Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York City, New York, USA.
Department of Family, Population & Preventive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, New York, USA.
Int J Cancer. 2022 Aug 15;151(4):526-538. doi: 10.1002/ijc.34034. Epub 2022 May 6.
A relatively high healthy lifestyle index (HLI) score, representing a healthy diet, participation in moderate to vigorous physical exercise, no smoking, low to no alcohol intake and a normal body mass index, has been associated with a reduced risk of invasive breast cancer. However, no study has shown an association between the HLI and the risk of ductal carcinoma in situ of the breast (DCIS), which is considered to be a nonobligate precursor of invasive breast cancer. We evaluated this association in a prospective cohort of 132 230 postmenopausal women, aged 50 to 79 years, recruited between 1993 and 1998 across the United States and enrolled in the Women's Health Initiative study. The HLI score was created and categorized into quartiles. During an average follow-up of 15.4 years, 2035 DCIS cases were ascertained. Multivariable-adjusted Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of HLI with the risk of DCIS. Women in the highest HLI quartile had a lower DCIS risk than those in the lowest quartile (HR = 0.80, 95% CI, 0.70-0.92) and this association was stronger in women with a family history of breast cancer (HR = 0.70, 95% CI, 0.52-0.93), and for ER+/PR+ DCIS (HR = 0.66, 95% CI, 0.52-0.83). These findings suggest that there is an inverse association between HLI and risk of DCIS, and suggest that the adoption of a healthy lifestyle might lower the risk of DCIS.
相对较高的健康生活方式指数（HLI）得分代表着健康的饮食、参与适度至剧烈的体育锻炼、不吸烟、低至不饮酒以及正常的体重指数，与降低浸润性乳腺癌的风险相关。然而，没有研究表明 HLI 与乳腺导管原位癌（DCIS）的风险之间存在关联，而 DCIS 被认为是浸润性乳腺癌的非强制性前体。我们在美国于 1993 年至 1998 年期间招募了年龄在 50 至 79 岁的 132230 名绝经后女性，在这项前瞻性队列研究中评估了这种关联，并将 HLI 评分进行了创建和分类为四等分。在平均 15.4 年的随访期间，确定了 2035 例 DCIS 病例。多变量调整的 Cox 回归用于估计 HLI 与 DCIS 风险之间的关联的风险比（HR）和 95%置信区间（CI）。HLI 最高四分位数的女性发生 DCIS 的风险低于最低四分位数的女性（HR=0.80，95%CI，0.70-0.92），并且这种关联在具有乳腺癌家族史的女性中更强（HR=0.70，95%CI，0.52-0.93），对于 ER+/PR+ DCIS（HR=0.66，95%CI，0.52-0.83）。这些发现表明 HLI 与 DCIS 风险之间存在负相关，并且表明采用健康的生活方式可能会降低 DCIS 的风险。
