Evidence map›Paper›PMID 39061008›Full record

SynthesisBMC cancer2024

Non-genetic factors and breast cancer: an umbrella review of meta-analyses.

Anneza Yiallourou, Katerina Pantavou, Georgios Markozannes, Antonis Pilavas, Andrea Georgiou, Andria Hadjikou, Mary Economou, Neophytos Christodoulou, Konstantinos Letsos, Elina Khattab and 7 more

Abstract readSystematic Review
In one paragraph

Synthesis in BMC cancer, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
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  4. Quercetin and Citreorosein fromCurrent pharmaceutical design · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Anneza YiallourouMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Katerina PantavouMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Georgios MarkozannesDepartment of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK.
Antonis PilavasMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Andrea GeorgiouMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Andria HadjikouMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Mary EconomouMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Neophytos ChristodoulouRoyal Papworth Hospital, Papworth Rd, Trumpington, Cambridge, CB2 0AY, UK.
Konstantinos LetsosMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Elina KhattabMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Chrystalleni KossyvaMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Maria ConstantinouMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Melanie TheodoridouMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus.
Daniele PiovaniDepartment of Biomedical Sciences, Humanitas University, Milan, 20072, Italy.
Konstantinos Κ TsilidisDepartment of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK.
Stefanos BonovasDepartment of Biomedical Sciences, Humanitas University, Milan, 20072, Italy.
Georgios K NikolopoulosMedical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus. nikolopoulos.georgios@ucy.ac.cy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrevious research has found associations between various non-genetic factors and breast cancer (BrCa) risk. This study summarises and appraises the credibility of the available evidence on the association between non-genetic factors and BrCa risk.

methodsWe conducted an umbrella review of meta-analyses. Medline, Scopus, and the Cochrane databases were systematically searched for meta-analyses examining non-genetic factors and BrCa incidence or mortality. The strength of the evidence was graded in four categories (i.e., weak, suggestive, highly suggestive, convincing).

resultsA total of 781 meta-analyses from 280 publications were evaluated and graded. We included exposures related to anthropometric measurements, biomarkers, breast characteristics and diseases, diet and supplements, environment, exogenous hormones, lifestyle and social factors, medical history, medication, reproductive history, and pregnancy. The largest number of examined associations was found for the category of diet and supplements and for exposures such as aspirin use and active smoking. The statistically significant (P-value < 0.05) meta-analyses were 382 (49%), of which 204 (53.4%) reported factors associated with increased BrCa risk. Most of the statistically significant evidence (n = 224, 58.6%) was graded as weak. Convincing harmful associations with heightened BrCa risk were found for increased body mass index (BMI), BMI and weight gain in postmenopausal women, oral contraceptive use in premenopausal women, increased androstenedione, estradiol, estrone, and testosterone concentrations, high Breast Imaging Reporting and Data System (BIRADS) classification, and increased breast density. Convincing protective factors associated with lower BrCa risk included high fiber intake and high sex hormone binding globulin (SHBG) levels while highly suggestive protective factors included high 25 hydroxy vitamin D [25(OH)D] levels, adherence to healthy lifestyle, and moderate-vigorous physical activity.

conclusionsOur findings suggest some highly modifiable factors that protect from BrCa. Interestingly, while diet was the most studied exposure category, the related associations failed to reach higher levels of evidence, indicating the methodological limitations in the field. To improve the validity of these associations, future research should utilise more robust study designs and better exposure assessment techniques. Overall, our study provides knowledge that supports the development of evidence-based BrCa prevention recommendations and guidance, both at an individual level and for public health initiatives.

trial registrationPROSPERO CRD42022370675.

Indexed as

Breast NeoplasmsDietDietary SupplementsFemaleHumansLife StyleMeta-Analysis as TopicRisk FactorsBreast cancerMeta-analysisNon-genetic factorsOverview of reviewsSystematic reviewUmbrella review

Identifiers

PMID39061008
PMCPMC11282738

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.