A pooled analysis of post‐diagnosis lifestyle factors in association with late estrogen‐receptor–positive breast cancer prognosis
Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor‐positive (ER+) breast cancer survivors, who may ha...
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| Veröffentlicht in: | International journal of cancer 2016-05, Vol.138 (9), p.2088-2097 |
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| creator | Nechuta, Sarah Chen, Wendy Y. Cai, Hui Poole, Elizabeth M. Kwan, Marilyn L. Flatt, Shirley W. Patterson, Ruth E. Pierce, John P. Caan, Bette J. Ou Shu, Xiao |
| description | Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor‐positive (ER+) breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all‐cause mortality among 6,295 5‐year ER+ Stage I–III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre‐ to post‐diagnosis weight change, body mass index (BMI) (kg/m2), recreational physical activity, alcohol intake and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q‐statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥10% weight gain and obesity (BMI, 30–34.99 and ≥35) were associated with increased risk of late recurrence (hazard ratios (95% confidence intervals): 1.24 (1.00–1.53), 1.40 (1.05–1.86) and 1.41 (1.02–1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01–1.62). Physical activity was inversely associated with late all‐cause mortality (0.81 (0.71–0.93) and 0.71 (0.61–0.82) for 4.9 to |
| doi_str_mv | 10.1002/ijc.29940 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4764465</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3959591571</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4790-3a4490b55fcd448f240b816b66df00bccb5e67361b102e1b4ea9e4d5f0439c83</originalsourceid><addsrcrecordid>eNpdkc9u1DAQxi0EokvhwAsgS1y4pB0ntpNckKoVf4oqcendsp3J1iuvHexsq7311isSb9gnwd0tFXDyaL6fP4_nI-QtgxMGUJ-6tT2p-57DM7Jg0LcV1Ew8J4uiQdWyRh6RVzmvARgTwF-So1pKkC2XC3J3RqcYPQ5UB-132WUax9LK8_3tz8HpVYgPPe9GzPPOIx21nWPK1AWqc47W6dnFQG_cfEW9npEWLsUVhnI_ocWp0Pe3v4qjm901UpNQ55laHSwmOhV0_8Jr8mLUPuObx_OYXH7-dLn8Wl18_3K-PLuoLG97qBrNeQ9GiNEOnHdjzcF0TBophxHAWGsEyraRzDCokRmOukc-iBF409uuOSYfD7bT1mxwsBjmpL2aktvotFNRO_WvEtyVWsVrxVvJuRTF4MOjQYo_tuWvauOyRe91wLjNirWylXUtOBT0_X_oOm5T2fKBAtE1XV2od39P9DTKn4gKcHoAbpzH3ZPOQD1kr0r2ap-9Ov-23BfNb0DPp9o</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1767058382</pqid></control><display><type>article</type><title>A pooled analysis of post‐diagnosis lifestyle factors in association with late estrogen‐receptor–positive breast cancer prognosis</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Nechuta, Sarah ; Chen, Wendy Y. ; Cai, Hui ; Poole, Elizabeth M. ; Kwan, Marilyn L. ; Flatt, Shirley W. ; Patterson, Ruth E. ; Pierce, John P. ; Caan, Bette J. ; Ou Shu, Xiao</creator><creatorcontrib>Nechuta, Sarah ; Chen, Wendy Y. ; Cai, Hui ; Poole, Elizabeth M. ; Kwan, Marilyn L. ; Flatt, Shirley W. ; Patterson, Ruth E. ; Pierce, John P. ; Caan, Bette J. ; Ou Shu, Xiao</creatorcontrib><description>Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor‐positive (ER+) breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all‐cause mortality among 6,295 5‐year ER+ Stage I–III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre‐ to post‐diagnosis weight change, body mass index (BMI) (kg/m2), recreational physical activity, alcohol intake and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q‐statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥10% weight gain and obesity (BMI, 30–34.99 and ≥35) were associated with increased risk of late recurrence (hazard ratios (95% confidence intervals): 1.24 (1.00–1.53), 1.40 (1.05–1.86) and 1.41 (1.02–1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01–1.62). Physical activity was inversely associated with late all‐cause mortality (0.81 (0.71–0.93) and 0.71 (0.61–0.82) for 4.9 to <17.4 and ≥17.4 metabolic equivalent‐hr/week). A U‐shaped association was observed for late all‐cause mortality and BMI using updated weight (1.42 (1.15–1.74) and 1.40 (1.09–1.81), <21.5 and ≥35, respectively). Smoking was associated with increased risk of late outcomes. In this large prospective pooling project, modifiable lifestyle factors were associated with late outcomes among long‐term ER+ breast cancer survivors.
What's new?
Late recurrence is a major concern for women with ER+ breast cancer, which accounts for close to two‐thirds of diagnosed breast cancers. The factors that predispose survivors to late recurrence, however, are not fully understood. This report describes a role for certain lifestyle factors. Using pooled data from prospective cohorts, the authors' show that post‐diagnosis lifestyle factors, including alcohol intake, exercise, obesity and smoking, are associated with late breast cancer outcomes in estrogen receptor‐positive breast cancer survivors. The modifiable nature of these factors could have implications for long‐term survivorship care guidelines.</description><identifier>ISSN: 0020-7136</identifier><identifier>EISSN: 1097-0215</identifier><identifier>DOI: 10.1002/ijc.29940</identifier><identifier>PMID: 26606746</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Body mass index ; Breast cancer ; Breast Neoplasms - mortality ; Breast Neoplasms - pathology ; Cancer ; cohort ; Cohort Studies ; Confidence intervals ; Disease Progression ; Estrogens ; Female ; Health risk assessment ; Humans ; Life Style ; lifestyle factors ; Lifestyles ; Medical prognosis ; Medical research ; Middle Aged ; Mortality ; Neoplasm Recurrence, Local - epidemiology ; Proportional Hazards Models ; prospective ; Receptors, Estrogen - biosynthesis ; recurrence ; Risk Factors ; Survivors ; Young Adult</subject><ispartof>International journal of cancer, 2016-05, Vol.138 (9), p.2088-2097</ispartof><rights>2015 UICC</rights><rights>2015 UICC.</rights><rights>2016 UICC</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4790-3a4490b55fcd448f240b816b66df00bccb5e67361b102e1b4ea9e4d5f0439c83</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fijc.29940$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fijc.29940$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26606746$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nechuta, Sarah</creatorcontrib><creatorcontrib>Chen, Wendy Y.</creatorcontrib><creatorcontrib>Cai, Hui</creatorcontrib><creatorcontrib>Poole, Elizabeth M.</creatorcontrib><creatorcontrib>Kwan, Marilyn L.</creatorcontrib><creatorcontrib>Flatt, Shirley W.</creatorcontrib><creatorcontrib>Patterson, Ruth E.</creatorcontrib><creatorcontrib>Pierce, John P.</creatorcontrib><creatorcontrib>Caan, Bette J.</creatorcontrib><creatorcontrib>Ou Shu, Xiao</creatorcontrib><title>A pooled analysis of post‐diagnosis lifestyle factors in association with late estrogen‐receptor–positive breast cancer prognosis</title><title>International journal of cancer</title><addtitle>Int J Cancer</addtitle><description>Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor‐positive (ER+) breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all‐cause mortality among 6,295 5‐year ER+ Stage I–III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre‐ to post‐diagnosis weight change, body mass index (BMI) (kg/m2), recreational physical activity, alcohol intake and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q‐statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥10% weight gain and obesity (BMI, 30–34.99 and ≥35) were associated with increased risk of late recurrence (hazard ratios (95% confidence intervals): 1.24 (1.00–1.53), 1.40 (1.05–1.86) and 1.41 (1.02–1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01–1.62). Physical activity was inversely associated with late all‐cause mortality (0.81 (0.71–0.93) and 0.71 (0.61–0.82) for 4.9 to <17.4 and ≥17.4 metabolic equivalent‐hr/week). A U‐shaped association was observed for late all‐cause mortality and BMI using updated weight (1.42 (1.15–1.74) and 1.40 (1.09–1.81), <21.5 and ≥35, respectively). Smoking was associated with increased risk of late outcomes. In this large prospective pooling project, modifiable lifestyle factors were associated with late outcomes among long‐term ER+ breast cancer survivors.
What's new?
Late recurrence is a major concern for women with ER+ breast cancer, which accounts for close to two‐thirds of diagnosed breast cancers. The factors that predispose survivors to late recurrence, however, are not fully understood. This report describes a role for certain lifestyle factors. Using pooled data from prospective cohorts, the authors' show that post‐diagnosis lifestyle factors, including alcohol intake, exercise, obesity and smoking, are associated with late breast cancer outcomes in estrogen receptor‐positive breast cancer survivors. The modifiable nature of these factors could have implications for long‐term survivorship care guidelines.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Body mass index</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - mortality</subject><subject>Breast Neoplasms - pathology</subject><subject>Cancer</subject><subject>cohort</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Disease Progression</subject><subject>Estrogens</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Life Style</subject><subject>lifestyle factors</subject><subject>Lifestyles</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Proportional Hazards Models</subject><subject>prospective</subject><subject>Receptors, Estrogen - biosynthesis</subject><subject>recurrence</subject><subject>Risk Factors</subject><subject>Survivors</subject><subject>Young Adult</subject><issn>0020-7136</issn><issn>1097-0215</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc9u1DAQxi0EokvhwAsgS1y4pB0ntpNckKoVf4oqcendsp3J1iuvHexsq7311isSb9gnwd0tFXDyaL6fP4_nI-QtgxMGUJ-6tT2p-57DM7Jg0LcV1Ew8J4uiQdWyRh6RVzmvARgTwF-So1pKkC2XC3J3RqcYPQ5UB-132WUax9LK8_3tz8HpVYgPPe9GzPPOIx21nWPK1AWqc47W6dnFQG_cfEW9npEWLsUVhnI_ocWp0Pe3v4qjm901UpNQ55laHSwmOhV0_8Jr8mLUPuObx_OYXH7-dLn8Wl18_3K-PLuoLG97qBrNeQ9GiNEOnHdjzcF0TBophxHAWGsEyraRzDCokRmOukc-iBF409uuOSYfD7bT1mxwsBjmpL2aktvotFNRO_WvEtyVWsVrxVvJuRTF4MOjQYo_tuWvauOyRe91wLjNirWylXUtOBT0_X_oOm5T2fKBAtE1XV2od39P9DTKn4gKcHoAbpzH3ZPOQD1kr0r2ap-9Ov-23BfNb0DPp9o</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Nechuta, Sarah</creator><creator>Chen, Wendy Y.</creator><creator>Cai, Hui</creator><creator>Poole, Elizabeth M.</creator><creator>Kwan, Marilyn L.</creator><creator>Flatt, Shirley W.</creator><creator>Patterson, Ruth E.</creator><creator>Pierce, John P.</creator><creator>Caan, Bette J.</creator><creator>Ou Shu, Xiao</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7T5</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160501</creationdate><title>A pooled analysis of post‐diagnosis lifestyle factors in association with late estrogen‐receptor–positive breast cancer prognosis</title><author>Nechuta, Sarah ; Chen, Wendy Y. ; Cai, Hui ; Poole, Elizabeth M. ; Kwan, Marilyn L. ; Flatt, Shirley W. ; Patterson, Ruth E. ; Pierce, John P. ; Caan, Bette J. ; Ou Shu, Xiao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4790-3a4490b55fcd448f240b816b66df00bccb5e67361b102e1b4ea9e4d5f0439c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Body mass index</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - mortality</topic><topic>Breast Neoplasms - pathology</topic><topic>Cancer</topic><topic>cohort</topic><topic>Cohort Studies</topic><topic>Confidence intervals</topic><topic>Disease Progression</topic><topic>Estrogens</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Life Style</topic><topic>lifestyle factors</topic><topic>Lifestyles</topic><topic>Medical prognosis</topic><topic>Medical research</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Proportional Hazards Models</topic><topic>prospective</topic><topic>Receptors, Estrogen - biosynthesis</topic><topic>recurrence</topic><topic>Risk Factors</topic><topic>Survivors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nechuta, Sarah</creatorcontrib><creatorcontrib>Chen, Wendy Y.</creatorcontrib><creatorcontrib>Cai, Hui</creatorcontrib><creatorcontrib>Poole, Elizabeth M.</creatorcontrib><creatorcontrib>Kwan, Marilyn L.</creatorcontrib><creatorcontrib>Flatt, Shirley W.</creatorcontrib><creatorcontrib>Patterson, Ruth E.</creatorcontrib><creatorcontrib>Pierce, John P.</creatorcontrib><creatorcontrib>Caan, Bette J.</creatorcontrib><creatorcontrib>Ou Shu, Xiao</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nechuta, Sarah</au><au>Chen, Wendy Y.</au><au>Cai, Hui</au><au>Poole, Elizabeth M.</au><au>Kwan, Marilyn L.</au><au>Flatt, Shirley W.</au><au>Patterson, Ruth E.</au><au>Pierce, John P.</au><au>Caan, Bette J.</au><au>Ou Shu, Xiao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A pooled analysis of post‐diagnosis lifestyle factors in association with late estrogen‐receptor–positive breast cancer prognosis</atitle><jtitle>International journal of cancer</jtitle><addtitle>Int J Cancer</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>138</volume><issue>9</issue><spage>2088</spage><epage>2097</epage><pages>2088-2097</pages><issn>0020-7136</issn><eissn>1097-0215</eissn><abstract>Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor‐positive (ER+) breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all‐cause mortality among 6,295 5‐year ER+ Stage I–III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre‐ to post‐diagnosis weight change, body mass index (BMI) (kg/m2), recreational physical activity, alcohol intake and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q‐statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥10% weight gain and obesity (BMI, 30–34.99 and ≥35) were associated with increased risk of late recurrence (hazard ratios (95% confidence intervals): 1.24 (1.00–1.53), 1.40 (1.05–1.86) and 1.41 (1.02–1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01–1.62). Physical activity was inversely associated with late all‐cause mortality (0.81 (0.71–0.93) and 0.71 (0.61–0.82) for 4.9 to <17.4 and ≥17.4 metabolic equivalent‐hr/week). A U‐shaped association was observed for late all‐cause mortality and BMI using updated weight (1.42 (1.15–1.74) and 1.40 (1.09–1.81), <21.5 and ≥35, respectively). Smoking was associated with increased risk of late outcomes. In this large prospective pooling project, modifiable lifestyle factors were associated with late outcomes among long‐term ER+ breast cancer survivors.
What's new?
Late recurrence is a major concern for women with ER+ breast cancer, which accounts for close to two‐thirds of diagnosed breast cancers. The factors that predispose survivors to late recurrence, however, are not fully understood. This report describes a role for certain lifestyle factors. Using pooled data from prospective cohorts, the authors' show that post‐diagnosis lifestyle factors, including alcohol intake, exercise, obesity and smoking, are associated with late breast cancer outcomes in estrogen receptor‐positive breast cancer survivors. The modifiable nature of these factors could have implications for long‐term survivorship care guidelines.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>26606746</pmid><doi>10.1002/ijc.29940</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Aged Aged, 80 and over Body mass index Breast cancer Breast Neoplasms - mortality Breast Neoplasms - pathology Cancer cohort Cohort Studies Confidence intervals Disease Progression Estrogens Female Health risk assessment Humans Life Style lifestyle factors Lifestyles Medical prognosis Medical research Middle Aged Mortality Neoplasm Recurrence, Local - epidemiology Proportional Hazards Models prospective Receptors, Estrogen - biosynthesis recurrence Risk Factors Survivors Young Adult |
| title | A pooled analysis of post‐diagnosis lifestyle factors in association with late estrogen‐receptor–positive breast cancer prognosis |
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