Papers cited were identified through MEDLINE and references from relevant articles, selected on the basis of the largest-scale and highest-quality evidence for each topic discussed, and on the basis of the authors' interpretation of the overall evidence available. Only papers published in English were included.
ReviewEpidemiology of breast cancer
Section snippets
Age
The incidence of breast cancer increases rapidly with age during the reproductive years and then increases at a slower rate after about age 50 years, the average age at menopause (Figure 2). The cumulative incidence of breast cancer among women in Europe and North America is about 2.7% by age 55, about 5.0% by age 65, and about 7.7% by age 75.2
International variation, effects of migration, and time trends
Both incidence of and mortality from breast cancer vary about five-fold among populations around the world (Figure 3). Rates are high in most of the more developed countries but low in less developed countries and in Japan (though rates in Japan are rising). Among migrants from low-risk to high-risk countries, the rates increase and eventually become similar to those among the rest of the population in the new country. A study of migrants from eastern Asia to the USA showed that the increase in
Menarche and the menstrual cycle
The older a woman is when she begins menstruating, the lower her risk of breast cancer.7 For each 1-year delay in menarche, the risk decreases by around 5%.8 There is also evidence that, although age at menarche is related to breastcancer risk at all ages, the effect may be stronger in younger (premenopausal) women.7 Other menstrual factors, such as cycle length and regularity, have not been consistently related to risk of breast cancer.
Childbearing
Childbearing seems to have a dual effect on risk of breast
Lifestyle
The classic risk factors for breast cancer, such as age at menarche, age at menopause, and parity, are not amenable to change for the purpose of reducing risk. However, other behavioural risk factors could be modified, and these changes to reduce the risk of breast cancer would have other health benefits: avoidance of obesity should reduce the risk of other diseases also; limitation of alcohol intake would be beneficial; breastfeeding is also beneficial for the baby; and maintenance of at least
Search strategy and selection criteria
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