The Nurses' Health Study: lifestyle and health among women

Key Points

  • The Nurses' Health Study is the first large prospective cohort study of women with updated exposure assessment for a broad range of lifestyle factors, endogenous hormones and DNA, in relation to risk of cancer.

  • The Nurses' Health Study can assess overall risks and benefits of lifestyle factors by evaluating them in relation to a range of cancers and other chronic conditions, and in terms of total mortality.

  • Using diet data, which was first collected in 1980, we showed that alcohol intake is related to an increased risk of breast cancer independent of other dietary factors. Adult dietary-fat intake was not related to increased breast cancer risk in this and subsequent prospective studies.

  • The long-term use of multivitamins containing folate is associated with a reduced risk of colon cancer. This association was confirmed by findings from several studies, including the discovery that a functional polymorphism in the methylene-tetrahydrofolate reductase gene was associated with increased colon cancer risk and that plasma levels of folate were inversely related to colon cancer risk.

  • Both oestrogen and testosterone levels in postmenopausal women are related to an increased risk of breast cancer. Because of this, plasma oestrogen and testosterone levels are now being added to risk-prediction models for breast cancer.

Abstract

The Nurses' Health Study has grown from a simple questionnaire-based study initiated in 1976 to a rich resource of information collected over 29 years. Important details about lifestyle have been collected throughout the study and, as the study has progressed, blood samples and DNA from buccal cells have been collected and stored. Tumour samples have also been collected from participants who developed cancer. Through analyses that integrate information from these various sources we are advancing our understanding of the causes of cancer and the potential for prevention.

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Figure 1: Original questionnaire used in Nurses Health Study.

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Acknowledgements

This work was supported by a grant from the National Cancer Institute. G.A.C. is supported in part by an American Cancer Society Clinical Research Professorship.

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Correspondence to Graham A. Colditz.

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DATABASES

Entrez Gene

IGF1

MTHFR

National Cancer Institute

breast cancer

colon cancer

endometrial cancer

ovarian cancer

FURTHER INFORMATION

Black Women's Health Study

Breast and Prostate Cancer and Hormone-Related Gene Variants Cohort Consortium

California Teachers Study

Cancer Prevention Study Overviews

Harvard Center for Cancer Prevention – Your Disease Risk

Iowa Women's Health Study

National Death Index

Nurses' Health Study

SEER

The Pooling Project of Prospective Studies of Diet and Cancer

Glossary

NESTED CASE–CONTROL STUDY

A study that is nested within a cohort study, whereby all cases and a small sample of non-cases are included — a design used frequently when genetic or other biomarker analyses are being conducted. It maintains the strengths of the prospective cohort (with exposure information collected before disease diagnosis) but is more efficient and economical because laboratory assays are conducted on only a small subset of the cohort.

BUCCAL SAMPLES

Cheek-cell samples used as a source of DNA and collected by a swish-and-spit method using mouthwash, or by using a buccal brush.

RADIAL SCARS

Benign lesions with a fibroelastic core from which ducts and lobules radiate.

ONE-CARBON METABOLISM

The chemical reactions and physical changes involving compounds that contain a single carbon atom. One-carbon metabolism is crucial for nucleotide biosynthesis and for methylation reactions. Several dietary factors, including folate and vitamin B6, are important cofactors in this process.

ENERGY ADJUSTMENT

A statistical technique to account for the influence of energy (calorie) intake when studying the association between a specific nutrient (for example, dietary fat) in relation to disease risk.

RELATIVE RISK

A quantitative measure that is used to describe the increase (or decrease) in risk associated with a specific risk factor. A relative risk is the ratio of two absolute risks: the numerator is the absolute risk among those with the risk factor, while the denominator is the absolute risk among those without the risk factor.

ABSOLUTE RISK

A person's chance of developing a specific disease over a specified time period. The absolute risk of disease is estimated by examining a large number of people who are similar in some respects (in terms of age, for example) and counting the number of individuals in this group who develop the disease over the specified time period.

PROSPECTIVE COHORT STUDY

In prospective cohort studies, exposure information is collected from large groups of participants who are then followed over time to assess their health outcomes, and to determine how these outcomes are related to the previously collected exposure data.

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Colditz, G., Hankinson, S. The Nurses' Health Study: lifestyle and health among women. Nat Rev Cancer 5, 388–396 (2005). https://doi.org/10.1038/nrc1608

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