الفهرس 
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Abstract
Breast cancer (BC) was the most common cancer in women worldwide; BC in young women needs more attention and has special tumor characteristics. BC is thought to be caused by complex interactions between genes, lifestyle and environment. Family history is an important risk factor, reproductive factors play an important role in the development of BC and there was a significant association between life style factors and the risk of BC as diet, physical inactivity, overweight and obesity. Exposure of females to light at night, pcshological stress and electromagnetic waves, recently those were assumed to carry a risk of BC occurrence.
Aim of the study:
This study was conducted to find out the most revealing risk factors and BC development among women aged 40 years old or less attending Minia oncology center comparing them with their controls.
Subjects and methods:
This is an observational analytical case control study, which carried out in Minia governorate during the period from December 2018 to September 2020. An approval was taken from the Ministry of Health and from Minia oncology center to obtain data about number of BC patient’s ≤ 40 years old attending the center during the previous years and to facilitate the communication with personnel working in the center.
A written informed consent was taken from each participant. This study was conducted among 300 subjects, includes 100 BC females ≤ 40 years old after exclusion of cases with family history of BC, BC females more than 40 years old and severely ill patients and 200 controls selected randomly from community where the cases are belonging to during the period from December 2018 to October 2019 after matching of age and exclusion of those who are relative for cases and with family history of BC.
Data were collected by a designed well-structured questionnaire; the aim of the study was explained to every subject. The questionnaire included socio demographic data, medical data concerning disease, lifestyle factors including: dietary history, smoking history, history of physical activity, reproductive factors and some probable risk factors (light at night and electromagnetic radiation exposure). Dietary history assessed by food frequency questionnaire and Nutrisurvey 2007 program is used to calculate the nutrient intake in grams and percentage from total calories.
Results:
The age of YWBC ranged between 25-40 years in both cases and controls, with mean age 33.4±4.1 for cases and 33.5±3.8 for controls. The commonest complaint was lump, the most common stages was stage III and stage IV. With slightly high rate of metastasis and recurrence rate. About half is ER and PR positive and about 29% was triple negative.
Of total female participants about 23% of YWBC versus 13% of controls have family history of BC (OR =2.44) and this difference was statistically significant.
Almost of YWBC (96%) were physically inactive compared to 84.5% of controls, 35% of studied BC cancer females were exposed to passive smoking versus 12.5% and these differences were statistically significant ( p = 0.005)
There were significant statistically difference as regard exposure to light at night and EMR exposure (p=0.02, 0.001 respectively).
Nearly more than one third of studied BC female (39%) had experience of stressful event versus (13.5%) of control (p=0.001).
There was no statistically significant difference regarding weight and height among cases and controls (p =0.19, 0.14) respectively.
The most predictable reproductive risk factors were first birth ≥30 years old (OR =3.09), followed by using hormonal contraception (OR =2.59), however lactation (OR =0.37) and delayed menarche >12 years old (OR =0.29) seemed to be a protective factor.
Mean caloric intake was higher among BC females (3071.2±750.9 calorie per day) than control (2575.6±638.2 calorie per day). Mean carbohydrate intake, fat and cholesterol intake was higher among female cases than controls.
The most predictable risk factors were preserved food (odds ratio=4.80) followed by processed meat (OR =4.5), smoking (OR =4.44), soft drink (OR =3.59), cholesterol (OR =3.31), and fried food (OR =2.19), but physical activity(OR =0.32) associated with decreased the risk.
The most protective factors were fiber intake more than or equal 30 gm per day (OR 0.16) followed by fish intake once or more per week (OR =0.18), vegetable serving more than 3 (OR =0.33), fruit serving more than 3 (OR =0.38) and coffee drink (OR =0.11).
Recommendations:
1. There is a need to increase awareness about BC among young women, and giving impotance to multiple issues concerning sexuality, fertility, and pregnancy after BC treatment.
2. Public health intervention program that provide efficient access to good family planning, with care when selecting hormonal contraception possibly a critical appraisal of the indication in young women,
3. Efforts to empower women to care of her and do regularly self-breast examination.
4. Counseling of young female patient with family history of breast cancer.
5. Educational programs to enhance public awareness of the protective role of breast feeding.
6. Improve targeting young women in effective and efficient screening of BC especially at high risk.
7. Enhancement of adopting health life style.
8. Everyone has a role in helping to create and support healthy eating and healthy sleeping patterns in multiple settings, from home to school to work to communities decrease hours with screens and EMR exposure