Observational data show strong evidence that greater adiposity, a sedentary lifestyle, and moderate to high levels of alcohol use are associated with a greater risk for breast cancer.

The evidence for specific dietary components is less clear, but a major clinical trial (the WHI Dietary Modification trial) will give a more definitive answer regarding a low-fat dietary pattern effect on breast cancer incidence.

Animal and human experimental studies provide evidence that there are plausible biological mechanisms linking these lifestyle factors to breast cancer initiation and promotion, largely through hormonal pathways.

The worldwide trends to increasing overweight and obesity and decreasing physical activity may lead to an increasing incidence of breast cancer unless other means of risk reduction counteract these effects.

Thus, the impact of a population-wide adoption of greater physical activity and improved energy balance would likely be large.

For individual women, counseling should include recommendation to increase physical activity and balance energy such that weight remains stable over lifetime, and, preferably, with a BMI remaining below 25.0.

For women who are already overweight or obese, recommendations for weight loss should include increasing physical activity (working up to 60 minutes per day [102]) and changing their dietary patterns to ones that are high in nutritious foods, for example, high in vegetables and fruits (at least five servings per day, preferably more) and high-fiber carbohydrates and low in fats, low-fiber carbohydrates, and alcoholic beverages (i.e., less than two drinks per day on average).

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