DÄ internationalArchive12/2015Global Burden of Disease Study is of Oncological Interest
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The proportion of the five most common risk factors that when quantified contribute most to the burden of disease overall is of great oncological interest for women. All five factors are associated with a notably increased risk for breast cancer: a high body mass index (often associated with a high risk diet), metabolic problems, such as diabetes with vascular damage, and therefore development of hypertension, lack of exercise, and smoking.

All these risks for breast cancer could be reduced by lifestyle modification (an example would be a BMI above 30 as a challenge in the medical consultation). In obese postmenopausal women, high estrogen concentrations (from testosterone via aromatase metabolized in large fat deposits) result in a breast cancer risk that is 12 times higher (1). This risk cannot be “compensated” for by mammography screening with the objective of fewer deaths due to breast cancer.

In carriers of the BRCA mutation whose breast cancer risk is high for that reason, a BMI of 25 or more means 1.5 times the risk of developing breast cancer (2).

The fifth most common factor in the Global Burden of Disease Study, “lack of exercise,” can be quantified in BRCA carriers at age 45: until that age, 63% of physically inactive and 43% of physically active women will develop breast cancer (2). Even in women who already have breast cancer it is worth tackling these five so important health risks as it is possible to halve the risks of recurrences/metastases in this way.

In conclusion: Avoiding the development of obesity along with increased physical exercise as common and effective non-genetic risk modifiers explicitly confirm the study’s data. This should stimulate the discussion about preventive advice in the direction of a lower risk lifestyle.

The most common cancer in women could certainly be reduced, and the same is likely to be true for many other internal diseases.

DOI: 10.3238/arztebl.2015.0211b

Prof. Dr. med. J. Matthias Wenderlein

Universität Ulm 

wenderlein@gmx.de

1.
Key TJ: Endogenous oestrogens and breast cancer risk in premenopausal and postmenopausal women. Steroids 2011; 76: 812–15 CrossRef MEDLINE
2.
Manders P, Pijpe A, Hooning MJ, et al.: Body weight and risk of breast cancer in BRCA1/2 mutation carriers. Breast Cancer Res Treat 2011; 126: 193–202 CrossRef
3.
Plass D, Vos T, Hornberg C, Scheidt-Nave C, Zeeb H, Krämer A: Trends in disease burden in Germany—results, implications and limitations of the Global Burden of Disease Study. Dtsch Arztebl Int 2014; 111: 629–38 VOLLTEXT MEDLINE
1.Key TJ: Endogenous oestrogens and breast cancer risk in premenopausal and postmenopausal women. Steroids 2011; 76: 812–15 CrossRef MEDLINE
2.Manders P, Pijpe A, Hooning MJ, et al.: Body weight and risk of breast cancer in BRCA1/2 mutation carriers. Breast Cancer Res Treat 2011; 126: 193–202 CrossRef
3.Plass D, Vos T, Hornberg C, Scheidt-Nave C, Zeeb H, Krämer A: Trends in disease burden in Germany—results, implications and limitations of the Global Burden of Disease Study. Dtsch Arztebl Int 2014; 111: 629–38 VOLLTEXT MEDLINE

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