Study: Diet during teen years and early adulthood is linked to breast cancer risk
|At a glance||Questions for your doctor|
This study is about:
Whether a certain diet in adolescence and early adulthood is associated with young-onset breast cancer in women.
Why is this study important?
The research in this study suggests that teenagers and young women with “inflammatory diets” (i.e. diets high in sugar, refined grains, and red meat and low in green leafy vegetables) have an increased risk of developing breast cancer before age 50. While this research is not as relevant for all adult women, it is important for young women and parents of teenage girls who may be concerned about their breast cancer risk.
The study authors looked at the influence on breast cancer of an inflammatory diet, which largely consists of foods that trigger an inflammation response in the body. These foods include sugary foods, diet soft drinks, refined grains (white bread, pasta, bagels, etc.), red and processed meat, margarine, corn, certain other types of vegetables (celery, mushrooms, green peppers, eggplant, and summer squash), and fish (tuna, mackerel, salmon, sardines, bluefish, swordfish) and lower intake of green leafy vegetables (spinach, lettuce), yellow vegetables (carrots, yellow/winter squash, yams), cruciferous vegetables (broccoli, Brussels sprouts, cauliflower, kale, greens, cabbage), and coffee.
Among the 45,204 women participating, the increased risk of premenopausal breast cancer was:
- 35% in women whose diet patterns during adolescence was classified as inflammatory.
- 40% in women whose diet patterns during early adulthood was classified as inflammatory.
Exactly how an inflammatory diet in adolescence and early adulthood impacts risk of premenopausal breast cancer is unclear; however, these results support other studies that show a risk between chronic inflammation and other types of cancers.
What does this mean for me?
The results presented in this study are important because very little is known about how an adolescent diet contributes to breast cancer risk in adults. Because we are beginning to understand that breast cancer may begin much earlier than previously thought, taking years or even decades to develop, it is important to encourage young girls and teenagers to eat healthier. Dr. Karin Michels of the University of California Los Angeles who helped lead this study said, “Eating a healthier diet later in life does not seem to help as much as starting out eating well.”
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Harris , Willett WC, Vaidya RL, Michels KB. An Adolescent and Early Adulthood Dietary Pattern Associated with Inﬂammation and the Incidence of Breast Cancer. Cancer Res. 2017. 77(5):1179-1187.
FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
This article is relevant for:
Adolescent and young adult women
This article is also relevant for:
healthy people with average cancer risk
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IN-DEPTH REVIEW OF RESEARCH
Although the effect of adult diet on cancer risk has been well studied, statistical models and animal studies suggest that the years before a woman has her first child are critical when trying to estimate breast cancer risk. This study specifically looks at how a woman’s diet during her teenage years and early adulthood affects breast cancer risk.
Researchers of this study wanted to know:
How a woman’s diet during her teenage years and young adulthood affects her risk of breast cancer later in life.
Population(s) looked at in the study:
Holly R. Harris and colleagues used data from the Nurses’ Health Study, which began in 1989. At the beginning of the study 116,430 nurses participated by filling out a questionnaire on their lifestyle and medical history. Eight years later, 47,355 participants (who were 33 to 52 years old the time) completed a second questionnaire about their diet during high school. Women were excluded from the analysis if their reported daily caloric intake was less than 500 calories or greater than 5,000 calories, if they left more than 20 questions unanswered, if they did not report their height, or if they were diagnosed with any cancer except melanoma.
Adolescent diet was measured by asking the participants which of 124 food items they ate, including foods that were commonly eaten from 1960 to 1980 when they would have been in high school. These women first reported their adult diets in 1991, when they were 27 to 44 years old. That survey included 130 food items and was completed every 4 years. For both adolescent and adult surveys, participants were asked how often, on average, they had eaten each food item, ranging from “never” to “6 or more times a day.”
Every other year, participants were asked if they had been diagnosed with breast cancer in the previous 2 years. They were considered premenopausal if they still had periods, or had at least one ovary remaining if they were 48 years old or older. Women were considered postmenopausal if they reported being so due to natural menopause or oophorectomy.
The inflammatory diet pattern was previously identified in other studies; researchers looked at the levels of biomarkers of inflammation (certain molecules know to be elevated during an inflammatory response) in participants blood. They then compared levels to the food items the participants ate.
Researchers in this study analyzed diets and breast cancer in three categories: adolescent (ages 13 to18), early adulthood (ages 27 to 44), and combined diets (adolescent and early adulthood). They also looked at other variables. Adolescent variables included age, total adolescent calories, height at age 18, age at which their periods began, body mass index, and adolescent physical activity. These same variables were included for adult women. Premenopausal women were also asked about age at first childbirth, number of children delivered, oral contraceptive use, adult physical activity, alcohol consumption, weight change since age 18, and history of benign breast disease. Postmenopausal adult variables included age at menopause and hormone usage.
Among the 45,204 study participants, 1,477 cases of breast cancer were reported over the 22-year follow-up: 870 premenopausal cases and 490 postmenopausal cases.
- Women who consumed an inflammatory diet during adolescence:
- had a higher Body Mass Index (BMI) at age 18
- were less physically active in adulthood
- gained more weight since age 18
- were more likely to have used oral contraceptives
- ate an average 3.3 servings of refined grains and 1.2 servings of red meat a day
- Women whose diet was low in inflammatory foods:
- ate 1.5 servings of refined grains and 0.6 servings of red meat a day
- on average, these women also ate 0.7 servings a day of leafy vegetables compared to 0.3 servings for women whose diet pattern included inflammatory food
The most significant finding was:
- Women who remembered having eaten a very highly inflammatory diet as teens were 35% more likely to develop premenopausal breast cancer than women who ate the least inflammatory diet.
- Women who remembered having eaten a very highly inflammatory diet as young adults were 40% more likely to develop premenopausal breast cancer than women who ate the least inflammatory diet.
Among all participants, an adolescent inflammatory diet was associated with premenopausal breast cancer, and among all foods eaten, adolescent intake of processed meats was the food type most strongly associated with this risk. No association was made with an adolescent inflammatory diet and overall or postmenopausal breast cancer.
Few studies on adolescent diet and breast cancer have been conducted because of the difficulty in accurately reporting diet during this time. To accurately collect this data researchers would have to randomly assign large numbers of teenagers to eat different diets and then follow them for over 20 years. Among the few studies reported, eating higher amounts of soy and fiber during adolescence has been linked to reduced breast cancer risk, while eating red meat during adolescence has been shown to increase the risk of premenopausal breast cancer. More research is needed to confirm the results presented in this study.
Researchers did have not have participants’ adolescent levels. If foods eaten during adolescence influence biomarkers levels differently than they do in adults, this would not be detected in this study. Other limitations were that participants self-reported dietary information, and they were 33 to 52 years old when they were asked to remember their diets decades before, during high school. While recalling one’s adolescent diet has been shown to be reasonable, some reporting error is likely. It is also possible that teens who ate more nutritiously during adolescence had other lifelong healthy habits which were not taken into account.
In summary, this new report suggests that women who ate an inflammatory diet during adolescence and early adulthood were at increased risk of premenopausal breast cancer. The results of this study are important because very little is known about how adolescent diet contributes to risk of premenopausal breast cancer. Eating less refined flour, sugar, and red meat and eating more vegetables provides many healthful benefits, and this study shows that doing so early in life can impact the risk of premenopausal breast cancer. “A healthy lifestyle early on is much, much more important than we appreciated,” Michels said. “Now we have to communicate this to girls.”
The American Cancer Society (ACS) guidelines on exercise, nutrition and weight for cancer prevention recommend the following:
Diet and nutrition
- Follow a healthy eating pattern, including:
- foods that are high in nutrients in amounts that help you acheive and maintain a healthy body weight.
- a variety of vegetables, fiber-rich legumes (beans and peas) and whole fruits in a variety of colors. Consume at least 2½ to 3 cups of vegetables and 1½ to 2 cups of fruit each day, depending on your calorie requirements.
- whole grains rather than refined grains. At least half of the grains you eat should be whole grains.
- A healthy eating pattern that limits or does not include:
- red and processed meats.
- sugar-sweetened beverages.
- highly processed foods and refined grain products.
- It is best not to drink alcohol. People who choose to drink alcohol should:
- have no more than 1 drink per day (women) or 2 drinks per day (men).
- Exercise regularly.
- Adults should get at least 150 minutes of moderate-intensity activity (equal to a brisk walk) or 75 minutes of vigorous activity (heart rate is increased, breathing is faster and you are sweating) each week, preferably spread throughout the week.
- Physical activity has been shown to lower the risk of several types of cancer, including breast, endometrial, and colon. It also reduces the risk of other serious diseases including diabetes and heart disease.
- Achieve and keep a healthy weight.
- Being overweight or obese is a risk factor for many cancers, including breast, colon, endometrial and pancreatic. You can control your weight through regular exercise and healthy eating.
Other experts, including the following, also provide guidelines for exercise, nutrition and health:
- The Academy of Nutrition and Dietetics
- The United States Office of Disease Prevention and Health Promotion
- The American Institute for Cancer Research
- Should I be following an anti-inflammatory diet?
- How much fiber should I incorporate into my diet?
- What are other ways to reduce my breast cancer risk?
- Can you refer me to a nutritionist?
The following are studies focused on nutrition and cancer prevention.
- NCT05094466: Parent and Family Obesity Intervention in Reducing Obesity Risk in Racial Ethnic Minority Families. This compares the effects of parent/caregiver-focused programs to family-focused programs in reducing obesity risk in racial ethnic minority families.
- NCT04374747: Fruit and Vegetable Intervention in Lactating Women to Reduce Breast Cancer Risk. This trial is for nursing mothers. This study will see whether eating at least 8 to 10 daily servings of fruits and vegetables reduces breast cancer biomarkers.
- NCT03448003: Comprehensive Lifestyle Change To Prevent Breast Cancer. This trial looks at how well lifestyle changes work to prevent breast cancer. Premenopausal women 18 years and older with intact breasts and ovaries are eligible.
- NCT04192071: Virtual Human Delivered Nutrition Module for Colorectal Cancer Prevention. This study will develop and test an interactive nutrition module for use with colorectal cancer screening to learn which messages and graphics promote understanding of cancer risk and promote screening.
The following resources can help you locate a nutritionist near you or via telehealth
- You can find a registered dietician in your area through Eatright.org, the website for the Academy of Nutrition and Dietetics. Search for nutritionists by specialty, including "cancer," "weight management" and "heart health."
- The YMCA has a free program called Livestrong at the YMCA. This program includes a free 12-week membership and fitness training with certified exercise experts. You can search by zip code for a program near you.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers have specialists to manage the symptoms and side effects from cancer prevention or treatment.
Who covered this study?
Bad diet in youth might raise risk of early breast cancer This article rates 4.5 out of 5 stars
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