Citation
Tan, Justina Pik Choo
(2004)
Nutritional and Lifestyle Risk Factors for Breast Cancer Among Malaysian Women: A Case-Control Study.
Masters thesis, Universiti Putra Malaysia.
Abstract
Breast cancer is the most common incident cancer in women worldwide,
accounting for 9% of all new cancers. While the exact causes of breast
cancer are unknown, the risks are higher among older women (50 years
and above) than those less than 35 years. Dietary factors that have been
linked to breast cancer include saturated fat, meat, vegetables and fruits.
Other factors that have been linked to breast cancer include age at
menarche, age at first and last birth, smoking, use of oral contraceptives
and body mass index. This case-control study was carried out to
determine the nutritional and lifestyle risk factors of breast cancer among
Malaysian women. A total of 162 pre- and post-menopausal women (81
cases and 81 controls) was included in the study, which was carried out
between 1 January to 31 December, 2000. Cases were selected frorrf the
Breast Cancer Clinics in Hospital Kuala Lumpur (HKL) and Universiti
Malaya Medical Centre (UMMC). All cases were newly diagnosed and
have not undergone any treatment or surgery. Controls were women staff
and wives of staff of Universiti Putra Malaysia (UPM). They were matched
by age (+ 5 years) and ethnicity with the cases. Additional Chinese
controls (17 women) were selected from the Malaysian-Chinese
Association (MCA) from Ampang Jaya by invitation to the group's leader.
Data collection was carried out in four main parts: the interview (to obtain
socio-demographic and lifestyle data); anthropometric measurements;
dietary information, using semi-quantitative food frequency questionnaire;
and biochemical data (to obtain serum lipid profile). Majority of the
respondents were pre-menopausal women with the mean age of 46.63 in
cases and 47.58 in controls. Half of the breast cancer patients were seen
at UMMC while the other half in HKL, and most of them (43.1%)
presented with a second stage of cancer. Smoking, exercise, breast-self
examination and breastfeeding practices were not significantly different
between the two study groups. However, there was a significant
difference in the duration of exercise between cases and controls.
Reproductive history like age at menarche, age at first marriage, age at
first birth and parity. were also not significantly different between cases
and controls. Anthropometric indicators like height, weight, waist and hip
measurements, a s well a s body m ass i ndex a nd w aist-hip ratio d id n ot
show any association with breast cancer, and neither were they
significantly different between case and control subjects. Intakes of
micronutrient were not significantly different between the two study groups
with the exception of sodium. Blood lipid profiles also did not show any
difference between groups. Preliminary data showed that women who
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have four to five children were 1.32 times more at risk for breast cancer
as compared to those who never had any children (95% CI=1.32-1.47).
Multiple logistic regression model showed that menarche at higher age
and increased BMI decreased breast cancer risk while higher age at last
birth increased breast cancer risk. The relatively small sample size of this
study could have resulted in this results. Furthermore, there could have
been recall bias and under-reporting of energy intake among case
subjects due to the occurrence of the disease. Larger cohort and
interventional studies should be carried out to further explore this factors
with relation to breast cancer.
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