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Enough studies have shown the role of smoking cessation in decreasing the risk of breast cancer, but smoking cessation is difficult and more studies are needed to work on effective strategies of smoking cessation in women who are at risk of breast cancer or who are diagnosed with breast cancer.

Alcohol Alcohol consumption is a risk factor for breast cancer; several large studies have shown this association in women 37 — The risk for breast cancer increases with the amount of alcohol use but is still present with light to moderate alcohol intake The largest cohort study on the relationship between alcohol and breast cancer was done on , women. Based on the results of this study, small amounts of alcohol use 10 g per day is associated with a ten percent increase in the risk of breast cancer Similar results were reported in a similar study conducted on , women.

The linear increase in the risk of breast cancer with alcohol consumption is reported in this study Some studies have reported that folic acid intake attenuates the risk of breast cancer with alcohol consumption More studies are needed about the role of folic acid in prevention of breast cancer in alcoholic women.

However, in women who are using alcohol, recommendation to use folic acid is logical. In contrast with smoking, alcohol intake after the diagnosis of breast cancer may not play an important role in survival of the patients 44 , However, it is recommended to discontinue alcohol use because the evidence is not enough for a conclusion and because alcohol consumption has other adverse effects on the health 46 , Enough evidence is available concerning the risk of breast cancer with alcohol intake.

However, more studies are needed to reveal the role of folic acid use and alcohol discontinuation. Therefore, it seems that the recommendation to discontinue alcohol is logical and, in women who are not able to discontinue alcohol, folic acid may be beneficial.

Factors associated with smoking initiation among Saudi male adolescents: A longitudinal study

Fat intake Fat intake is associated with an increased risk of breast cancer. But there are variations in the results of different studies. Some variables such as amount of fat consumed, reproductive variables, and menopausal age are variables that alter the relationship between fat intake and breast cancer 48 — Although some cohort studies have reported an increased risk of breast cancer in postmenopausal women with a high fat diet, interventions to reduce fat intake have reported no significant decrease in the risk of breast cancer in healthy postmenopausal women.

The results of studies reporting the role of weight and BMI in the risk of breast cancer are more consistent in comparison to results of studies reporting the role of fat intake in breast cancer. Considering the relationship between fat intake and weight, it seems that the role of weight and BMI is more important than that of fat intake.

Although it seems that weight and BMI play a more important role in the risk of breast cancer in comparison to fat intake, there is no difference in the behavior and lifestyle changes that should be recommended to women. Reducing the amount of fat intake reduces the weight and BMI in women, but more studies are needed to show their role in reducing the risk of breast cancer. Meat, caffeine, minerals, and vitamins Some studies have reported an increase in the risk of breast cancer with an increase in the consumption of red meat and caffeine 52 — The results of studies about caffeine use are inconsistent; some studies reported no association between caffeine consumption and risk of breast cancer It is difficult to assess the role of one specific agent in the risk of breast cancer because of associations between different food materials in different cultures.

Breast cancer risk also decreases with an increase in calcium and vitamin D intake This association does not exist with other vitamins and most studies do not support the role of vitamin E and vitamin C in decreasing the risk of breast cancer More studies about the role of vitamins in breast cancer are recommended. There is inadequate evidence about the role of vitamins, minerals, meat, and caffeine in the risk of breast cancer.

More research is recommended to increase vitamin intake and restrict meat and caffeine intake. Breast feeding Breastfeeding decreases the risk of breast cancer. Twelve months of breastfeeding is associated with a 4. One study in Turkey has reported that shorter durations of breastfeeding can be an important factor that can increase the risk of breast cancer in women. Postmenopausal women who had more than forty-eight months of lactation are at a reduced risk for breast cancer However, there are other factors, such as parity, that can alter the association between lactation and breast cancer.

Even so, it seems that the association is strong enough to recommend breastfeeding in women. Also, breastfeeding has other beneficial effects for both mother and infant.

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Night shift work Night shift work is known to increase the risk of breast cancer by increasing melatonin levels 63 , However, the results of different studies are varied Still more evidence is needed to prove an association between night shift work, melatonin, and breast cancer.

Stress While the relationship between stress and other psychological factors and the risk of breast cancer is not strong, it seems that major life events do play a role in the risk of breast cancer It is shown that perceived stress can increase the risk of breast cancer when combined with other risky behaviors such as inadequate physical activity, alcohol intake, smoking, low green tea intake, and high meat and seafood intake Therefore, it is more important for individuals who are in high stress situations to consider nutritional changes and physical activity in order to reduce their risk of breast cancer.

In individuals with a breast cancer diagnosis, the level of stress may be higher and the effect of this stress and its control on breast cancer risk may be the subject of future studies in this regard.

Also, other psychiatric conditions such as depression may play a role. There are few studies available that assess the role of psychiatric disorders on breast cancer risk. Some observational studies have reported a decrease in the risk of breast cancer in women who are using NSAIDs, but one randomized controlled trial on the role of aspirin use for prevention of breast cancer reported no significant effects on a year follow up in the study population Research findings do not support the role of NSAIDs in the survival of patients with a definite diagnosis of breast cancer 72 , and it seems that the benefits of NSAIDs are limited to individuals who have not been diagnosed with breast cancer.

However, more studies are needed to investigate the role of NSAIDs in women who are diagnosed with breast cancer. Although some studies have reported the role of NSAIDs in the prevention of breast cancer, different results were reported in women who were diagnosed with breast cancer. Digoxin Several researchers have reported an increase in the risk of breast cancer in patients who are using digoxin 73 — Women should be informed about this risk before starting digoxin Women who are using digoxin should undergo regular screenings for breast cancer since it is often not possible to discontinue digoxin in patients who are candidates for using it.

It seems that digoxin use does not change the risk of recurrence in women with breast cancer who are undergoing treatment Therefore, digoxin can be used in women with breast cancer who need digoxin treatment. They should have regular examinations to watch for possible recurrences.

Also, all women should be informed of the risk of digoxin use for breast cancer. Importance of education As noted above, several nutritional changes, physical activity, and alcohol and smoking cessation can reduce the risk of breast cancer in women. Therefore, educating women about these factors and their importance in the risk of breast cancer plays an important role in the prevention of breast cancer Some studies have reported that only giving information about lifestyle changes may not be enough to change the behavior of the female students.

A consultancy service may be required in order to change the behaviors of the female students However, it is not clear how useful consultancy service could be. Also, it is important to start this education in early adolescence.

Conclusion As discussed in this review, lifestyle changes are an important factor for prevention of breast cancer. Such changes include reducing weight, adopting a suitable diet, changing unnecessary drugs, etc. Also, in women who are diagnosed and are under treatment for breast cancer, lifestyle changes can reduce the recurrence rate and increase the chance of survival.

Women should be informed about the role of lifestyle changes in the prevention of breast cancer and their role in the survival and recurrence rate in patients with breast cancer.

More studies are needed to assess the role of education in lifestyle changes, to decrease the incidence and recurrence of breast cancer, and to increase the survival rate. Acknowledgments The authors want to thank to Hormozgan University of Medical Sciences for its support in preparing this review.

Footnotes The authors of this paper declare that they have no conflicts of interest. All authors read and approved the final manuscript. References 1. Daughters and Mothers Against Breast Cancer DAMES : Main outcomes of a randomized controlled trial of weight loss in overweight mothers with breast cancer and their overweight daughters.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. Research on aging. Breast cancer stage at diagnosis and area-based socioeconomic status: a multicenter year retrospective clinical epidemiological study in China.

BMC cancer. Late-stage diagnosis of breast cancer in women of lower socioeconomic status: public health implications. American journal of public health. The association of socioeconomic status and access to low-volume service providers in breast cancer.

PloS one. Global cancer statistics.

CA: a cancer journal for clinicians. Global cancer statistics, Mettlin C. Global breast cancer mortality statistics. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. American journal of epidemiology.

International journal of cancer Journal international du cancer. Effect of a diet and physical activity intervention on body weight and nutritional patterns in overweight and obese breast cancer survivors. Med Oncol. Pre- to post-diagnosis weight change and associations with physical functional limitations in breast cancer survivors.

Journal of cancer survivorship : research and practice. Weight gain prior to entry into a weight-loss intervention study among overweight and obese breast cancer survivors.

Weight change trajectory in women with breast cancer receiving chemotherapy and the effect of different regimens.

Journal of clinical nursing. Tea consumption, alcohol drinking and physical activity associations with breast cancer risk among Chinese females: a systematic review and meta-analysis.

Randomized controlled trial of aerobic exercise on insulin and insulin-like growth factors in breast cancer survivors: the Yale Exercise and Survivorship study.

Effects of exercise training on fasting insulin, insulin resistance, insulin-like growth factors, and insulin-like growth factor binding proteins in postmenopausal breast cancer survivors: a randomized controlled trial. Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Post-diagnosis physical activity and survival after breast cancer diagnosis: the Long Island Breast Cancer Study.

Breast cancer research and treatment. Schmid D, Leitzmann MF.

Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Diet and physical activity in relation to weight change among breast cancer patients.

Associations between anthropometric characteristics, physical activity, and breast cancer risk in a Canadian cohort. Active and passive cigarette smoking and breast cancer risk: results from the EPIC cohort.

Active smoking and the risk of estrogen receptor-positive and triple-negative breast cancer among women ages 20 to 44 years. Cigarette smoking and breast cancer: a case-control study in Serbia.

A prospective study of smoking and breast cancer risk among African-American women.

Prevention Plus Provides Community Wellness Information

Cigarette smoking and postmenopausal breast cancer risk in a prospective cohort. British journal of cancer. Cigarette smoking and breast cancer risk in relation to joint estrogen and progesterone receptor status: a case-control study in Japan. Smoking at time of diagnosis and breast cancer-specific survival: new findings and systematic review with meta-analysis. Health, education, social welfare, transportation, urbanism, sports, and environment have been identified as essential areas, although each municipality can adapt the composition of this working group to its needs and circumstances.

The Identification of resources for health promotion and prevention. In this application, municipalities can include information on available resources for the factors addressed in the Strategy. The resources mainly concern physical activity, healthy eating, prevention of harmful consumption of alcohol, smoking prevention, and emotional well-being.

Figure 2. One of the aspects that has contributed to the success of the local implementation is that municipalities can apply annually for funds, which are provided through an Agreement between the MHSSE and the SFMP for promoting the Spanish Healthy Cities Network and enhancing the local implementation of the Strategy.

The local implementation of the Strategy is a flexible process, although common guidelines are proposed, they can be adapted to the specific conditions and context of each municipality. Municipalities are encouraged to adopt a Social Determinants of health and Equity approach.

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Training of professionals is considered an essential element of the programme. An online course on Local Health 50 hours has been set up, including information on the local implementation of the Strategy, practical tools, as well as examples of good practices on health promotion and prevention carried out at local level.

This course is aimed at professionals who participate in the local implementation of the strategy.

Around 2, professionals have finished the course on Local Health and about 5, students are currently enrolled in the fourth edition. Considerations for future Following the establishment of the intersectoral groups and the identification of resources for health, existing interventions will be assessed.

The policies and interventions being carried out at a municipal level by the health sector as well as other sectors which impact health will be reviewed.It also provides guidance on linking workplace risk assessment with the process of stress prevention.

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Life Apr 11, Women can decrease their risk of breast cancer by engaging in regular exercise. There is inadequate evidence about the role of vitamins, minerals, meat, and caffeine in the risk of breast cancer. In addition to technical improvements, decreases in mortality have also been achieved through the introduction of practice protocols, specifically through the clinical assessment of patients, the awareness of the problem of health care providers, and the indications for bronchoscopy secondary prevention.

Ontario College of Family Physicians; Birnbaum LS. There are few studies available that assess the role of psychiatric disorders on breast cancer risk.

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