Lifestyles are changing rapidly throughout North and sub-Saharan Africa; behavioural, reproductive, and lifestyle factors more typical of the populations in industrialized countries are becoming more prevalent. Examples of such factors are delayed childbearing, lower parity, reduced prevalence of breastfeeding, increased consumption of processed foods (foods rich in saturated fats, trans fatty acids, and sugar), and an increase in the prevalence of obesity and sedentary behaviour. However, the impact of these changes on breast cancer is not clear.
Although breast cancer is the most common cancer among women in North Africa, risk factors have not been fully studied in an epidemiological context. The incidence of breast cancer in North Africa is still lower than in high-income countries, but data suggest that breast cancer is more frequently diagnosed in younger women in North Africa, and this difference in incident age is not entirely explained by the prominent youth bulge in the population pyramids that illustrate the distribution of various age groups in North African countries.
The lack of knowledge about breast cancer subtypes and about lifestyle and environmental factors associated with specific phenotypes is a major obstacle for prevention, and has a far-reaching human and social impact due to its consequences on economy and education. Through active prevention, it may be possible to significantly reduce the risk of breast cancer in North Africa.
The EDSMAR study is a population-based case–control study that was initiated in February 2016. Its purpose is to investigate the etiology of breast cancer in North African women at two centres in Morocco: the Sheikha Fatma Centre for Gynaecological-Mammary Oncology at the National Institute of Oncology in Rabat and the Cancer Research Institute at the Centre Hospitalier Universitaire (CHU) Hassan II in Fez. The ultimate goal of the project is to identify modifiable nutritional and lifestyle risk factors for breast cancer in Morocco.
This study is very important because it is among the first to investigate specific factors (including lifestyle factors and dietary habits) in the North African population that may be associated with specific subtypes of breast cancer. The resulting availability of a large biobank of blood and urine samples, a comprehensive database of responses to standardized lifestyle and dietary questionnaires, and refined measurements of adiposity from hundreds of women will be of great value for breast cancer research in this population for decades to come.
The project is supported by the Lalla Salma Foundation for the Prevention and Treatment of Cancer in Rabat, Morocco, and by internal resources at IARC.