1. Prenatal and childhood origin of an adult disease; The case of breast cancer Gabriel Gulis SDU Esbjerg, Denmark Anna Pakosova Trnava University, Trnava, Slovakia

2. Breast cancer mortality

3. Breast cancer morbidity

4. Major risk factors Hormonal risks (menarche, parity, menopause) Lifestyle (diet, alcohol, smoking, physical exercise) Medications (oral contraceptives, HRT) Genetic predisposition Early life risk factors

5. birthweight birth length gestational age at birth twin, zygosity age of mother at delivery weight and height of mother in/out of pregnancy birth order

6. What data are available in Slovakia Presentation of data and data soruces available in Slovakia on early life risk factors Data sources: birthbook birthregistry medical record

7. Data from Birthbook Birthweight/birthlength twin, zygosity gestational age at birth age of mother at delivery birth order

8. Data of birth registry Birthweight/birth length twin, zygosity gestational age at birth age of mother at delivery birth order *data from birth registry are available since 1959

9. Data from Medical record Birthweight/birth length twin, zygosity age of mother at delivery birth order weight/height of mother at different ages age at menarche age at menopause

10. Data from Medical record Use of oral contraceptives use of hormone contraceptives alcohol smoking

11. Changes of data sources over time

12. Description of Slovak study - methodology Prospective, hospital based case-control study Trnava region, Trnava and Skalica district hospitals 3 years, 250 cases and controls Newly diagnosed histologically confirmed cases, if possible at the beginning of treatment Age and region matched controls by frequency matching

13. Description of Slovak study – practical performance Key collaborators in hospitals are head nurses, good collaboration with heads of oncology departments as well

14. Possibilities for intervention Based on study we expect to bring new field for breast cancer prevention among adolescents: Increase information campaigns in schools Breast cancer awareness programs, risk factors, determinants Involvment of pediatricians

15. Summary Work in progress, first experiences Interest of clinicians from hospitals is crucial High willingness of cases to participate Implications for intervention

16. Acknowledgement: The authors acknowledge a grant number R03 TW 06137 of Fogarty Center of NIH, USA which made the study possible