to explore the association between MD and the compliance with the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) recommendations for cancer prevention.</p><p>Methods</p><p>Data of 3584 women attending screening from a population-based multicenter cross-sectional study (DDM-Spain) collected from October 7, 2007 through July 14, 2008, was used to calculate a score that measures the level of compliance with the WCRF/AICR recommendations: R1)Maintain adequate body weight; R2)Be physically active; 3R)Limit the intake of high density foods; R4)Eat mostly plant foods; R5)Limit the intake of animal foods; R6)Limit alcohol intake; R7)Limit salt and salt preserved food intake; R8)Meet nutritional needs through diet. The association between the score and MD (assessed by a single radiologist using a semi-quantitative scale) was evaluated using ordinal logistic models with random center-specific intercepts adjusted for the main determinants of MD. Stratified analyses by menopausal status and smoking status were also carried out.</p><p>Results</p><p>A higher compliance with the WCRF/AICR recommendations was associated with lower MD (OR_{1-unit increase} = 0.93 95%CI:0.86;0.99). The association was stronger in postmenopausal women (OR = 0.91 95%CI:0.84;0.99) and nonsmokers (OR = 0.87;95%CI:0.80;0.96 for nonsmokers, OR = 1.01 95%CI:0.91;1.12 for smokers, <i>P</i>-interaction = 0.042). Among nonsmokers, maintaining adequate body weight (OR = 0.81 95%CI:0.65;1.01), practicing physical activity (OR = 0.68 95%CI:0.48;0.96) and moderating the intake of high-density foods (OR = 0.58 95%CI:0.40;0.86) and alcoholic beverages (OR = 0.76 95%CI:0.55;1.05) were the recommendations showing the strongest associations with MD.</p><p>Conclusions</p><p>postmenopausal women and non-smokers with greater compliance with the WCRF/AICR guidelines have lower MD. These results may provide guidance to design specific recommendations for screening attendants with high MD and therefore at higher risk of developing BC.</p></div

Description of all women’s characteristics and by menopausal status and by smoking habit.

<p>^<b>a</b>Defined as: Not met = score in recommendation <0.25; Not far from met = score in recommendation 0.25–075; Met = score in the recommendation ≥0.75.</p><p>Description of all women’s characteristics and by menopausal status and by smoking habit.</p

Association between menstrual and reproductive characteristics and gastric and colorectal cancer risk.

<p>Association between menstrual and reproductive characteristics and gastric and colorectal cancer risk.</p

Flow chart displaying the selection process of colorectal cancer cases and controls.

<p>MCC-Spain study 2008–2013.</p

Additional file 2: Table S2. of The RS4939827 polymorphism in the SMAD7 GENE and its association with Mediterranean diet in colorectal carcinogenesis

Associations between polymorphisms and the Mediterranean Diet Pattern of Sofi considering different genetic models. Genetic models: codominant, dominant, recessive, overdominant, log-additive. (DOCX 16 kb

Additional file 1: Table S1. of The RS4939827 polymorphism in the SMAD7 GENE and its association with Mediterranean diet in colorectal carcinogenesis

Analysis of SNPs related to CRC. The minimally adjusted odds ratio (OR) was computed adjusting by sex, age, educational level. Area, places where cases and controls were recruited, was used as random variable. Association is evaluated for carrying 1 or 2 SNP minor frequency alleles relative to a reference of zero SNP minor frequency allele. (DOCX 22 kb

Association of WCRF/AICR score and individual recommendations with breast cancer risk by menopausal status.

<p>¹ Adjusted for total calorie intake, smoking habit, age at first delivery, education, history of breast problems, family history of BC and menopausal status.</p><p>²</p><p></p><p></p><p></p><p></p><p><mi>P</mi><mi>A</mi><mi>F</mi><mo>=</mo></p><p></p><p><mo stretchy="false">[</mo><mi>P</mi></p><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>6</mn><mo>−</mo><mn>9</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>6</mn><mo>−</mo><mn>9</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><p><mo>]</mo><mo>+</mo><mo>[</mo></p><mi>P</mi><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>5</mn><mo>−</mo><mn>6</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>5</mn><mo>−</mo><mn>6</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><mo stretchy="false">]</mo><mo>+</mo><mo stretchy="false">[</mo><mi>P</mi><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>4</mn><mo>−</mo><mn>5</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>4</mn><mo>−</mo><mn>5</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><p><mo>]</mo><mo>+</mo><mo>[</mo></p><mi>P</mi><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>3</mn><mo>−</mo><mn>4</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>3</mn><mo>−</mo><mn>4</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><mo stretchy="false">]</mo><mo>+</mo><mo stretchy="false">[</mo><mi>P</mi><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>0</mn><mo>−</mo><mn>3</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>0</mn><mo>−</mo><mn>3</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><p></p><p><mn>1</mn><mo>+</mo><mo stretchy="false">[</mo><mi>P</mi></p><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>6</mn><mo>−</mo><mn>9</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>6</mn><mo>−</mo><mn>9</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><p><mo>]</mo><mo>+</mo><mo>[</mo></p><mi>P</mi><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>5</mn><mo>−</mo><mn>6</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>5</mn><mo>−</mo><mn>6</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><mo stretchy="false">]</mo><mo>+</mo><mo stretchy="false">[</mo><mi>P</mi><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>4</mn><mo>−</mo><mn>5</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>4</mn><mo>−</mo><mn>5</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><p><mo>]</mo><mo>+</mo><mo>[</mo></p><mi>P</mi><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>3</mn><mo>−</mo><mn>4</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>3</mn><mo>−</mo><mn>4</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><mo stretchy="false">]</mo><mo>+</mo><mo stretchy="false">[</mo><mi>P</mi><p><mi>F</mi></p><p></p><p><mo>[</mo></p><p><mn>0</mn><mo>−</mo><mn>3</mn></p><mo>]</mo><p></p><p></p><p></p><mo>⋅</mo><p><mo>(</mo></p><p><mi>O</mi></p><p><mi>R</mi></p><p></p><p><mo>[</mo></p><p><mn>0</mn><mo>−</mo><mn>3</mn></p><mo>]</mo><p></p><p></p><p></p><mo>−</mo><mn>1</mn><p></p><mo>)</mo><p></p><p></p><p></p><mo>•</mo><mn>100</mn><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p>PAF=PopulationAtributableFraction</p><p></p><p></p><p>PF=Proportionofpopulationinthespecificexposurecategory</p><p></p><p></p><p>OR=Oddsratiofortheespecificexposurecategory</p><p></p><p></p><p></p><p></p><p></p><p><mrow></mrow></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p>³ Number of controls and cases that do not accomplish the specific recommendation.</p><p>⁴ OR per unit decrease (recommendation met vs not met). Adjusted for total calorie intake, smoking habit, age at first delivery, education, history of breast problems, family history of BC, menopausal status and score excluding the recommendation under study.</p><p>⁵ OR per unit decrease (recommendation met vs not met). Adjusted for total calorie intake, smoking habit, age at first delivery, education, history of breast problems, family history of BC and score excluding the recommendation under study.</p><p>Association of WCRF/AICR score and individual recommendations with breast cancer risk by menopausal status.</p

Distribution WCRF/AICR score and individual recommendations and other baseline characteristics for cases and controls.

<p>Distribution WCRF/AICR score and individual recommendations and other baseline characteristics for cases and controls.</p