Potential breast cancer risk factors among Saudi women aged 19–50 years in Jeddah: a case–control study Sulafa T. Al-Qutub a , Rajaa M. Al-Raddadi b , Bakr M. Bin Sadiq c , Wafa Sait d , Aboelkhair Al-Gahmi c and Samia Al-Amoudi d a Community Medicine, Saudi Society for Public Health, b Research Department, Saudi Epidemiology Association, c King Faisal Specialist Hospital and Research Center and d Department of Obstetrics and Gynecology, Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer, King Abdulaziz University, Jeddah, Saudi Arabia Correspondence to Samia Al-Amoudi, MD, ABCM, Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer, King Abdulaziz University, PO Box 140295, Jeddah 21333, Saudi Arabia Tel: + 966 505 626 441; fax: + 00966 126408397; e-mail: dr.samia_amoudi@hotmail.com Received 17 February 2013 Accepted 15 September 2013 Journal of the Egyptian Public Health Association 2013, 88:165–170 Background and objectives The Saudi cancer registry reported in 2009 that the frequency of breast cancer is the highest among all types of cancer among Saudi women aged 30–59 years. The Makkah region had the second highest frequency of reported breast cancer cases, with patients having a median age of 46 years. The objectives of this study were to explore the distribution of selected known and hypothetically claimed breast cancer risk factors among Saudi women aged 19–50 years and describe the association of breast cancer with selected risk factors. Design and setting An unmatched case–control study was conducted on breast cancer cases at three different hospitals in Jeddah. Patients and methods Online OpenEpi was used and the method of Kelsey and colleagues was selected from OpenEpi output; the calculated number of cases and controls was 134 each. Women aged 19–50 years were included and the analysis was conducted on 151 cases and 166 controls as they met the age inclusion criteria. Results The mean age of patients was 40 years. A subgroup analysis for age at menarche less than 12 years showed an odds ratio (OR) of 1.4 6 [95% confidence interval (CI) 0.88–2.44]. A high proportion of cases reported the use of exogenous estrogen and progesterone (OR= 4.7, 95% CI 1.7–13.0), previous mammography screening (89% of cases vs. 11% of controls), and affected family members (4.6 vs. 1.8, OR = 2.64 [95% CI 0.67–10.4]. The OR for exercise frequency in the study group was 1.45 (95% CI 0.90–2.35). The OR for breastfeeding among mothers who breast- fed for more than 12 months was 0.56 (95% CI 0.35–0.88). Conclusion and recommendations This study provides information on associative factors such as early age at menarche ( o12 years), monthly income of at least 20 000 SR (5333 USD), use of exogenous estrogen and progesterone, previous biopsies/surgeries, previous clinical breast examination and mammography screening, and affected family members. Protective factors among premenopausal women, such as breastfeeding and exercising, have been described. Conducting comprehensive sessions on breastfeeding and physical education targeting young generations is highly recommended in order to reduce the risk for breast cancer among Saudi women aged 19–50 years. Keywords: breast cancer, case–control study, risk factors, Saudi women J Egypt Public Health Assoc 88:165–170 & 2013 Egyptian Public Health Association 0013-2446 Introduction The ninth cancer incidence report pertaining to cancer incidence in 2005 by the Saudi cancer registry (2009) showed that breast cancer is ranked first in cancer frequency among Saudi women aged 30–59 years. The estimated cancer incidence in the Makkah region was 20.9/ 100 000, with a median age of 46 years at diagnosis [1]. Cancer is the end product of a series of DNA mutations that lead to selective growth for a particular clone of cells. Mutation in the genes occurs through three major mechanisms: environmental, chance, and hereditary [2]. In 2007, reports from the international agency for research on cancer identified 415 known or probable carcinogens [2–4]. Much of the lifetime risk for breast cancer is associated with genetic defects in breast cancer susceptibility genes BRCAI and BRCAII, but only 5–6% of all breast cancer cases are directly attributed to those genes [5–8]. Moreover, positive family history is reported by only 15–20% of women with breast cancer [8–10]. Original article 165 0013-2446 & 2013 Egyptian Public Health Association DOI: 10.1097/01.EPX.0000435728.60811.bd Copyright © Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.