The burden of breast cancer attributable to modifiable risk factors

INTRODUCTION: Breast cancer (BC) is a preventable non-communicable disease and the most common cancer among women of reproductive age. Although largely associated with non-modifiable risk factors, the prevention of modifiable risk factors for BC (smoking, alcohol use, physical inactivity, and dietary risks) can help decrease society's burden. The aim of this study was to examine the BC burden among women of reproductive age attributable to these risk factors in the ten leading countries in the World Health Organization (WHO) European region, in order to describe the potential burden which can be avoided. METHODS: Within the EU CA 18218, we analyzed Disability-Adjusted Life-Years (DALY) rates of BC per 100,000 among women aged 15-49 years attributable to the four modifiable risk factors: smoking, alcohol use, physical inactivity and dietary risks. Estimates were taken from the Global Burden of Disease Study 2019, for ten countries with the highest DALY rates of BC in WHO European region in 2019: Monaco, Georgia, Bulgaria, Montenegro, Ukraine, North Macedonia, Armenia, Serbia, Greece and Romania. RESULTS: The highest DALY rate for BC was in Monaco (758.37) and Georgia (708.99). The highest DALY rate attributable to the four modifiable risk factors combined was in Monaco (178.89) and Bulgaria (171.68). The highest attributable DALY rate to smoking was in Bulgaria (49.04), and Monaco (44.67). The highest attributable DALY rate to alcohol use was in Ukraine (87.24) and Bulgaria (83.25). The highest attributable DALY rate to physical inactivity was in Monaco (9.88), followed by Bulgaria (3.49), as was the DALY rate attributable to dietary risks (48.51, and 35.90, respectively). CONCLUSIONS: The variable burden of BC attributable to the modifiable risk factors between the examined countries calls for strengthening regional activities. The proportion of BC burden attributable to these risk factors is non-negligible, given its impact on the total burden of the disease. KEY MESSAGES: • A combination of four modifiable risk factors significantly contributes to the burden of breast cancer. • Regional collaboration on risk factors is needed to prevent the burden of breast cancer.