The paper is motivated by severe concerns regarding currently applied care of the pregnancy-associated breast cancer (PABC) characterised by particularly poor outcomes of the disease. Psychological and ethical aspects play a crucial role in PABC: the highest priority not to damage the foetus significantly complicates any treatment generally, and it is quite usual that patients disclaim undergoing any breast cancer treatment during pregnancy. Although, due to global demographic trends, PABC is far from appearing rarely now, severe societal and economic consequences of the disease are still neglected by currently applied reactive medical approach. These actualities require creating new strategies which should be better adapted to the needs of the society at large by advancing the PABC care based on predictive diagnostic approaches specifically in premenopausal women, innovative screening programmes focused on young female populations, targeted prevention in high-risk groups, and optimised treatment concepts. The article summarises the facts and provides recommendations to advance the field-related research and medical services specifically dedicated to the PABC care.

Biomedical Centre Faculty of Medicine in Plzen Charles University Plzen Czech Republic

Breast Cancer Research Centre Rheinische Friedrich Wilhelms Universität Bonn Bonn Germany

CEMBIO Rheinische Friedrich Wilhelms Universität Bonn Bonn Germany

Centre for Integrated Oncology Cologne Bonn Rheinische Friedrich Wilhelms Universität Bonn Bonn Germany

Department of Histology and Embryology Faculty of Medicine in Plzen Charles University Plzen Czech Republic

Radiological Clinic Rheinische Friedrich Wilhelms Universität Bonn Sigmund Freud Str 25 53105 Bonn Germany

Zobrazit více v PubMed

White TT. Carcinoma of the breast and pregnancy; analysis of 920 cases collected from the literature and 22 new cases. Ann Surg. 1954;139(1):9–18. doi: 10.1097/00000658-195401000-00002. PubMed DOI PMC

Golubnitschaja O, Debald M, Yeghiazaryan K, Kuhn W, Pešta M, Costigliola V, Grech G. Breast cancer epidemic in the early twenty-first century: evaluation of risk factors, cumulative questionnaires and recommendations for preventive measures. Tumour Biol. 2016;37(10):12941–12957. doi: 10.1007/s13277-016-5168-x. PubMed DOI

Rodriguez AO, Chew H, Cress R, Xing G, McElvy S, Danielsen B, Smith L. Evidence of poorer survival in pregnancy-associated breast cancer. Obstet Gynecol. 2008;112(1):71–78. doi: 10.1097/AOG.0b013e31817c4ebc. PubMed DOI

Kim YG, Jeon YW, Ko BK, Sohn G, Kim E-K, Moon B-I, Youn HJ, Kim HA, Korean Breast Cancer Society Clinicopathologic characteristics of pregnancy-associated breast cancer: results of analysis of a nationwide breast cancer registry database. J Breast Cancer. 2017;20(3):264–269. doi: 10.4048/jbc.2017.20.3.264. PubMed DOI PMC

Langer A, Mohallem M, Stevens D, Rouzier R, Lerebours F, Chérel P. A single-institution study of 117 pregnancy-associated breast cancers (PABC): presentation, imaging, clinicopathological data and outcome. Diagn Interv Imaging. 2014;95(4):435–441. doi: 10.1016/j.diii.2013.12.021. PubMed DOI

Sánchez C, Acevedo F, Medina L, Ibáñez C, Razmilic D, Elena Navarro M, et al. Breast cancer and pregnancy: a comparative analysis of a Chilean cohort. Ecancermedicalscience. 2014;8:434. PubMed PMC

Shachar SS, Gallagher K, McGuire K, Zagar TM, Faso A, Muss HB, Sweeting R, Anders CK. Multidisciplinary management of breast cancer during pregnancy. Oncologist. 2017;22(3):324–334. doi: 10.1634/theoncologist.2016-0208. PubMed DOI PMC

Zagouri F, Psaltopoulou T, Dimitrakakis C, Bartsch R, Dimopoulos M-A. Challenges in managing breast cancer during pregnancy. J Thorac Dis. 2013;5(Suppl 1):S62–S67. PubMed PMC

Loibl S, Han SN, von Minckwitz G, Bontenbal M, Ring A, Giermek J, Fehm T, van Calsteren K, Linn SC, Schlehe B, Gziri MM, Westenend PJ, Müller V, Heyns L, Rack B, van Calster B, Harbeck N, Lenhard M, Halaska MJ, Kaufmann M, Nekljudova V, Amant F. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol. 2012;13(9):887–896. doi: 10.1016/S1470-2045(12)70261-9. PubMed DOI

Moreira WB, Brandão EC, Soares AN, de Lucena CEM, Antunes CMF. Prognosis for patients diagnosed with pregnancy-associated breast cancer: a paired case-control study. Sao Paulo Med J Rev Paul Med. 2010;128(3):119–124. doi: 10.1590/S1516-31802010000300003. PubMed DOI PMC

American College of Pediatrics - December 2013 Information for the adolescent woman and her parents: abortion and the risk of breast cancer. Issues Law Med. 2017;32:99–104. PubMed

Hou N, Ogundiran T, Ojengbede O, Morhason-Bello I, Zheng Y, Fackenthal J, Adebamowo C, Anetor I, Akinleye S, Olopade OI, Huo D. Risk factors for pregnancy-associated breast cancer: a report from the Nigerian Breast Cancer Study. Ann Epidemiol. 2013;23(9):551–557. doi: 10.1016/j.annepidem.2013.06.008. PubMed DOI PMC

Molckovsky A, Madarnas Y. Breast cancer in pregnancy: a literature review. Breast Cancer Res Treat. 2008;108(3):333–338. doi: 10.1007/s10549-007-9616-6. PubMed DOI

White TT. Carcinoma of the breast in the pregnant and the nursing patient; review of 1,375 cases. Am J Obstet Gynecol. 1955;69(6):1277–1286. doi: 10.1016/S0002-9378(16)38162-5. PubMed DOI

Amant F, Loibl S, Neven P, Van Calsteren K. Breast cancer in pregnancy. Lancet. 2012;379(9815):570–579. doi: 10.1016/S0140-6736(11)61092-1. PubMed DOI

Ruiz R, Herrero C, Strasser-Weippl K, Touya D, St Louis J, Bukowski A, et al. Epidemiology and pathophysiology of pregnancy-associated breast cancer: a review. Breast. 2017;35:136–141. doi: 10.1016/j.breast.2017.07.008. PubMed DOI

Johansson ALV, Andersson TM-L, Hsieh C-C, Jirström K, Dickman P, Cnattingius S, Lambe M. Stage at diagnosis and mortality in women with pregnancy-associated breast cancer (PABC) Breast Cancer Res Treat. 2013;139(1):183–192. doi: 10.1007/s10549-013-2522-1. PubMed DOI

Callihan EB, Gao D, Jindal S, Lyons TR, Manthey E, Edgerton S, Urquhart A, Schedin P, Borges VF. Postpartum diagnosis demonstrates a high risk for metastasis and merits an expanded definition of pregnancy-associated breast cancer. Breast Cancer Res Treat. 2013;138(2):549–559. doi: 10.1007/s10549-013-2437-x. PubMed DOI PMC

Schedin P. Pregnancy-associated breast cancer and metastasis. Nat Rev Cancer. 2006;6(4):281–291. doi: 10.1038/nrc1839. PubMed DOI

Pentheroudakis G, Orecchia R, Hoekstra HJ, Pavlidis N, ESMO Guidelines Working Group Cancer, fertility and pregnancy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v266–v273. doi: 10.1093/annonc/mdq198. PubMed DOI

Kakoulidis I, Skagias L, Politi E. Pregnancy associated breast cancer (PABC): aspects in diagnosis. Breast Dis. 2015;35(3):157–166. doi: 10.3233/BD-150408. PubMed DOI

Andersson TM-L, Johansson ALV, Hsieh C-C, Cnattingius S, Lambe M. Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol. 2009;114(3):568–572. doi: 10.1097/AOG.0b013e3181b19154. PubMed DOI

Keyser EA, Staat BC, Fausett MB, Shields AD. Pregnancy-associated breast cancer. Rev Obstet Gynecol. 2012;5(2):94–99. PubMed PMC

Beadle BM, Woodward WA, Middleton LP, Tereffe W, Strom EA, Litton JK, Meric-Bernstam F, Theriault RL, Buchholz TA, Perkins GH. The impact of pregnancy on breast cancer outcomes in women<or=35 years. Cancer. 2009;115(6):1174–1184. doi: 10.1002/cncr.24165. PubMed DOI PMC

| Human Development Reports [Internet]. [cited 2018 Jan 2]. Available from: http://hdr.undp.org/en/2016-report.

Lyons TR, Schedin PJ, Borges VF. Pregnancy and breast cancer: when they collide. J Mammary Gland Biol Neoplasia. 2009;14(2):87–98. doi: 10.1007/s10911-009-9119-7. PubMed DOI PMC

Yager JD, Davidson NE. Estrogen carcinogenesis in breast cancer. N Engl J Med. 2006;354(3):270–282. doi: 10.1056/NEJMra050776. PubMed DOI

Germain D. Estrogen carcinogenesis in breast cancer. Endocrinol Metab Clin N Am. 2011;40(3):473–484. doi: 10.1016/j.ecl.2011.05.009. PubMed DOI

Lanzino M, Morelli C, Garofalo C, Panno ML, Mauro L, Andò S, et al. Interaction between estrogen receptor alpha and insulin/IGF signaling in breast cancer. Curr Cancer Drug Targets. 2008;8(7):597–610. doi: 10.2174/156800908786241104. PubMed DOI

Gupta PB, Proia D, Cingoz O, Weremowicz J, Naber SP, Weinberg RA, Kuperwasser C. Systemic stromal effects of estrogen promote the growth of estrogen receptor-negative cancers. Cancer Res. 2007;67(5):2062–2071. doi: 10.1158/0008-5472.CAN-06-3895. PubMed DOI

Shakhar K, Valdimarsdottir HB, Bovbjerg DH. Heightened risk of breast cancer following pregnancy: could lasting systemic immune alterations contribute? Cancer Epidemiol Biomark Prev. 2007;16(6):1082–1086. doi: 10.1158/1055-9965.EPI-07-0014. PubMed DOI

Graham C, Chooniedass R, Stefura WP, Becker AB, Sears MR, Turvey SE, Mandhane PJ, Subbarao P, CHILD Study Investigators. HayGlass KT. In vivo immune signatures of healthy human pregnancy: inherently inflammatory or anti-inflammatory? PLoS One. 2017;12(6):e0177813. doi: 10.1371/journal.pone.0177813. PubMed DOI PMC

Aagaard-Tillery KM, Silver R, Dalton J. Immunology of normal pregnancy. Semin Fetal Neonatal Med. 2006;11(5):279–295. doi: 10.1016/j.siny.2006.04.003. PubMed DOI

Rapacz-Leonard A, Dąbrowska M, Janowski T. Major histocompatibility complex I mediates immunological tolerance of the trophoblast during pregnancy and may mediate rejection during parturition. Mediat Inflamm. 2014;2014:579279. PubMed PMC

O’Brien J, Lyons T, Monks J, Lucia MS, Wilson RS, Hines L, et al. Alternatively activated macrophages and collagen remodeling characterize the postpartum involuting mammary gland across species. Am J Pathol. 2010;176(3):1241–1255. doi: 10.2353/ajpath.2010.090735. PubMed DOI PMC

Strange R, Li F, Saurer S, Burkhardt A, Friis RR. Apoptotic cell death and tissue remodelling during mouse mammary gland involution. Dev Camb Engl. 1992;115:49–58. PubMed

Strange R, Metcalfe T, Thackray L, Dang M. Apoptosis in normal and neoplastic mammary gland development. Microsc Res Tech. 2001;52(2):171–181. doi: 10.1002/1097-0029(20010115)52:2<171::AID-JEMT1003>3.0.CO;2-T. PubMed DOI

Watson CJ, Kreuzaler PA. Remodeling mechanisms of the mammary gland during involution. Int J Dev Biol. 2011;55(7-8-9):757–762. doi: 10.1387/ijdb.113414cw. PubMed DOI

Martinson HA, Jindal S, Durand-Rougely C, Borges VF, Schedin P. Wound healing-like immune program facilitates postpartum mammary gland involution and tumor progression. Int J Cancer. 2015;136(8):1803–1813. doi: 10.1002/ijc.29181. PubMed DOI PMC

Guo Q, Minnier J, Burchard J, Chiotti K, Spellman P, Schedin P. Physiologically activated mammary fibroblasts promote postpartum mammary cancer. JCI Insight. 2017;2:e89206. doi: 10.1172/jci.insight.89206. PubMed DOI PMC

Avishai E, Yeghiazaryan K, Golubnitschaja O. Impaired wound healing: facts and hypotheses for multi-professional considerations in predictive, preventive and personalised medicine. EPMA J. 2017;8(1):23–33. doi: 10.1007/s13167-017-0081-y. PubMed DOI PMC

Stolzenburg-Veeser L, Golubnitschaja O. Mini-encyclopaedia of the wound healing—opportunities for integrating multi-omic approaches into medical practice. J Proteomics. 2018. 10.1016/j.jprot.2017.07.017. PubMed

Lenhard MS, Bauerfeind I, Untch M. Breast cancer and pregnancy: challenges of chemotherapy. Crit Rev Oncol Hematol. 2008;67(3):196–203. doi: 10.1016/j.critrevonc.2008.02.007. PubMed DOI

Rovera F, Chiappa C, Coglitore A, Baratelli GM, Fachinetti A, Marelli M, Frattini F, Lavazza M, Bascialla L, Rausei S, Boni L, Corben AD, Dionigi G, Dionigi R. Management of breast cancer during pregnancy. Int J Surg. 2013;11(Suppl 1):S64–S68. doi: 10.1016/S1743-9191(13)60020-5. PubMed DOI

Murphy CG, Mallam D, Stein S, Patil S, Howard J, Sklarin N, Hudis CA, Gemignani ML, Seidman AD. Current or recent pregnancy is associated with adverse pathologic features but not impaired survival in early breast cancer. Cancer. 2012;118(13):3254–3259. doi: 10.1002/cncr.26654. PubMed DOI

Stensheim H, Møller B, van Dijk T, Fosså SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol. 2009;27(1):45–51. doi: 10.1200/JCO.2008.17.4110. PubMed DOI

Basaran D, Turgal M, Beksac K, Ozyuncu O, Aran O, Beksac MS. Pregnancy-associated breast cancer: clinicopathological characteristics of 20 cases with a focus on identifiable causes of diagnostic delay. Breast Care. 2014;9:355–359. doi: 10.1159/000366436. PubMed DOI PMC

Faguy K. Breast disorders in pregnant and lactating women. Radiol Technol. 2015;86:419M–438M. PubMed

Taylor D, Lazberger J, Ives A, Wylie E, Saunders C. Reducing delay in the diagnosis of pregnancy-associated breast cancer: how imaging can help us. J Med Imaging Radiat Oncol. 2011;55(1):33–42. doi: 10.1111/j.1754-9485.2010.02227.x. PubMed DOI

Aziz S, Pervez S, Khan S, Siddiqui T, Kayani N, Israr M, Rahbar M. Case control study of novel prognostic markers and disease outcome in pregnancy/lactation-associated breast carcinoma. Pathol Res Pract. 2003;199(1):15–21. doi: 10.1078/0344-0338-00347. PubMed DOI

Dolle JM, Daling JR, White E, Brinton LA, Doody DR, Porter PL, et al. Risk factors for triple-negative breast cancer in women under the age of 45 years. Cancer Epidemiol Biomarkers Prev. 2009;18:1157–1166. doi: 10.1158/1055-9965.EPI-08-1005. PubMed DOI PMC

Bonnier P, Romain S, Dilhuydy JM, Bonichon F, Julien JP, Charpin C, Lejeune C, Martin PM, Piana L, Société Franĉaise de Sénologie et de Pathologie Mammaire Study Group Influence of pregnancy on the outcome of breast cancer: a case-control study. Societe Francaise de Senologie et de Pathologie Mammaire Study Group. Int J Cancer. 1997;72(5):720–727. doi: 10.1002/(SICI)1097-0215(19970904)72:5<720::AID-IJC3>3.0.CO;2-U. PubMed DOI

Ishida T, Yokoe T, Kasumi F, Sakamoto G, Makita M, Tominaga T, Simozuma K, Enomoto K, Fujiwara K, Nanasawa T, Fukutomi T, Hirota T, Fukuda M, Miura S, Koyama H, Inaji H, Sonoo H. Clinicopathologic characteristics and prognosis of breast cancer patients associated with pregnancy and lactation: analysis of case-control study in Japan. Jpn J Cancer Res Gann. 1992;83(11):1143–1149. doi: 10.1111/j.1349-7006.1992.tb02737.x. PubMed DOI PMC

Strasser-Weippl K, Ramchandani R, Fan L, Li J, Hurlbert M, Finkelstein D, Shao ZM, Goss PE. Pregnancy-associated breast cancer in women from Shanghai: risk and prognosis. Breast Cancer Res Treat. 2015;149(1):255–261. doi: 10.1007/s10549-014-3219-9. PubMed DOI PMC

Mielke S, Meden H, Kuhn W. Expression of the c-erbB-2-encoded oncoprotein p185 (HER-2/neu) in pregnancy as a model for oncogene-induced carcinogenesis. Med Hypotheses. 1998;50(5):359–362. doi: 10.1016/S0306-9877(98)90205-5. PubMed DOI

Hsiao Y-H, Su YA, Tsai H-D, Mason JT, Chou M-C, Man Y. Increased invasiveness and aggressiveness in breast epithelia with cytoplasmic p63 expression. Int J Biol Sci. 2010;6(5):428–442. doi: 10.7150/ijbs.6.428. PubMed DOI PMC

Asztalos S, Pham TN, Gann PH, Hayes MK, Deaton R, Wiley EL, Emmadi R, Kajdacsy-Balla A, Banerji N, McDonald W, Khan SA, Tonetti DA. High incidence of triple negative breast cancers following pregnancy and an associated gene expression signature. Springerplus. 2015;4(1):710. doi: 10.1186/s40064-015-1512-7. PubMed DOI PMC

Johannsson O, Loman N, Borg A, Olsson H. Pregnancy-associated breast cancer in BRCA1 and BRCA2 germline mutation carriers. Lancet. 1998;352(9137):1359–1360. doi: 10.1016/S0140-6736(05)60750-7. PubMed DOI

Robertson C, Primic-Zakelj M, Boyle P, Hsieh CC. Effect of parity and age at delivery on breast cancer risk in Slovenian women aged 25-54 years. Int J Cancer. 1997;73(1):1–9. doi: 10.1002/(SICI)1097-0215(19970926)73:1<1::AID-IJC1>3.0.CO;2-U. PubMed DOI

Trichopoulos D, Hsieh CC, MacMahon B, Lin TM, Lowe CR, Mirra AP, et al. Age at any birth and breast cancer risk. Int J Cancer. 1983;31(6):701–704. doi: 10.1002/ijc.2910310604. PubMed DOI

Collaborative Group on Hormonal Factors in Breast Cancer Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet. 2002;360:187–195. doi: 10.1016/S0140-6736(02)09454-0. PubMed DOI

Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104:96–113. doi: 10.1111/apa.13102. PubMed DOI PMC

Hadjisavvas A, Loizidou MA, Middleton N, Michael T, Papachristoforou R, Kakouri E, Daniel M, Papadopoulos P, Malas S, Marcou Y, Kyriacou K. An investigation of breast cancer risk factors in Cyprus: a case control study. BMC Cancer. 2010;10(1):447. doi: 10.1186/1471-2407-10-447. PubMed DOI PMC

Johansson ALV, Andersson TM-L, Hsieh C-C, Cnattingius S, Dickman PW, Lambe M. Family history and risk of pregnancy-associated breast cancer (PABC) Breast Cancer Res Treat. 2015;151(1):209–217. doi: 10.1007/s10549-015-3369-4. PubMed DOI

Pollán M. Epidemiology of breast cancer in young women. Breast Cancer Res Treat. 2010;123(Suppl 1):3–6. doi: 10.1007/s10549-010-1098-2. PubMed DOI

Rousset-Jablonski C, Gompel A. Screening for familial cancer risk: focus on breast cancer. Maturitas. 2017;105:69–77. doi: 10.1016/j.maturitas.2017.08.004. PubMed DOI

Yu JH, Kim MJ, Cho H, Liu HJ, Han S-J, Ahn T-G. Breast diseases during pregnancy and lactation. Obstet Gynecol Sci. 2013;56(3):143–159. doi: 10.5468/ogs.2013.56.3.143. PubMed DOI PMC

Albrektsen G, Heuch I, Hansen S, Kvåle G. Breast cancer risk by age at birth, time since birth and time intervals between births: exploring interaction effects. Br J Cancer. 2005;92(1):167–175. doi: 10.1038/sj.bjc.6602302. PubMed DOI PMC

Colditz GA, Frazier AL. Models of breast cancer show that risk is set by events of early life: prevention efforts must shift focus. Cancer Epidemiol Biomarkers Prev. 1995;4:567–571. PubMed

Warren Andersen S, Trentham-Dietz A, Gangnon RE, Hampton JM, Figueroa JD, Skinner HG, Engelman CD, Klein BE, Titus LJ, Egan KM, Newcomb PA. Reproductive windows, genetic loci, and breast cancer risk. Ann Epidemiol. 2014;24(5):376–382. doi: 10.1016/j.annepidem.2014.02.007. PubMed DOI PMC

Gaudet MM, Press MF, Haile RW, Lynch CF, Glaser SL, Schildkraut J, Gammon MD, Douglas Thompson W, Bernstein JL. Risk factors by molecular subtypes of breast cancer across a population-based study of women 56 years or younger. Breast Cancer Res Treat. 2011;130(2):587–597. doi: 10.1007/s10549-011-1616-x. PubMed DOI PMC

Millikan RC, Newman B, Tse C-K, Moorman PG, Conway K, Dressler LG, Smith LV, Labbok MH, Geradts J, Bensen JT, Jackson S, Nyante S, Livasy C, Carey L, Earp HS, Perou CM. Epidemiology of basal-like breast cancer. Breast Cancer Res Treat. 2008;109(1):123–139. doi: 10.1007/s10549-007-9632-6. PubMed DOI PMC

Simmen FA, Simmen RCM. The maternal womb: a novel target for cancer prevention in the era of the obesity pandemic? Eur J Cancer Prev. 2011;20(6):539–548. doi: 10.1097/CEJ.0b013e328348fc21. PubMed DOI PMC

Polivka J, Kralickova M, Polivka J, Kaiser C, Kuhn W, Golubnitschaja O. Mystery of the brain metastatic disease in breast cancer patients: improved patient stratification, disease prediction and targeted prevention on the horizon? EPMA J. 2017;8(2):119–127. doi: 10.1007/s13167-017-0087-5. PubMed DOI PMC

Islami F, Goding Sauer A, Miller KD, Siegel RL, Fedewa SA, Jacobs EJ, McCullough M, Patel AV, Ma J, Soerjomataram I, Flanders WD, Brawley OW, Gapstur SM, Jemal A. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2017;68(1):31–54. doi: 10.3322/caac.21440. PubMed DOI

Catsburg C, Miller AB, Rohan TE. Active cigarette smoking and risk of breast cancer. Int J Cancer. 2015;136(9):2204–2209. doi: 10.1002/ijc.29266. PubMed DOI

White AJ, Bradshaw PT, Herring AH, Teitelbaum SL, Beyea J, Stellman SD, et al. Exposure to multiple sources of polycyclic aromatic hydrocarbons and breast cancer incidence. Environ Int. 2016;89–90:185–192. doi: 10.1016/j.envint.2016.02.009. PubMed DOI PMC

Liu Y, Colditz GA, Rosner B, Berkey CS, Collins LC, Schnitt SJ, Connolly JL, Chen WY, Willett WC, Tamimi RM. Alcohol intake between menarche and first pregnancy: a prospective study of breast cancer risk. J Natl Cancer Inst. 2013;105(20):1571–1578. doi: 10.1093/jnci/djt213. PubMed DOI PMC

Schottenfeld D, Jr JFF, editors. Cancer epidemiology and prevention. Third edition. Oxford: Oxford University Press; 2006.

Richter K, Acker J, Kamcev N, Bajraktarov S, Piehl A, Niklewski G. Recommendations for the prevention of breast cancer in shift workers. EPMA J. 2011;2(4):351–356. doi: 10.1007/s13167-011-0126-6. PubMed DOI PMC

Blakeman V, Williams JL, Meng Q-J, Streuli CH. Circadian clocks and breast cancer. Breast Cancer Res. 2016;18(1):89. doi: 10.1186/s13058-016-0743-z. PubMed DOI PMC

Fritschi L, Glass DC, Heyworth JS, Aronson K, Girschik J, Boyle T, Grundy A, Erren TC. Hypotheses for mechanisms linking shiftwork and cancer. Med Hypotheses. 2011;77(3):430–436. doi: 10.1016/j.mehy.2011.06.002. PubMed DOI

Megdal SP, Kroenke CH, Laden F, Pukkala E, Schernhammer ES. Night work and breast cancer risk: a systematic review and meta-analysis. Eur J Cancer. 2005;41:2023–2032. doi: 10.1016/j.ejca.2005.05.010. PubMed DOI

Wegrzyn LR, Tamimi RM, Rosner BA, Brown SB, Stevens RG, Eliassen AH, Laden F, Willett WC, Hankinson SE, Schernhammer ES. Rotating night-shift work and the risk of breast cancer in the nurses’ health studies. Am J Epidemiol. 2017;186(5):532–540. doi: 10.1093/aje/kwx140. PubMed DOI PMC

Rafnsson V, Tulinius H, Jónasson JG, Hrafnkelsson J. Risk of breast cancer in female flight attendants: a population-based study (Iceland) Cancer Causes Control. 2001;12(2):95–101. doi: 10.1023/A:1008983416836. PubMed DOI

Linnersjö A, Hammar N, Dammström B-G, Johansson M, Eliasch H. Cancer incidence in airline cabin crew: experience from Sweden. Occup Environ Med. 2003;60(11):810–814. doi: 10.1136/oem.60.11.810. PubMed DOI PMC

Pukkala E, Auvinen A, Wahlberg G. Incidence of cancer among Finnish airline cabin attendants, 1967-92. BMJ. 1995;311(7006):649–652. doi: 10.1136/bmj.311.7006.649. PubMed DOI PMC

Chan DSM, Vieira AR, Aune D, Bandera EV, Greenwood DC, McTiernan A, Navarro Rosenblatt D, Thune I, Vieira R, Norat T. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25(10):1901–1914. doi: 10.1093/annonc/mdu042. PubMed DOI PMC

Hardefeldt PJ, Edirimanne S, Eslick GD. Diabetes increases the risk of breast cancer: a meta-analysis. Endocr Relat Cancer. 2012;19(6):793–803. doi: 10.1530/ERC-12-0242. PubMed DOI

Boyle P, Boniol M, Koechlin A, Robertson C, Valentini F, Coppens K, Fairley LL, Boniol M, Zheng T, Zhang Y, Pasterk M, Smans M, Curado MP, Mullie P, Gandini S, Bota M, Bolli GB, Rosenstock J, Autier P. Diabetes and breast cancer risk: a meta-analysis. Br J Cancer. 2012;107(9):1608–1617. doi: 10.1038/bjc.2012.414. PubMed DOI PMC

Park Y-MM, O’Brien KM, Zhao S, Weinberg CR, Baird DD, Sandler DP. Gestational diabetes mellitus may be associated with increased risk of breast cancer. Br J Cancer. 2017;116(7):960–963. doi: 10.1038/bjc.2017.34. PubMed DOI PMC

Zubor P, Gondova A, Polivka J, Kasajova P, Konieczka K, Danko J, Golubnitschaja O. Breast cancer and Flammer syndrome: any symptoms in common for prediction, prevention and personalised medical approach? EPMA J. 2017;8(2):129–140. doi: 10.1007/s13167-017-0089-3. PubMed DOI PMC

Bubnov R, Polivka J, Zubor P, Konieczka K, Golubnitschaja O. “Pre-metastatic niches” in breast cancer: are they created by or prior to the tumour onset? “Flammer syndrome” relevance to address the question. EPMA J. 2017;8(2):141–157. doi: 10.1007/s13167-017-0092-8. PubMed DOI PMC

Smokovski I, Risteski M, Polivka J, Zubor P, Konieczka K, Costigliola V, Golubnitschaja O. Postmenopausal breast cancer: European challenge and innovative concepts. EPMA J. 2017;8(2):159–169. doi: 10.1007/s13167-017-0094-6. PubMed DOI PMC

Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, Young J. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG. 2012;119(13):1572–1582. doi: 10.1111/j.1471-0528.2012.03475.x. PubMed DOI PMC

Ballard-Barbash R, Hunsberger S, Alciati MH, Blair SN, Goodwin PJ, McTiernan A, Wing R, Schatzkin A. Physical activity, weight control, and breast cancer risk and survival: clinical trial rationale and design considerations. J Natl Cancer Inst. 2009;101(9):630–643. doi: 10.1093/jnci/djp068. PubMed DOI PMC

Bernstein L. Exercise and breast cancer prevention. Curr Oncol Rep. 2009;11(6):490–496. doi: 10.1007/s11912-009-0066-7. PubMed DOI

Zeng H, Irwin ML, Lu L, Risch H, Mayne S, Mu L, Deng Q, Scarampi L, Mitidieri M, Katsaros D, Yu H. Physical activity and breast cancer survival: an epigenetic link through reduced methylation of a tumor suppressor gene L3MBTL1. Breast Cancer Res Treat. 2012;133(1):127–135. doi: 10.1007/s10549-011-1716-7. PubMed DOI

Kauppila A, Kyyrönen P, Hinkula M, Pukkala E. Birth intervals and breast cancer risk. Br J Cancer. 2009;101(7):1213–1217. doi: 10.1038/sj.bjc.6605300. PubMed DOI PMC

Tworoger SS, Eliassen AH, Sluss P, Hankinson SE. A prospective study of plasma prolactin concentrations and risk of premenopausal and postmenopausal breast cancer. J Clin Oncol. 2007;25(12):1482–1488. doi: 10.1200/JCO.2006.07.6356. PubMed DOI

Fazzo L, Carere M, Tisano F, Bruno C, Cernigliaro A, Cicero MR, et al. Cancer incidence in Priolo, Sicily: a spatial approach for estimation of industrial air pollution impact. Geospat Health. 2016;11:320. doi: 10.4081/gh.2016.320. PubMed DOI

Zimeri AM, Robb SW, Hassan SM, Hire RR, Davis MB. Assessing heavy metal and PCB exposure from tap water by measuring levels in plasma from sporadic breast cancer patients, a pilot study. Int J Environ Res Public Health. 2015;12(12):15683–15691. doi: 10.3390/ijerph121215013. PubMed DOI PMC

Alatise OI, Schrauzer GN. Lead exposure: a contributing cause of the current breast cancer epidemic in Nigerian women. Biol Trace Elem Res. 2010;136(2):127–139. doi: 10.1007/s12011-010-8608-2. PubMed DOI PMC

Little MP, McElvenny DM. Male breast cancer incidence and mortality risk in the Japanese atomic bomb survivors—differences in excess relative and absolute risk from female breast cancer. Environ Health Perspect. 2017;125(2):223–229. PubMed PMC

Grant EJ, Brenner A, Sugiyama H, Sakata R, Sadakane A, Utada M, Cahoon EK, Milder CM, Soda M, Cullings HM, Preston DL, Mabuchi K, Ozasa K. Solid cancer incidence among the life span study of atomic bomb survivors: 1958-2009. Radiat Res. 2017;187(5):513–537. doi: 10.1667/RR14492.1. PubMed DOI PMC

Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer. 2013;108(11):2205–2240. doi: 10.1038/bjc.2013.177. PubMed DOI PMC

Kotepui M. Diet and risk of breast cancer. Contemp Oncol Poznan Pol. 2016;20:13–19. PubMed PMC

Seitz HK, Pelucchi C, Bagnardi V, La Vecchia C. Epidemiology and pathophysiology of alcohol and breast cancer: update 2012. Alcohol Alcohol. 2012;47(3):204–212. doi: 10.1093/alcalc/ags011. PubMed DOI

Kim HJ, Jung S, Eliassen AH, Chen WY, Willett WC, Cho E. Alcohol consumption and breast cancer risk in younger women according to family history of breast cancer and folate intake. Am J Epidemiol. 2017;186(5):524–531. doi: 10.1093/aje/kwx137. PubMed DOI PMC

Härmä M, Kecklund G. Shift work and health—how to proceed? Scand J Work Environ Health. 2010;36(2):81–84. doi: 10.5271/sjweh.2902. PubMed DOI

Charrier A, Olliac B, Roubertoux P, Tordjman S. Clock genes and altered sleep-wake rhythms: their role in the development of psychiatric disorders. Int J Mol Sci. 2017;18(5):E938. doi: 10.3390/ijms18050938. PubMed DOI PMC

Wang X-S, Armstrong MEG, Cairns BJ, Key TJ, Travis RC. Shift work and chronic disease: the epidemiological evidence. Occup Med. 2011;61(2):78–89. doi: 10.1093/occmed/kqr001. PubMed DOI PMC

Schubauer-Berigan MK, Anderson JL, Hein MJ, Little MP, Sigurdson AJ, Pinkerton LE. Breast cancer incidence in a cohort of U.S. flight attendants. Am J Ind Med. 2015;58(3):252–266. doi: 10.1002/ajim.22419. PubMed DOI PMC

Wu AH, Kurian AW, Kwan ML, John EM, Lu Y, Keegan THM, Gomez SL, Cheng I, Shariff-Marco S, Caan BJ, Lee VS, Sullivan-Halley J, Tseng CC, Bernstein L, Sposto R, Vigen C. Diabetes and other comorbidities in breast cancer survival by race/ethnicity: the California Breast Cancer Survivorship Consortium (CBCSC) Cancer Epidemiol Biomarkers Prev. 2015;24(2):361–368. doi: 10.1158/1055-9965.EPI-14-1140. PubMed DOI PMC

Xie C, Wang W, Li X, Shao N, Li W. Gestational diabetes mellitus and maternal breast cancer risk: a meta-analysis of the literature. J Matern-Fetal Neonatal Med. 2017;7:1–11. PubMed

Yeghiazaryan K, Cebioglu M, Golubnitschaja O. Global figures argue in favour of preventive measures and personalised treatment to optimise inadequate diabetes care. New Strateg. Adv. PreDiabetes Care Integr. Approach PPPM [Internet]. Dordrecht : Springer; 2013 [cited 2018 Jan 23]. p. 1–13. Available from: https://link.springer.com/chapter/10.1007/978-94-007-5971-8_1. DOI

Gaetani S, Romano A, Provensi G, Ricca V, Lutz T, Passani MB. Eating disorders: from bench to bedside and back. J Neurochem. 2016;139(5):691–699. doi: 10.1111/jnc.13848. PubMed DOI

Jagielska G, Kacperska I. Outcome, comorbidity and prognosis in anorexia nervosa. Psychiatr Pol. 2017;51(2):205–218. doi: 10.12740/PP/64580. PubMed DOI

Cox TR, Rumney RMH, Schoof EM, Perryman L, Høye AM, Agrawal A, Bird D, Latif NA, Forrest H, Evans HR, Huggins ID, Lang G, Linding R, Gartland A, Erler JT. The hypoxic cancer secretome induces pre-metastatic bone lesions through lysyl oxidase. Nature. 2015;522(7554):106–110. doi: 10.1038/nature14492. PubMed DOI PMC

Konieczka K, Ritch R, Traverso CE, Kim DM, Kook MS, Gallino A, Golubnitschaja O, Erb C, Reitsamer HA, Kida T, Kurysheva N, Yao K. Flammer syndrome. EPMA J. 2014;5(1):11. doi: 10.1186/1878-5085-5-11. PubMed DOI PMC

Golubnitschaja O, Debald M, Kuhn W, Yeghiazaryan K, Bubnov RV, Goncharenko VM, et al. Flammer syndrome and potential formation of pre-metastatic niches: a multi-centred study on phenotyping, patient stratification, prediction and potential prevention of aggressive breast cancer and metastatic disease. EPMA J. 2016;7:A25. doi: 10.1186/s13167-016-0072-4. DOI

Yeghiazaryan K, Flammer J, Golubnitschaja O. Predictive molecular profiling in blood of healthy vasospastic individuals: clue to targeted prevention as personalised medicine to effective costs. EPMA J. 2010;1(2):263–272. doi: 10.1007/s13167-010-0032-3. PubMed DOI PMC

Golubnitschaja O. Feeling cold and other underestimated symptoms in breast cancer: anecdotes or individual profiles for advanced patient stratification? EPMA J. 2017;8(1):17–22. doi: 10.1007/s13167-017-0086-6. PubMed DOI PMC

Golubnitschaja O, Filep N, Yeghiazaryan K, Blom HJ, Hofmann-Apitius M, Kuhn W. Multi-omic approach decodes paradoxes of the triple-negative breast cancer: lessons for predictive, preventive and personalised medicine. Amino Acids. 2017; 10.1007/s00726-017-2524-0. PubMed

Eibye S, Kjær SK, Mellemkjær L. Incidence of pregnancy-associated cancer in Denmark, 1977-2006. Obstet Gynecol. 2013;122(3):608–617. doi: 10.1097/AOG.0b013e3182a057a2. PubMed DOI

Mitochondria-based holistic 3PM approach as the 'game-changer' for individualised rehabilitation-the proof-of-principle model by treated breast cancer survivors

Aronia melanocarpa L. fruit peels show anti-cancer effects in preclinical models of breast carcinoma: The perspectives in the chemoprevention and therapy modulation

Anti-breast cancer effects of phytochemicals: primary, secondary, and tertiary care

Prostate cancer management: long-term beliefs, epidemic developments in the early twenty-first century and 3PM dimensional solutions

Genoprotective activities of plant natural substances in cancer and chemopreventive strategies in the context of 3P medicine

Anticancer Activities of Thymus vulgaris L. in Experimental Breast Carcinoma in Vivo and in Vitro

Predictive and individualized management of stroke-success story in Czech Republic