Shapira Niva
Department of Nutrition, School of Health Professions, Ashkelon Academic College, Ashkelon, Israel.
Eur J Cancer Prev. 2017 Sep;26(5):385-395. doi: 10.1097/CEJ.0000000000000406.
Breast cancer (BC), the leading cancer in women, is increasing in prevalence worldwide, concurrent with western metabolic epidemics, that is, obesity, metabolic syndrome, and diabetes, and shares major risk factors with these diseases. The corresponding potential for nutritional contributions toward BC prevention is reviewed and related to critical stages in the life cycle and their implications for carcinogenic and pathometabolic trajectories. BC initiation potentially involves diet-related pro-oxidative, inflammatory, and procarcinogenic processes, that interact through combined lipid/fatty acid peroxidation, estrogen metabolism, and related DNA-adduct/depurination/mutation formation. The pathometabolic trajectory is affected by high estrogen, insulin, and growth factor cascades and resultant accelerated proliferation/progression. Anthropometric risk factors - high birth weight, adult tallness, adiposity/BMI, and weight gain - are often reflective of these trends. A sex-based nutritional approach targets women's specific risk in western obesogenic environments, associated with increasing fatness, estrogen metabolism, n-6 : n-3 polyunsaturated fatty acid ratio, and n-6 polyunsaturated fatty acid conversion to proinflammatory/carcinogenic eicosanoids, and effects of timing of life events, for example, ages at menarche, full-term pregnancy, and menopause. Recent large-scale studies have confirmed the effectiveness of the evidence-based recommendations against BC risk, emphasizing low-energy density diets, highly nutritious plant-based regimes, physical activity, and body/abdominal adiposity management. Better understanding of dietary inter-relationships with BC, as applied to food intake, selection, combination, and processing/preparation, and recommended patterns, for example, Mediterranean, DASH, plant-based, low energy density, and low glycemic load, with high nutrient/phytonutrient density, would increase public motivation and authoritative support for early/timely prevention, optimally merging with other dietary/health goals, for lifelong BC prevention.
乳腺癌（BC）是女性中最常见的癌症，在全球范围内的发病率呈上升趋势，这与西方的代谢性流行病（即肥胖、代谢综合征和糖尿病）同时出现，并且与这些疾病具有共同的主要风险因素。本文综述了营养对预防乳腺癌的潜在作用，并将其与生命周期中的关键阶段及其对致癌和病理代谢轨迹的影响联系起来。乳腺癌的发生可能涉及与饮食相关的促氧化、炎症和致癌过程，这些过程通过脂质/脂肪酸过氧化、雌激素代谢以及相关的DNA加合物/脱嘌呤/突变形成相互作用。病理代谢轨迹受到高雌激素、胰岛素和生长因子级联反应以及由此导致的加速增殖/进展的影响。人体测量学风险因素——高出生体重、成年身高、肥胖/体重指数和体重增加——通常反映了这些趋势。基于性别的营养方法针对西方致肥胖环境中女性的特定风险，这些风险与肥胖增加、雌激素代谢、n-6:n-3多不饱和脂肪酸比例以及n-6多不饱和脂肪酸转化为促炎/致癌类二十烷酸有关，以及生活事件的时间影响，例如初潮年龄、足月妊娠和绝经年龄。最近的大规模研究证实了基于证据的预防乳腺癌风险建议的有效性，强调低能量密度饮食、高营养的植物性饮食、体育活动以及身体/腹部肥胖管理。更好地理解饮食与乳腺癌之间的相互关系，包括食物摄入、选择、组合以及加工/制备方式，以及推荐的饮食模式，例如地中海饮食、得舒饮食、植物性饮食、低能量密度饮食和低血糖负荷饮食，同时具有高营养/植物营养素密度，将增加公众对早期/及时预防的积极性和权威性支持，并与其他饮食/健康目标最佳融合，以实现终身预防乳腺癌。
