Table 2 Characteristics of included studies
First author year | City | Patient recruitment period | Sample size (case, control) | Mean age | Study setting | Selection of controls | Description of case group | Description of control group | Matching factors | Risk factorsa |
|---|---|---|---|---|---|---|---|---|---|---|
Maleki 2020 [24] | Tehran | September 2011 to May 2016 | 1925 (958, 967) | Case: 46.0 ± 10.1 Control: 46.1 ± 10.2 | Imam Khomeini Hospital | Hospital-based | ▪ Patients admitted for treatment of breast cancer in surgical and chemotherapy wards ▪ Histopathological confirmation of new breast cancer within the past 12 months ▪ At least 18 years of age ▪ No history of concurrent cancer in other organs | Healthy relatives or friends of hospitalized patients for diseases other than cancer at the same hospital and at the same time | ▪ Age (± 5) ▪ City of residence | Age, occupation, education, physical activity, BMI, parity, age at first pregnancy, OCP use, duration of OCP use, breastfeeding history, breastfeeding duration, age at menarche, family history of breast cancer |
Safabakhsh 2020 [48] | Tehran | September 2017 to June 2018 | 300 (150, 150) | Case: 46.6 ± 10.7 Control: 46.1 ± 10.7 | Imam Khomeini Hospital | Hospital-based | ▪ Women with breast cancer ▪ Histopathological confirmation of new breast cancer within the past three months ▪ 24–73 years of age ▪ No history of breast or other cancers | ▪ Healthy relatives of hospitalized patients at the same hospital in the other wards such as dermatology, urology, orthopedic, etc. ▪No family relationship with cases | Age | Age, education, marital status, SES, height, weight, BMI, number of live children, breastfeeding duration, duration of OCP use, HRT, physical activity, smoking, alcohol use, supplement intake, dietary pattern, menopause status, age at menopause, age at menarche, family history of breast cancer |
Sasanfar 2019 [26] | Tehran | 2014 to 2016 | 868 (412, 456) | Case: 46.3 ± 10 Control: 44.2 ± 11.3 | Imam Khomeini Hospital | Hospital-based | ▪ Breast cancer patients referred to surgery, chemotherapy, or radiotherapy department ▪ Histopathological confirmation of new breast cancer within the past 12 months ▪ No history of any other cancers No long-term dietary restrictions ▪ No total energy intake of > 4500 or < 800 kcal ▪ No response to more than 70 items of FFQ | ▪ Healthy relatives or friends of hospitalized patients for diseases other than cancer at the same hospital ▪ No long-term dietary restrictions ▪ No total energy intake of > 4500 or < 800 kcal ▪ No response to more than 70 items of FFQ | ▪ Age (± 10 years) ▪ City of residence | Age, education, marital status, physical activity, BMI, dietary pattern, smoking, alcohol use, OCP use, HRT, infertility treatment, parity, age at menarche, family history of breast cancer |
Vahid 2018 [19] | Tehran | March 2015 to February 2016 | 293 (145, 148) | Case: 49.83 ± 11.86 Control: 48.54 ± 12.0 | Cancer Research Center (Shahid Beheshti University of Medical Sciences) | Hospital-based | ▪ Patients with breast cancer who were diagnosed by a pathologist within the previous month ▪ Selection of eligible patients randomly | Hospitalized female patients in the same center randomly | Age (± 10) | Age, occupation, education, marital status, BMI, smoking, physical activity, dietary pattern, parity, breastfeeding history, OCP use, HRT, menopause status, age at menarche, family history of breast cancer |
Heidari 2018 [49] | Tehran | September 2015 to February 2016 | 401 (134, 267) | Case: 49.49 ± 10.68 Control: 47.13 ± 10.08 | ▪ Imam Hossein Hospital ▪ Shohada Hospital | Hospital-based | ▪ Breast cancer patients admitted to the two referral hospitals in Tehran city ▪ Histopathological confirmation of new breast cancer within the past six months | Hospitalized female patients in other sections of the same hospitals for a broad spectrum of non-neoplastic diseases that were unrelated to alcohol abuse, smoking, and long-term diet modification | ▪ Age(± 5) ▪ Menopause status | Age, education, height, weight, BMI, WHR, breastfeeding duration, physical activity, age at marriage, age at first live birth, OCP use, smoking, supplement intake, dietary pattern, day bra use, night bra use, age at menarche, menopause status, family history of cancer |
Fararouei 2018 [22] | Shiraz | November 2014 to March 2016 | 1010 (505, 505) | Case: 41.78 ± 10.56 Control: 42.24 ± 10.62 | Namazi Hospital | Hospital-based | ▪ Patients admitted for treatment of breast cancer in surgical and radiotherapy wards ▪ Histopathological confirmation of new breast cancer ▪ 20–55 years of age ▪ Without any recent significant change in their weight or size from the last six months | Hospitalized female patients for diseases other than cancer at the same hospital randomly | Age (± 5) | Age, education, occupation, marital status, age at marriage, BMI, physical activity, OCP use, smoking, second-hand smoking, dietary pattern, family history of breast cancer |
Dianatinasab 2017 [21] | Shiraz | November 2014 to March 2016 | 1052 (526, 526) | Case: 47.8 ± 10.58 Control: 46.75 ± 11.08 | Namazi Hospital | Hospital-based | ▪ Patients admitted to the hospital due to breast cancer ▪ Histopathological confirmation of new breast cancer ▪ Without a change in their weight in the past 6 months | Hospitalized female patients in the same hospital without having any hormonal, gynecology, cancer diseases, or change in their weight in the past 6 months | Age | Age, occupation, education, marital status, place of residence, age at marriage, BMI, physical activity, smoking, second-hand smoking, hair coloring, cosmetic use, day sleep duration, quality sleep, regular bedtime, past life stress, menopause status, age at first delivery, parity number, birth interval, prenatal age, abortion history, birth weight, OCP use, breastfeeding duration, chest X-ray history, hysterectomy, age at menarche, family history of breast cancer |
Pourzand 2016 [50] | Tabriz | January 2012 to June 2013 | 582 (285, 297) | Case: 46.4 ± 10.02 Control: 41.4 ± 9.6 | Shams Hospital | Hospital-based | ▪ Women with breast cancer admitted to the surgery ward of the hospital ▪ Newly diagnosed breast cancer patient ▪ age of 25 to 65 years ▪ No prior history of histologically confirmed malignancies ▪ No previous history of cancer ▪ No history of cystic abnormalities or benign breast disease ▪ Not a pregnant, postpartum, or breastfeeding mother ▪ Not following a specific dietary habit ▪ Not having disorders of polycystic ovary syndrome and chronic inflammatory disorders ▪ No chronic use of methotrexate, sulfasalazine, anticonvulsants, and contraceptive drugs ▪ Body mass index (BMI) < 45 kg/m2 | ▪ Hospitalized female patients at the same hospital for no neoplastic disease ▪ No prior history of malignancies and benign neoplasms ▪ The will to participate in the study ▪ Not pregnant, postpartum, and breastfeeding mother ▪ Not following a vegetarian diet ▪ Not having chronic inflammatory disorders | ▪ Age at diagnosis (± 5) ▪ Residence status (rural/urban and/or province) | Age, occupation, BMI, physical activity, menopause status, pregnancy number, number of lactation, dietary pattern |
Montazeri 2016 [51] [In Persian] | Tehran Tabriz | 2007–2014 | 975 (432, 543) | Case: 48.6 ± 4.7 Control: 40.6 ± 10.7 | ▪ Shohadaye Tajrish Hospital ▪ Taleghani Hospital Pars Hospital ▪ Azar Clinic ▪ Khatam Clinic ▪ Day Clinic ▪ Ghazi Hospital ▪ Imam Reza Hospital ▪ Noor Nejat hospital | Hospital-based | ▪ Women with admitted breast cancer to the surgery ward of Shohadaye Tajrish, Imam Reza, Noor Nejat Hospitals, Azar, Khatam, and Day Clinics, Also women with admitted breast cancer to the radiotherapy and chemotherapy ward of Shohadaye Tajrish, Pars, Taleghani, and Ghazi Hospitals ▪ Histopathological confirmation of new breast cancer ▪ The will to participate in the study ▪ No previous history of cancer ▪ No prior history of benign breast disease ▪ No change in dietary pattern in the last five years ▪ No history of hormonal and gynecological diseases ▪ No chronic use of methotrexate, cyclosporine, metformin, aspirin, anticonvulsant and contraceptive drugs ▪ Not having autoimmune diseases ▪ No pregnancy or breastfeeding | ▪ Healthy relatives of patients at the same hospital in the other wards such as dermatology and cosmetic surgery, urology, Ear noses and throat, gastroenterology orthopedic ▪ No previous history of malignant and benign mass ▪ No change in dietary pattern in the last five years ▪ No chronic use of methotrexate, cyclosporine, metformin, aspirin, anticonvulsant and contraceptive drugs ▪ No history of hormonal and gynecological diseases ▪ No pregnancy or breastfeeding | ▪ Age (± 5) ▪ Place of residence | Age, age at first delivery, pregnancy number, breastfeeding duration, number of lactation, age at menarche, age at menopause |
Salarabadi 2015 [52] | Kermanshah | 2012 to 2014 | 151 (47, 105) | Case: 38.82 ± 5.37 Control: 38.89 ± 6.41 | Imam Reza Hospital | Unknown | ▪ Women with breast cancer admitted to the surgery ward of the hospital ▪ Histopathological confirmation of new breast cancer ▪ Without any menopausal evidence ▪ No pregnancy or breastfeeding ▪ No history of malignancy ▪ No familial history of breast cancer ▪ Were not exposed to PAHs producing manufacturers as well as X-ray resources according to their living and working addresses | ▪ Normal healthy women ▪ Without any menopausal evidence ▪ No pregnancy or breastfeeding ▪ No history of malignancy ▪ No familial history of breast cancer ▪ Didn’t exposed to PAHs producing manufacturers as well as X-ray resources according to their living and working addresses | Age (± 5) SES | Age, sunlight exposure, physical activity, OCP use, dietary pattern, supplement intake |
Arbabi 2014 [53] | Sabzevar | 2010 to 2012 | 176 (60, 116) | Case: 36.45 ± 7.02 Control: 34.2 ± 5.7 | Emdad Hospital | Unknown | ▪ Women with breast cancer admitted to the surgery ward of the hospital ▪ Histopathological confirmation of new breast cancer ▪ Without any menopausal evidence ▪ No history of malignancy ▪ No pregnancy or breastfeeding ▪Dind't exposed to PAHs producing manufacturers as well as X-ray resources according to their living and working addresses | ▪ Normal women ▪ Without any menopausal evidence ▪ No history of malignancy ▪ No pregnancy or breastfeeding ▪ Dind't exposed to PAHs producing manufacturers as well as X-ray resources according to their living and working addresses | Age (± 5) | Age, marital status, age at marriage, weight, height, BMI, age at first pregnancy, dietary pattern, supplement intake, age at menarche |
Hosseinzadeh 2014 [54] | Tabriz | December 2012 to September 2013 | 448 (157, 291) | Case: 47.6 ± 10.7 Control: 46.8 ± 10.4 | Imam Reza Hospital | Hospital-based | ▪ Women with breast cancer admitted to the oncology ward of the hospital ▪ Histopathological confirmation of new breast cancer within the past 12 months | Female patients admitted in the same hospital in orthopedic, surgery, ear, nose, and throat, and trauma clinics without any neoplastic or hormonal disease and hysterectomy history | Age | Age, occupation, education, place of residence, marital status, income, age at marriage, smoking, second-hand smoking, hookah, drug user, alcohol use, exercise, stress, number of live births, abortion history, breastfeeding history, OCP use, HRT, age at menopause, menopause status, biopsy history, infertility therapy, diet containing sufficient fruit and vegetables, high-fat diet, migration, income |
Sheikhi 2014 [25] | Tehran | April to May 2009 | 93 (53, 40) | Case: 40..2 ± 10.01 Control: 39.78 ± 11.21 | Iranian Center for Breast Cancer, Academic Center for Education, Culture, and Research (ACECR) | Unknown | ▪ Histopathological confirmation of new breast cancer within the past month ▪ Aged 20–65 years ▪ Residing in Tehran ▪ Without any other diagnosed diseases ▪ BMI ≤ 40 kg/m2 ▪ Without any type of special diet in the past two months ▪ No pregnancy or breastfeeding | ▪ Healthy women ▪ Without any cancer ▪ Age 20–65 years ▪ Residing in Tehran ▪ Without any other diagnosed diseases ▪ BMI ≤ 40 kg/m2 Without any type of special diet in the past 2 months ▪ No pregnancy or breastfeeding | Unknown | Age, marital status, dietary pattern, WC, family history of breast disease or cancer, HRT, menopause status |
Bahadoran 2013 [55] | Tehran | April 2010 to July 2010 | 274 (100, 174) | Case: 46..2 ± 9.3 Control: 45.9 ± 9.4 | Shohada-e-Tajrish Hospital | Hospital-based | ▪ Women with breast cancer admitted to the oncology, radiotherapy, chemotherapy, or surgery ward of the hospital ▪ Histopathological confirmation of new breast cancer within the past 5 months ▪ Aged 30–65 years ▪ Without any type of special diet ▪ No history of any cancer or cyst (excluding current breast cancer) ▪ No history of hormone therapy | ▪ Women referring to outpatient clinics of the hospital, including gynecology and dermatology ▪ Without any type of special diet ▪ Without any history of cancers or cysts ▪ Without any acute or chronic diseases affecting the nutritional status ▪ Without any hormone therapy were recruited from among individuals | Age (± 5) | Age, occupation, physical activity, weight, BMI, age at menarche, familial history of breast cancer, smoking, diabetes, menopause status |
Hajian 2013 [56] [In Persian] | Babol | April 2008 to September 2009 | 300 (100, 200) | Case: 51.2 ± 9.6 Control: 51.1 ± 9.3 | ▪ Beheshti Hospital ▪ Yahyanejad Hospital ▪ Hariri Cancer Screening Center | Hospital-based | ▪ ▪ Patients in pathologic centers of two major educational hospitals and the Hariri cancer screening center ▪ ▪ Histopathological confirmation of new breast cancer | ▪ Outpatient clinics in the same hospitals without any cancers and systemic diseases such as diabetes, hypertension, and cardiovascular disease ▪ Relatives of hospitalized patients without any cancers and systemic diseases such as diabetes, hypertension, and cardiovascular disease | Age (± 3) | Age, education, age at first pregnancy, age at menarche, marital status, place of residence, menopause status, exercise, familial history of cancer, history of radiation exposure |
Hajian 2012 [57] | Babol | April 2008 to September 2009 | 300 (100, 200) | Case: 51.2 ± 9.6 Control: 51.1 ± 9.3 | ▪ Beheshti Hospital ▪ Yahyanejad Hospital ▪ Hariri Cancer Screening Center | Hospital-based | Histopathological confirmation of new breast cancer | ▪ Outpatient clinics of the same hospitals without any cancers and systemic diseases such as diabetes, hypertension, and cardiovascular disease ▪ Relatives of hospitalized patients without any cancers and systemic diseases such as diabetes, hypertension, and cardiovascular disease | Age (± 3) | Age, education, age at first pregnancy, age at menarche, parity, abortion history, OCP use, smoking, exercise, BMI, menopause status, breastfeeding duration |
Hajian 2011 [58] | Babol | April 2008 to September 2009 | 300 (100, 200) | Case: 51.2 ± 9.6 Control: 51.1 ± 9.3 | ▪ Beheshti Hospital ▪ Yahyanejad Hospital ▪ Hariri Cancer Screening Center | Hospital-based | Histopathological confirmation of new breast cancer | ▪ Outpatient clinics in the same hospitals without any cancers and systemic diseases such as diabetes, hypertension, and cardiovascular disease ▪ Relatives of hospitalized patients without any cancers and systemic diseases such as diabetes, hypertension, and cardiovascular disease | Age (± 3) | Age at menarche, age at first pregnancy, number of pregnancies, number of live births, menopause status, breastfeeding duration, OCP use, abortion history |
Rezaeiian 2012 [59] [In Persian] | Tehran | 2007–2010 | 346 (177, 169) | Case: 49.1 ± 8.9 Control: 40.09 ± 11.4 | Hospitals affiliated with Shahid Beheshti University of Medical Sciences | Hospital-based | ▪ Patients admitted for treatment of breast cancer oncology ward ▪ Histopathological confirmation of new breast cancer ▪ Aged 30–60 years ▪ The will to participate in the study ▪ No history of any benign mass breast ▪ No change in dietary pattern in the last 3 years ▪ No history of hormonal and gynecological diseases ▪ No chronic use of methotrexate, cyclosporine, metformin, aspirin, anticonvulsant and contraceptive drugs | ▪ Healthy women in the same hospital ▪ No history of any malignant or benign mass ▪ No change in dietary pattern in the last five years ▪ No pregnancy or breastfeeding ▪ No history of hormonal and gynecological diseases ▪ No chronic use of methotrexate, cyclosporine, metformin, aspirin, anticonvulsant and contraceptive drugs | ▪ Age ▪ Place of residence | Age, marital status, physical activity, number of pregnancies, abortion number, menopause status, age at menopause, dietary pattern |
Ghiasvand 2012 [20] | Shiraz | September 2005 to December 2008 | 986 (493, 493) | Case: 58.2 ± 7.2 Control: 58.0 ± 7.4 | Motahari Breast Clinic | Hospital-based | Histopathological confirmation of new breast cancer Aged above 50 years | ▪ Healthy female visitors accompanying patients and patients referred to the Faghihi hospital for general surgery, urology, and cardiovascular diseases without any history of breast cancer ▪ No history of hormonal and gynecological diseases | ▪ Age (± 5) ▪ Province of residence | Age, education, occupation, BMI, age at menarche, age at first pregnancy, parity, breastfeeding history, breastfeeding duration, OCP use, duration of OCP use, family history of breast cancer |
Arbabi Bidgoli 2011 [60] | Tehran | June 2009 to June 2010 | 150 (50, 100) | Case: 36.45 ± 7.02 Control: 34.2 ± 5.7 | Emdad Shahid Beheshti University hospital | Unknown | ▪ Histopathological confirmation of new breast cancer ▪ ▪ No menopausal evidence ▪ No pregnancy or breastfeeding | ▪ Normal women ▪ No menopausal evidence ▪ No pregnancy or breastfeeding | Age (± 5) | Age, marital status, age at marriage, BMI, weight gain after 18, age at first delivery, age at menarche, irregular menstruation, age at first pregnancy, abortion history, infertility, breastfeeding history, breastfeeding duration, OCP use, duration of OCP use, age at first OCP use, family history of breast cancer, family history of cancer, ovarian cyst |
Tehranian 2010 [23] | Tehran | – | 624 (312, 312) | Case: 32.2 ± 4.28 Control: 32.9 ± 4.3 | Imam Khomeini Hospital | Hospital-based | ▪ Histopathological confirmation of new breast cancer ▪ Aged below 40 years | ▪Women referred to the same hospital due to non-neoplastic and non-hormonal disease ▪ No diagnosis of cancer or other chronic diseases ▪ Aged below 40 years | ▪ Age ▪ ethnicity | Age, marital status, parity, age at first delivery, age at menarche, breastfeeding history, breastfeeding duration, family history of breast cancer, OCP use, abortion history |
Ghosn 2020 [61] | Isfahan | – | 1050 (350, 700) | Case: 65 ± 11 Control: 61 ± 10 | – | population-based | ▪ Patients were recruited from those referred to hospitals or private clinics who were undergoing surgical resection of breast cancer, chemotherapy, radiotherapy, or all of the ▪ Histopathological confirmation of new breast cancer ▪ Aged below 40 years ▪ Without any history of any type of neoplastic lesion or cysts ▪ No history of hormone replacement therapy ▪ Without any kind of special diet | ▪ Healthy women referring to primary health care centers for their annual personal checkups or attending to receive required information about their children ▪ No relationship with breast cancer patients or had no family history of breast cancer ▪No history of any malignancy, cysts, and medical disorder ▪ No history of hormone replacement therapy Without any type of special diet | ▪ Age ▪ ES | Age, education, marital status, place of residence, BMI, physical activity, smoking, supplement intake, dietary pattern, breastfeeding history, menopause status, family history of breast cancer |
Saremi 2019 [62] [In Persian] | Arak | March 2017 to May 2018 | 296 (150, 146) | Case: 46.81 ± 6.96 Control: 44.14 ± 6.52 | Ayatollah Khonsari Hospital | Population-based | ▪ Breast cancer patients referred to chemotherapy, radiotherapy, or oncology departments ▪ Histopathological confirmation of new breast cancer ▪ No hysterectomy ▪ Aged 20–55 years ▪ No history of organ transplantation ▪ No history of ovarian surgery ▪ Residing in Arak for at least three years ▪ Do not interrupt the menstrual cycle | ▪ Neighbors with no history of breast cancer ▪ No pregnancy ▪ No history of chronic disease (diabetes, cardiovascular disease) ▪ No hysterectomy | Age | Age, BMI, physical activity, marital status |
Lotfi 2008 [63] | Yazd | February 2006 to December 2006 | 160 (80, 80) | Case: 48.9 ± 9.7 Control: 49.1 ± 9.8 | – | population-based | ▪ Breast cancer patients from different clinical centers are involved in diagnostic and treatment of disease ▪ Histopathological confirmation of new breast cancer ▪ Aged 30–75 years ▪ Residing in the urban area of Yazd city | Healthy women from the community of Yazd city according to the place of residence of cases | Age (± 2) | Age, education, occupation, marital status, age of first marriage, menopause status, OCP use, age at menarche, number of live birth, breastfeeding duration, BMI, history of radiation exposure, family history of breast cancer |