Systematic review and meta-analysis of lifestyle and reproductive factors associated with risk of breast cancer in Asian women

INTRODUCTION: Assessing breast cancer risks from lifestyle and reproductive factors is critical for developing population-specific risk prediction tools. However, limited studies have evaluated these risks in recent Asian birth cohorts.

METHODS: We systematically reviewed articles published from January 2010 to December 2023, examining breast cancer risk factors in Asian women. Data were described narratively, estimates pooled, and prevalence and attributable proportions compared across Asian populations.

RESULTS: Of the 128 studies reviewed, 103 reported adjusted effect sizes for meta-analysis. Lifestyle and reproductive factors were predictive of breast cancer risk in Asian women, with varying impacts on pre-menopausal and post-menopausal women. Relative risks were similar within Asian populations and in comparison to European populations, except for menarche, menopause, and hormone receptor therapy. However, risk factor distributions differed across populations. Whilst alcohol intake (21%) and oral contraceptive use (20%) emerged as the most attributable modifiable risk factors in Europeans, passive smoking (24%) and higher BMI (17%,≥24kg/m2 among post-menopausal women) were predominant in Asians.

CONCLUSION: Our study shows that whilst the effects of lifestyle and reproductive breast cancer risk factors are largely similar across different populations, their distributions vary.

IMPACT: Our analysis underscores the importance of considering population-specific risk factor distributions when developing risk prediction tools for Asian populations.