Healthy lifestyle and risk of breast cancer among postmenopausal women in the European Prospective Investigation into Cancer and Nutrition cohort study.

International journal of cancer. 2015;136(11):2640-8

Plain language summary

Breast cancer is the most common cancer among women. A number of modifiable lifestyle factors have been shown to be associated with breast cancer risk including diet, physical activity, smoking, alcohol consumption and body fat. A health index combining these five risk factors was created and used to establish an association between lifestyle and breast cancer risk amongst participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a large prospective epidemiological study which recruited 521,330 healthy men and women, including 242,918 postmenopausal women, across Europe. The diet score was based on intakes of seven dietary factors: cereal fibre, folate, the ratio of polyunsaturated to saturated fat, fatty fish (as a marker for omega-3 fatty acids), margarine (as a marker for industrially produced trans-fats), glycaemic load and fruits and vegetables. There was a lower risk of breast cancer in postmenopausal women with healthier lifestyles. All individual components of the healthy lifestyle index were significantly associated with breast cancer risk, except smoking. The combined healthy lifestyle index was overall more strongly associated with breast cancer risk compared to the individual factors. The authors conclude that breast cancer prevention policies should include strategies to engage all women in lasting healthy diet and lifestyle habits.


Breast cancer is the most common cancer among women and prevention strategies are needed to reduce incidence worldwide. A healthy lifestyle index score (HLIS) was generated to investigate the joint effect of modifiable lifestyle factors on postmenopausal breast cancer risk. The study included 242,918 postmenopausal women from the multinational European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, with detailed information on diet and lifestyle assessed at baseline. The HLIS was constructed from five factors (diet, physical activity, smoking, alcohol consumption and anthropometry) by assigning scores of 0-4 to categories of each component, for which higher values indicate healthier behaviours. Hazard ratios (HR) were estimated by Cox proportional regression models. During 10.9 years of median follow-up, 7,756 incident breast cancer cases were identified. There was a 3% lower risk of breast cancer per point increase of the HLIS. Breast cancer risk was inversely associated with a high HLIS when fourth versus second (reference) categories were compared [adjusted HR = 0.74; 95% confidence interval (CI): 0.66-0.83]. The fourth versus the second category of the HLIS was associated with a lower risk for hormone receptor double positive (adjusted HR = 0.81, 95% CI: 0.67-0.98) and hormone receptor double negative breast cancer (adjusted HR = 0.60, 95% CI: 0.40-0.90). Findings suggest having a high score on an index of combined healthy behaviours reduces the risk of developing breast cancer among postmenopausal women. Programmes which engage women in long term health behaviours should be supported.

Lifestyle medicine

Fundamental Clinical Imbalances : Hormonal ; Immune and inflammation
Patient Centred Factors : Mediators/Cancer/breast/lifestyle
Environmental Inputs : Diet ; Nutrients ; Physical exercise
Personal Lifestyle Factors : Nutrition ; Exercise and movement
Functional Laboratory Testing : Not applicable

Methodological quality

Allocation concealment : Not applicable


Nutrition Evidence keywords : Diet ; Smoking ; Exercise ; Alcohol ; Body fat