Breast cancer and environmental factors: dangers, risks and bias of lacking a measure of risk.

https://ehjournal.biomedcentral.com/track/pdf/10.1186/s12940-017-0287-4

Fig. 1

Complexity of factors affecting risk for developing breast cancer. This synopsis of much of the evidence described in this report demonstrates the complexities of the potential connections between exposures to environmental toxicants and development of breast cancer, all embedded in a web-like framework of interconnected factors. Solid arrowsindicated connections that have been demonstrated directly between exposures and breast cancer risk, or, as appropriate, mediated through factors described in the framing section of this review. These relationships reflect results of the combined human epidemiological and/or animal studies discussed. Dashed arrows indicate connections between exposures and risk for breast cancer that are more ambiguous, with evidence coming from non-human or -animal studies, but without the in vivo data to support more directly the link. Arrows are not weighted to indicate relative strength of links. Rather the purpose of this model is to demonstrate the complexity of the relationships between environmental factors and breast cancer. (Updated and modified from Gray et al. 2009 [11])

My first comment after reading only parts of the paper which are of interest for my own research (approximately 70% of the paper) is the following: having in mind the figure of the numerous interactions of environmental factors on the human DNA of breast cells, I would find very useful and rational to have another figure with the quantum of risk. Between all those dangers only a few ones have a significant effect. It is a pity that smoking is written in the only figure of this paper in the same font as all other potential dangers. This is a bias or it should have been warned as a matter of a future paper. Indeed for everyone it is mandatory to get the measured risk and not only the dangers. Without the quantum of risk you are afraid and you cannot act, with the quantum and the list of dangers you can customize your prevention.