Published November 18, 2025 | Version v1
Directed Acyclic Graph Open

Causal relationship between current alcohol intake and incidence of breast cancer in postmenopausal women

Contributors

  • 1 UiT The Arctic University of Norway, Department of Community Medicine, Tromsø, Norway

Visualisation

Description

This DAG represents the causal relationship between current alcohol intake and incidence of breast cancer in postmenopausal Norwegian women. Women were randomly recruited in the Norwegian Women and Health (NOWAC) cohort study from 1996 to 2004. For this analysis we included 32 735 women included who reported that they consumed alcohol and were not prevalent cancer cases.

This study was designed to address the effect of light-moderate drinking since the majority of women in this cohort (~95%) reported no more than 1 drink/day. Except for the outcome, other nodes in the DAG represent self-reported variables collected at baseline only (1996-2004), same time as the current alcohol intake. The outcome information was collected prospectively until December 2020 from the national cancer registries. Nodes in this DAG are presented shortly, for example breastfeeding duration represents breast feeding duration in months for each born child. More details on how each variable was collected and computed are given in the supplementary material of the published paper: https://doi.org/10.2147/CLEP.S531643.

The low-moderate drinking, Norwegian context, and background knowledge from the NOWAC data were taken into account when depicting the DAG for this specific cohort. For example, only education was used as an indicator socioeconomic status and this choice was based on these assumptions: 1) NOWAC studies found that variation in cancer risk was most evident by education levels than by income; 2) other Norwegian studies found that risk of cancer varies meaningfully by income among Norwegian men but not women; and 3) Norwegian studies consistently find that education influences lifestyle choices and (including alcohol intake) and medical behaviors.

Another example is the lack of an arrow from alcohol intake to BMI (body mass index). Empirical evidence shows that heavy drinking affects body weight status, evidence mainly found for men. The assumption in the presented DAG was that this relationship is not applicable to the NOWAC cohort, which consists of women who are generally low to moderate drinkers. These and other assumptions together with the empirical evidence are provided in the supplementary material of the published paper: https://doi.org/10.2147/CLEP.S531643.

But these assumptions may be wrong, and since I plan to continue working on alcohol and health outcomes, any discussion is greatly appreciated!

Variables

18 nodes
  • Current alcohol Exposure No description
  • PM Breast cancer Outcome No description
  • Age at menarche No description
  • Breast cancer in family No description
  • Breastfeeding duration No description
  • Calcium intake No description
  • Fruits and vegetables No description
  • Lifetime alcohol No description
  • Medical behaviours No description
  • Menopause hormone therapy No description
  • Oral contraceptives No description
  • Pack-years smoked No description
  • Parity / bearing child & age at first birth No description
  • Physical activity No description
  • Age No description
  • BMI No description
  • Education No description
  • Height No description

Relationships

79 edges

List Matrix
  • Age at menarche PM Breast cancer
  • Age at menarche BMI
  • Breast cancer in family Medical behaviours
  • Breast cancer in family PM Breast cancer
  • Breastfeeding duration Lifetime alcohol
  • Breastfeeding duration PM Breast cancer
  • Breastfeeding duration Pack-years smoked
  • Breastfeeding duration BMI
  • Calcium intake Current alcohol
  • Calcium intake PM Breast cancer
  • Calcium intake BMI
  • Current alcohol PM Breast cancer
  • Fruits and vegetables Current alcohol
  • Fruits and vegetables PM Breast cancer
  • Fruits and vegetables BMI
  • Lifetime alcohol Current alcohol
  • Lifetime alcohol PM Breast cancer
  • Medical behaviours Calcium intake
  • Medical behaviours Current alcohol
  • Medical behaviours Fruits and vegetables
  • Medical behaviours Menopause hormone therapy
  • Medical behaviours Physical activity
  • Medical behaviours BMI
  • Menopause hormone therapy PM Breast cancer
  • Menopause hormone therapy Pack-years smoked
  • Menopause hormone therapy Physical activity
  • Menopause hormone therapy BMI
  • Oral contraceptives Breastfeeding duration
  • Oral contraceptives Parity / bearing child & age at first birth
  • Oral contraceptives BMI
  • Pack-years smoked Calcium intake
  • Pack-years smoked Current alcohol
  • Pack-years smoked Fruits and vegetables
  • Pack-years smoked Lifetime alcohol
  • Pack-years smoked PM Breast cancer
  • Pack-years smoked Physical activity
  • Pack-years smoked BMI
  • Parity / bearing child & age at first birth Breastfeeding duration
  • Parity / bearing child & age at first birth Calcium intake
  • Parity / bearing child & age at first birth Current alcohol
  • Parity / bearing child & age at first birth Fruits and vegetables
  • Parity / bearing child & age at first birth Lifetime alcohol
  • Parity / bearing child & age at first birth PM Breast cancer
  • Parity / bearing child & age at first birth Pack-years smoked
  • Parity / bearing child & age at first birth Physical activity
  • Parity / bearing child & age at first birth BMI
  • Physical activity Calcium intake
  • Physical activity Current alcohol
  • Physical activity Fruits and vegetables
  • Physical activity PM Breast cancer
  • Physical activity BMI
  • Age Calcium intake
  • Age Current alcohol
  • Age Fruits and vegetables
  • Age Lifetime alcohol
  • Age Medical behaviours
  • Age Menopause hormone therapy
  • Age PM Breast cancer
  • Age Pack-years smoked
  • Age Parity / bearing child & age at first birth
  • Age Physical activity
  • Age BMI
  • Age Education
  • Age Height
  • BMI PM Breast cancer
  • Education Breastfeeding duration
  • Education Calcium intake
  • Education Current alcohol
  • Education Fruits and vegetables
  • Education Lifetime alcohol
  • Education Medical behaviours
  • Education Menopause hormone therapy
  • Education Oral contraceptives
  • Education PM Breast cancer
  • Education Pack-years smoked
  • Education Parity / bearing child & age at first birth
  • Education Physical activity
  • Education BMI
  • Height PM Breast cancer

Read across: each marked cell is an edge from the row's variable to the column's.

  • No sign given
  • Directed
Current alcoholPM Breast cancerAge at menarcheBreast cancer in familyBreastfeeding durationCalcium intakeFruits and vegetablesLifetime alcohol Medical behavioursMenopause hormone therapyOral contraceptives Pack-years smoked Parity / bearing child & age at first birthPhysical activityAgeBMIEducationHeight
Current alcohol
PM Breast cancer
Age at menarche
Breast cancer in family
Breastfeeding duration
Calcium intake
Fruits and vegetables
Lifetime alcohol
Medical behaviours
Menopause hormone therapy
Oral contraceptives
Pack-years smoked
Parity / bearing child & age at first birth
Physical activity
Age
BMI
Education
Height

Code

Submitted as opencausal_fcwsac2k.txt. Also available as:

JSON CSV DAGitty

This JSON follows CausalJSON 0.2, the Open Causal Graph Format.

{
  "$schema": "https://opencausal.org/causaljson/0.2/causaljson.schema.json",
  "graph": {
    "id": "fcwsac2k",
    "doi": "10.83031/fcwsac2k",
    "version": 1,
    "title": "Causal relationship between current alcohol intake and incidence of breast cancer in postmenopausal women",
    "description": "This DAG represents the causal relationship between current alcohol intake and incidence of breast cancer in postmenopausal Norwegian women. Women were randomly recruited in the Norwegian Women and Health (NOWAC) cohort study from 1996 to 2004. For this analysis we included 32 735 women included who reported that they consumed alcohol and were not prevalent cancer cases.\r\n\r\nThis study was designed to address the effect of light-moderate drinking since the majority of women in this cohort (~95%) reported no more than 1 drink/day. Except for the outcome, other nodes in the DAG represent self-reported variables collected at baseline only (1996-2004), same time as the current alcohol intake. The outcome information was collected prospectively until December 2020 from the national cancer registries. Nodes in this DAG are presented shortly, for example breastfeeding duration represents breast feeding duration in months for each born child. More details on how each variable was collected and computed are given in the supplementary material of the published paper: https://doi.org/10.2147/CLEP.S531643.\r\n\r\nThe low-moderate drinking, Norwegian context, and background  knowledge from the NOWAC data were taken into account when depicting the DAG for this specific cohort. For example, only education was used as an indicator socioeconomic status and this choice was based on these assumptions: 1) NOWAC studies found that variation in cancer risk was most evident by education levels than by income; 2) other Norwegian studies found that risk of cancer varies meaningfully by income among Norwegian men but not women; and 3) Norwegian studies consistently find that education influences lifestyle choices and (including alcohol intake) and medical behaviors.\r\n\r\nAnother example is the lack of an arrow from alcohol intake to BMI (body mass index). Empirical evidence shows that heavy drinking affects body weight status, evidence mainly found for men. The assumption in the presented DAG was that this relationship is not applicable to the NOWAC cohort, which consists of women who are generally low to moderate drinkers. These and other assumptions together with the empirical evidence are provided in the supplementary material of the published paper: https://doi.org/10.2147/CLEP.S531643.\r\n\r\nBut these assumptions may be wrong, and since I plan to continue working on alcohol and health outcomes, any discussion is greatly appreciated!",
    "type": "dag",
    "created": "2025-11-18T15:36:33+00:00",
    "authors": [
      {
        "given_name": "Fjorida",
        "family_name": "Llaha",
        "orcid": "0000-0003-0534-6484",
        "affiliations": [
          {
            "name": "UiT The Arctic University of Norway, Department of Community Medicine, Tromsø, Norway"
          }
        ]
      }
    ],
    "submitter": {
      "given_name": "Fjorida",
      "family_name": "Llaha",
      "orcid": "0000-0003-0534-6484"
    },
    "license": "CC-BY-4.0",
    "rights_url": "https://creativecommons.org/licenses/by/4.0/legalcode",
    "publisher": "Open Causal",
    "language": "en",
    "layout": {
      "coordinate_system": "screen"
    }
  },
  "nodes": [
    {
      "id": "Age_at_menarche",
      "label": "Age at menarche",
      "position": {
        "x": 0.84,
        "y": 0.789
      }
    },
    {
      "id": "Breast_cancer_in_family",
      "label": "Breast cancer in family",
      "position": {
        "x": 0.5,
        "y": 0.201
      }
    },
    {
      "id": "Breastfeeding_duration",
      "label": "Breastfeeding duration",
      "position": {
        "x": 0.087,
        "y": 0.814
      }
    },
    {
      "id": "Calcium_intake",
      "label": "Calcium intake",
      "position": {
        "x": 0.596,
        "y": 0.735
      }
    },
    {
      "id": "Current_alcohol",
      "label": "Current alcohol",
      "role": "exposure",
      "position": {
        "x": 0.194,
        "y": 0.577
      }
    },
    {
      "id": "Fruits_and_vegetables",
      "label": "Fruits and vegetables",
      "position": {
        "x": 0.375,
        "y": 0.692
      }
    },
    {
      "id": "Lifetime_alcohol",
      "label": "Lifetime alcohol ",
      "position": {
        "x": 0.077,
        "y": 0.426
      }
    },
    {
      "id": "Medical_behaviours",
      "label": "Medical behaviours",
      "position": {
        "x": 0.321,
        "y": 0.42
      }
    },
    {
      "id": "Menopause_hormone_therapy",
      "label": "Menopause hormone therapy",
      "position": {
        "x": 0.679,
        "y": 0.907
      }
    },
    {
      "id": "Oral_contraceptives",
      "label": "Oral contraceptives ",
      "position": {
        "x": 0.561,
        "y": 0.929
      }
    },
    {
      "id": "PM_Breast_cancer",
      "label": "PM Breast cancer",
      "role": "outcome",
      "position": {
        "x": 0.855,
        "y": 0.624
      }
    },
    {
      "id": "Pack_years_smoked",
      "label": "Pack-years smoked ",
      "position": {
        "x": 0.901,
        "y": 0.25
      }
    },
    {
      "id": "Parity_bearing_child_age_at_first_birth",
      "label": "Parity / bearing child & age at first birth",
      "position": {
        "x": 0.319,
        "y": 0.937
      }
    },
    {
      "id": "Physical_activity",
      "label": "Physical activity",
      "position": {
        "x": 0.614,
        "y": 0.416
      }
    },
    {
      "id": "Age",
      "label": "Age",
      "position": {
        "x": 0.405,
        "y": 0.041
      }
    },
    {
      "id": "BMI",
      "label": "BMI",
      "position": {
        "x": 0.754,
        "y": 0.063
      }
    },
    {
      "id": "Education",
      "label": "Education",
      "position": {
        "x": 0.146,
        "y": 0.129
      }
    },
    {
      "id": "Height",
      "label": "Height",
      "position": {
        "x": 0.904,
        "y": 0.536
      }
    }
  ],
  "edges": [
    {
      "source": "Age_at_menarche",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Age_at_menarche",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Breast_cancer_in_family",
      "target": "Medical_behaviours",
      "type": "directed"
    },
    {
      "source": "Breast_cancer_in_family",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Breastfeeding_duration",
      "target": "Lifetime_alcohol",
      "type": "directed"
    },
    {
      "source": "Breastfeeding_duration",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Breastfeeding_duration",
      "target": "Pack_years_smoked",
      "type": "directed"
    },
    {
      "source": "Breastfeeding_duration",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Calcium_intake",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Calcium_intake",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Calcium_intake",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Current_alcohol",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Fruits_and_vegetables",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Fruits_and_vegetables",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Fruits_and_vegetables",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Lifetime_alcohol",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Lifetime_alcohol",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Medical_behaviours",
      "target": "Calcium_intake",
      "type": "directed"
    },
    {
      "source": "Medical_behaviours",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Medical_behaviours",
      "target": "Fruits_and_vegetables",
      "type": "directed"
    },
    {
      "source": "Medical_behaviours",
      "target": "Menopause_hormone_therapy",
      "type": "directed"
    },
    {
      "source": "Medical_behaviours",
      "target": "Physical_activity",
      "type": "directed"
    },
    {
      "source": "Medical_behaviours",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Menopause_hormone_therapy",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Menopause_hormone_therapy",
      "target": "Pack_years_smoked",
      "type": "directed"
    },
    {
      "source": "Menopause_hormone_therapy",
      "target": "Physical_activity",
      "type": "directed"
    },
    {
      "source": "Menopause_hormone_therapy",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Oral_contraceptives",
      "target": "Breastfeeding_duration",
      "type": "directed"
    },
    {
      "source": "Oral_contraceptives",
      "target": "Parity_bearing_child_age_at_first_birth",
      "type": "directed"
    },
    {
      "source": "Oral_contraceptives",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Pack_years_smoked",
      "target": "Calcium_intake",
      "type": "directed"
    },
    {
      "source": "Pack_years_smoked",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Pack_years_smoked",
      "target": "Fruits_and_vegetables",
      "type": "directed"
    },
    {
      "source": "Pack_years_smoked",
      "target": "Lifetime_alcohol",
      "type": "directed"
    },
    {
      "source": "Pack_years_smoked",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Pack_years_smoked",
      "target": "Physical_activity",
      "type": "directed"
    },
    {
      "source": "Pack_years_smoked",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "Breastfeeding_duration",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "Calcium_intake",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "Fruits_and_vegetables",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "Lifetime_alcohol",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "Pack_years_smoked",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "Physical_activity",
      "type": "directed"
    },
    {
      "source": "Parity_bearing_child_age_at_first_birth",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Physical_activity",
      "target": "Calcium_intake",
      "type": "directed"
    },
    {
      "source": "Physical_activity",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Physical_activity",
      "target": "Fruits_and_vegetables",
      "type": "directed"
    },
    {
      "source": "Physical_activity",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Physical_activity",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Calcium_intake",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Fruits_and_vegetables",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Lifetime_alcohol",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Medical_behaviours",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Menopause_hormone_therapy",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Pack_years_smoked",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Parity_bearing_child_age_at_first_birth",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Physical_activity",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Education",
      "type": "directed"
    },
    {
      "source": "Age",
      "target": "Height",
      "type": "directed"
    },
    {
      "source": "BMI",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Breastfeeding_duration",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Calcium_intake",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Current_alcohol",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Fruits_and_vegetables",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Lifetime_alcohol",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Medical_behaviours",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Menopause_hormone_therapy",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Oral_contraceptives",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "PM_Breast_cancer",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Pack_years_smoked",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Parity_bearing_child_age_at_first_birth",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "Physical_activity",
      "type": "directed"
    },
    {
      "source": "Education",
      "target": "BMI",
      "type": "directed"
    },
    {
      "source": "Height",
      "target": "PM_Breast_cancer",
      "type": "directed"
    }
  ]
}
source,target,edge_type
Age_at_menarche,PM_Breast_cancer,directed
Age_at_menarche,BMI,directed
Breast_cancer_in_family,Medical_behaviours,directed
Breast_cancer_in_family,PM_Breast_cancer,directed
Breastfeeding_duration,Lifetime_alcohol,directed
Breastfeeding_duration,PM_Breast_cancer,directed
Breastfeeding_duration,Pack_years_smoked,directed
Breastfeeding_duration,BMI,directed
Calcium_intake,Current_alcohol,directed
Calcium_intake,PM_Breast_cancer,directed
Calcium_intake,BMI,directed
Current_alcohol,PM_Breast_cancer,directed
Fruits_and_vegetables,Current_alcohol,directed
Fruits_and_vegetables,PM_Breast_cancer,directed
Fruits_and_vegetables,BMI,directed
Lifetime_alcohol,Current_alcohol,directed
Lifetime_alcohol,PM_Breast_cancer,directed
Medical_behaviours,Calcium_intake,directed
Medical_behaviours,Current_alcohol,directed
Medical_behaviours,Fruits_and_vegetables,directed
Medical_behaviours,Menopause_hormone_therapy,directed
Medical_behaviours,Physical_activity,directed
Medical_behaviours,BMI,directed
Menopause_hormone_therapy,PM_Breast_cancer,directed
Menopause_hormone_therapy,Pack_years_smoked,directed
Menopause_hormone_therapy,Physical_activity,directed
Menopause_hormone_therapy,BMI,directed
Oral_contraceptives,Breastfeeding_duration,directed
Oral_contraceptives,Parity_bearing_child_age_at_first_birth,directed
Oral_contraceptives,BMI,directed
Pack_years_smoked,Calcium_intake,directed
Pack_years_smoked,Current_alcohol,directed
Pack_years_smoked,Fruits_and_vegetables,directed
Pack_years_smoked,Lifetime_alcohol,directed
Pack_years_smoked,PM_Breast_cancer,directed
Pack_years_smoked,Physical_activity,directed
Pack_years_smoked,BMI,directed
Parity_bearing_child_age_at_first_birth,Breastfeeding_duration,directed
Parity_bearing_child_age_at_first_birth,Calcium_intake,directed
Parity_bearing_child_age_at_first_birth,Current_alcohol,directed
Parity_bearing_child_age_at_first_birth,Fruits_and_vegetables,directed
Parity_bearing_child_age_at_first_birth,Lifetime_alcohol,directed
Parity_bearing_child_age_at_first_birth,PM_Breast_cancer,directed
Parity_bearing_child_age_at_first_birth,Pack_years_smoked,directed
Parity_bearing_child_age_at_first_birth,Physical_activity,directed
Parity_bearing_child_age_at_first_birth,BMI,directed
Physical_activity,Calcium_intake,directed
Physical_activity,Current_alcohol,directed
Physical_activity,Fruits_and_vegetables,directed
Physical_activity,PM_Breast_cancer,directed
Physical_activity,BMI,directed
Age,Calcium_intake,directed
Age,Current_alcohol,directed
Age,Fruits_and_vegetables,directed
Age,Lifetime_alcohol,directed
Age,Medical_behaviours,directed
Age,Menopause_hormone_therapy,directed
Age,PM_Breast_cancer,directed
Age,Pack_years_smoked,directed
Age,Parity_bearing_child_age_at_first_birth,directed
Age,Physical_activity,directed
Age,BMI,directed
Age,Education,directed
Age,Height,directed
BMI,PM_Breast_cancer,directed
Education,Breastfeeding_duration,directed
Education,Calcium_intake,directed
Education,Current_alcohol,directed
Education,Fruits_and_vegetables,directed
Education,Lifetime_alcohol,directed
Education,Medical_behaviours,directed
Education,Menopause_hormone_therapy,directed
Education,Oral_contraceptives,directed
Education,PM_Breast_cancer,directed
Education,Pack_years_smoked,directed
Education,Parity_bearing_child_age_at_first_birth,directed
Education,Physical_activity,directed
Education,BMI,directed
Height,PM_Breast_cancer,directed

dag {
Age_at_menarche [label="Age at menarche",pos="0.84,0.789"]
Breast_cancer_in_family [label="Breast cancer in family",pos="0.5,0.201"]
Breastfeeding_duration [label="Breastfeeding duration",pos="0.087,0.814"]
Calcium_intake [label="Calcium intake",pos="0.596,0.735"]
Current_alcohol [exposure,label="Current alcohol",pos="0.194,0.577"]
Fruits_and_vegetables [label="Fruits and vegetables",pos="0.375,0.692"]
Lifetime_alcohol [label="Lifetime alcohol ",pos="0.077,0.426"]
Medical_behaviours [label="Medical behaviours",pos="0.321,0.42"]
Menopause_hormone_therapy [label="Menopause hormone therapy",pos="0.679,0.907"]
Oral_contraceptives [label="Oral contraceptives ",pos="0.561,0.929"]
PM_Breast_cancer [outcome,label="PM Breast cancer",pos="0.855,0.624"]
Pack_years_smoked [label="Pack-years smoked ",pos="0.901,0.25"]
Parity_bearing_child_age_at_first_birth [label="Parity / bearing child & age at first birth",pos="0.319,0.937"]
Physical_activity [label="Physical activity",pos="0.614,0.416"]
Age [pos="0.405,0.041"]
BMI [pos="0.754,0.063"]
Education [pos="0.146,0.129"]
Height [pos="0.904,0.536"]
Age_at_menarche -> PM_Breast_cancer
Age_at_menarche -> BMI
Breast_cancer_in_family -> Medical_behaviours
Breast_cancer_in_family -> PM_Breast_cancer
Breastfeeding_duration -> Lifetime_alcohol
Breastfeeding_duration -> PM_Breast_cancer
Breastfeeding_duration -> Pack_years_smoked
Breastfeeding_duration -> BMI
Calcium_intake -> Current_alcohol
Calcium_intake -> PM_Breast_cancer
Calcium_intake -> BMI
Current_alcohol -> PM_Breast_cancer
Fruits_and_vegetables -> Current_alcohol
Fruits_and_vegetables -> PM_Breast_cancer
Fruits_and_vegetables -> BMI
Lifetime_alcohol -> Current_alcohol
Lifetime_alcohol -> PM_Breast_cancer
Medical_behaviours -> Calcium_intake
Medical_behaviours -> Current_alcohol
Medical_behaviours -> Fruits_and_vegetables
Medical_behaviours -> Menopause_hormone_therapy
Medical_behaviours -> Physical_activity
Medical_behaviours -> BMI
Menopause_hormone_therapy -> PM_Breast_cancer
Menopause_hormone_therapy -> Pack_years_smoked
Menopause_hormone_therapy -> Physical_activity
Menopause_hormone_therapy -> BMI
Oral_contraceptives -> Breastfeeding_duration
Oral_contraceptives -> Parity_bearing_child_age_at_first_birth
Oral_contraceptives -> BMI
Pack_years_smoked -> Calcium_intake
Pack_years_smoked -> Current_alcohol
Pack_years_smoked -> Fruits_and_vegetables
Pack_years_smoked -> Lifetime_alcohol
Pack_years_smoked -> PM_Breast_cancer
Pack_years_smoked -> Physical_activity
Pack_years_smoked -> BMI
Parity_bearing_child_age_at_first_birth -> Breastfeeding_duration
Parity_bearing_child_age_at_first_birth -> Calcium_intake
Parity_bearing_child_age_at_first_birth -> Current_alcohol
Parity_bearing_child_age_at_first_birth -> Fruits_and_vegetables
Parity_bearing_child_age_at_first_birth -> Lifetime_alcohol
Parity_bearing_child_age_at_first_birth -> PM_Breast_cancer
Parity_bearing_child_age_at_first_birth -> Pack_years_smoked
Parity_bearing_child_age_at_first_birth -> Physical_activity
Parity_bearing_child_age_at_first_birth -> BMI
Physical_activity -> Calcium_intake
Physical_activity -> Current_alcohol
Physical_activity -> Fruits_and_vegetables
Physical_activity -> PM_Breast_cancer
Physical_activity -> BMI
Age -> Calcium_intake
Age -> Current_alcohol
Age -> Fruits_and_vegetables
Age -> Lifetime_alcohol
Age -> Medical_behaviours
Age -> Menopause_hormone_therapy
Age -> PM_Breast_cancer
Age -> Pack_years_smoked
Age -> Parity_bearing_child_age_at_first_birth
Age -> Physical_activity
Age -> BMI
Age -> Education
Age -> Height
BMI -> PM_Breast_cancer
Education -> Breastfeeding_duration
Education -> Calcium_intake
Education -> Current_alcohol
Education -> Fruits_and_vegetables
Education -> Lifetime_alcohol
Education -> Medical_behaviours
Education -> Menopause_hormone_therapy
Education -> Oral_contraceptives
Education -> PM_Breast_cancer
Education -> Pack_years_smoked
Education -> Parity_bearing_child_age_at_first_birth
Education -> Physical_activity
Education -> BMI
Height -> PM_Breast_cancer
}

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