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Association Between Diet During Preadolescence and Adolescence and Risk for Breast Cancer During Adulthood View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Journal of Adolescent Health 52 (2013) S30eS35 www.jahonline.org Review article Association Between Diet During Preadolescence and Adolescence and Risk for Breast Cancer During Adulthood Somdat Mahabir, Ph.D., M.P.H. * Modifiable Risk Factors Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland Article history: Received May 3, 2012; Accepted August 31, 2012 Keywords: Preadolescent diet; Adolescent diet; Adult breast cancer ABSTRACT IMPLICATIONS AND It is increasingly evident that diet during preadolescence and adolescence has important conse- CONTRIBUTION quences for breast cancer during adulthood. However, only a few epidemiologic studies have been Current evidence points to conducted on the relationship between diet during preadolescence and adolescence, and cancer a trend in which aspects of during adulthood. This situation is partly because of methodological challenges such as the long diet during preadolescence latency period, the complexity of breast cancer, the lack of validated diet assessment tools, and the and adolescence either large number of subjects that must be followed, all of which increase costs. In addition, funding increases or decreases risk opportunities are few for such studies. Results from the small number of epidemiologic studies are for adult breast cancer. inconsistent, but evidence is emerging that specific aspects of the diet during preadolescence and Several methodological iss- adolescence are important. For example, during preadolescence and adolescence, severe calorie uessuchasdietaryrecall restriction with poor food quality, high total fat intake, and alcohol intake tend to increase risk, bias may affect the validity whereas high soy intake decreases risk. Research on preadolescent and adolescent diet is a para- of the current evidence. digm shift in breast cancer investigations. This research paradigm has the potential to produce Therefore, it is crucial that transformative knowledge to inform breast cancer prevention strategies through dietary inter- research opportunities tar- vention during preadolescence and adolescence, rather than later in life, as is current practice, get the development of when it is perhaps less effective. Methodological challenges that have plagued the field might now tools that would accurately be overcome by leveraging several existing large-scale cohort studies in the U.S. and around the aidinboththeprospective world to investigate the role of diet during preadolescence and adolescence in risk for adult breast and retrospective collection cancer. of dietary data in early life Published by Elsevier Inc on behalf of Society for Adolescent Health and Medicine. such as in preadolescence and adolescence. However, Open access under CC BY-NC-ND license. because of the emerging evidence, it is not too early to consider issuing volun- tary advice to adolescents regarding risk and potential benefits in preventing later breast cancer development. Publication of this article was supported by the Centers for Disease Control and Prevention. Breast cancer results from the interaction of multiple deter- The author reports no potential conflicts of interest. minants, including genetic susceptibility and exposure to * Address correspondence to: Somdat Mahabir, Ph.D., M.P.H., Modifiable Risk modifiable risk factors. In addition, breast cancer diagnosis is Factors Branch, Epidemiology and Genomics Research Program, Division of age-related, with a marked increase in cancer incidence after the Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Room 5138, Bethesda, MD 20892. reproductive years. Most research on breast cancer focuses on E-mail address: [email protected]. risk factors during adulthood, but awareness is growing that 1054-139X Published by Elsevier Inc on behalf of Society for Adolescent Health and Medicine.Open access under CC BY-NC-ND license. http://dx.doi.org/10.1016/j.jadohealth.2012.08.008 S. Mahabir / Journal of Adolescent Health 52 (2013) S30eS35 S31 early-life exposures and events, including during preadolescence Preadolescent and Adolescent Diet and adolescence, can affect breast cancer risk. Clues from epidemiologic studies of cardiovascular disease Calories (CVD) indicate that early-life diet affects later risk for CVD. In 1989, Barker and colleagues [1] published data showing that In 1988, deWaard and Trichopoulos [19] proposed that an men with the lowest weights at birth and at 1 year of age had energy-rich diet during puberty and adolescence stimulates the the highest death rates from ischemic heart disease, and that growth of mammary glands and increases the occurrence of increasing weight was associated with a graded decrease in precancerous lesions in the breast. It is well established that risk. Barker et al proposed that an environment that induces energy restriction in animal models leads to reduced cancer poor fetal and infant growth will be followed by high risk of incidence. Prospective data from the Boyd Orr cohort study ischemic heart disease during adulthood. This idea has been (3,834 people took part in a family diet and health survey validated by several prospective cohort studies. For example, between 1937 and 1939) reported significant positive association studies in Sweden [2],Finland[3], Denmark [4], Norway [5], between childhood energy intake and all-cause cancer mortality, England [6], and Scotland [7] found that mortality from which included breast cancer [20]. Retrospective analysis of data ischemic heart disease was inversely associated with birth from the Nurses’ Health Study II (NHS II) cohort study of weight. In the U.S. [8,9] and India [10], a strong inverse asso- adolescent total caloric intake and breast cancer risk showed ciation between birth weight and nonfatal coronary heart a significant trend for increased risk with increased levels of total disease was reported. A recent systematic review of 17 pub- calories consumed [21]. A retrospective cohort study using the lished studies concluded that low birth weight increases risk Swedish Cancer Registry found that younger women with for ischemic heart disease [11]. If indeed early-life exposures anorexia nervosa (before age 40 years) have lower risk of breast affect CVD risk, by logical extension and because of similar cancer compared with women in the Swedish general population pathways, such exposures may also affect risk for breast [22]. Anorexia nervosa, an illness that occurs generally during cancer. For example, a single acute exposure to radiation to adolescence or early adulthood, is an indicator of caloric those who were in utero or in early childhood at the time of the restriction. On the contrary, early-life caloric restriction coupled atomic bombings of Hiroshima and Nagasaki resulted in with malnutrition or famine increases risk for breast cancer significantly elevated risk of malignancies decades later [12].In development. For example, women who were in the pubertal addition, studies of migrant populations show that rates of phase of life during World War II and exposed to calorie breast cancer change after migration and primarily affect the restriction without substantially poor diets had decreased risk of next generation [13,14], which supports the idea that early-life subsequent breast cancer compared with women exposed to exposures have a role. In Asia, breast cancer incidence rates are severe calorie restriction and poor food quality [23]. Birth much lower than in the U.S., but when Asian women migrate cohorts of subjects exposed to severe calorie restriction and poor to the U.S., their breast cancer risk increases gradually over diet quality such as experienced by European Jews who had several generations and eventually approaches that of U.S. potentially been exposed to the Holocaust and then migrated to white women [13]. Early studies suggest that the increased Israel had substantially increased breast cancer risk [24]. The breast cancer risk among Asians did not appear until the strongest increased breast cancer risk occurred in the youngest second generation was born in the U.S. [15]. These studies birth cohort of European Jews, which suggests that early-life [13,15] and other early studies [16,17] prompted the hypothesis exposure had a major role [24], and affirms that timing of the that exposure to western diet and lifestyle at an early age was exposure is clearly important. The Netherlands Cohort Study, in critical to breast cancer development. which a proxy was used to assess adolescent energy restriction In 2006, a review was published on early-life diet and the during the Hunger Winter (1944e1945), found evidence that risk for adult breast cancer [18]. The focus was not on the severe food restriction during the Hunger Winter significantly epidemiological evidence, but on postulated mechanistic links increased risk for adult breast cancer in the western rural areas, between early-life diet and breast cancer development. For but not in the western city areas [25]. Thus, the Netherlands this review, we used Pub Med to search for all published Cohort Study data did not provide clear evidence to support the epidemiologic studies of preadolescent and adolescent diet hypothesis that energy restriction resulting from severe famine in relation to adult breast cancer risk, and reviewed the leads to significantly
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