Although having a family history of breast cancer is a well established breast cancer risk factor, it is not known whether it influences mortality after breast cancer diagnosis.
Subjects were 4,153 women with first primary incident invasive breast cancer diagnosed between 1991 and 2000, and enrolled in the Breast Cancer Family Registry through population-based sampling in Northern California, USA; Ontario, Canada; and Melbourne and Sydney, Australia. Cases were oversampled for younger age at diagnosis and/or family history of breast cancer. Carriers of germline mutations in BRCA1 or BRCA2 were excluded. Cases and their relatives completed structured questionnaires assessing breast cancer risk factors and family history of cancer. Cases were followed for a median of 6.5 years, during which 725 deaths occurred. Cox proportional hazards regression was used to evaluate associations between family history of breast cancer at the time of diagnosis and risk of all-cause mortality after breast cancer diagnosis, adjusting for established prognostic factors.
The hazard ratios for all-cause mortality were 0.98 (95% confidence interval [CI]=0.84-1.15) for having at least one first- or second-degree relative with breast cancer, and 0.85 (95% CI=0.70-1.02) for having at least one first-degree relative with breast cancer, compared with having no such family history. Estimates did not vary appreciably when stratified by case or tumor characteristics.
Family history of breast cancer is not associated with all-cause mortality after breast cancer diagnosis for women without a known germline mutation in BRCA1 or BRCA2. Therefore, clinical management should not depend on family history of breast cancer.
breast cancer; survival; mortality; family history
Studies have examined the prognostic relevance of reproductive factors prior to breast cancer (BC) diagnosis, but most have been small and overall their findings inconclusive. Associations between reproductive risk factors and all-cause mortality after BC diagnosis were assessed using a population-based cohort of 3,107 women of white European ancestry with invasive BC (1,130 from Melbourne and Sydney, Australia; 1,441 from Ontario, Canada; and 536 from Northern California, USA). During follow-up with a median of 8.5 years, 567 deaths occurred. At recruitment, questionnaire data were collected on oral contraceptive use, number of full-term pregnancies, age at first full-term pregnancy, time from last full-term pregnancy to BC diagnosis, breastfeeding, age at menarche and menopause and menopausal status at BC diagnosis. Hazard ratios (HR) for all-cause mortality were estimated using Cox proportional hazards models with and without adjustment for age at diagnosis, study center, education and body mass index. Compared with nulliparous women, those who had a child up to 2 years, or between 2 to 5 years, prior to their BC diagnosis were more likely to die. The unadjusted HR estimates were 2.75 (95%CI=1.98–3.83, p<0.001) and 2.20 (95%CI=1.65–2.94, p<0.001), respectively, and the adjusted estimates were 2.25 (95%CI=1.59–3.18, p<0.001) and 1.82 (95%CI=1.35–2.46, p<0.001), respectively). When evaluating the prognosis of women recently diagnosed with BC, the time since last full-term pregnancy should be routinely considered along with other established host and tumor prognostic factors, but consideration of other reproductive factors may not be warranted.
Breast cancer; survival; reproductive; outcome; pregnancy
Background and purpose
Previous studies have shown that physical inactivity and obesity are risk factors for the development of colorectal cancer. However, controversy exists regarding the influence of these factors on survival in colorectal cancer patients. We evaluated the impact of recreational physical activity and body mass index (BMI) before and after colorectal cancer diagnosis on disease-specific mortality and all-cause mortality.
Patients and Methods
This prospective cohort study included 1339 women enrolled in the Women’s Health Initiative study who were diagnosed with colorectal cancer subsequent to study enrolment. BMI and recreational physical activity were measured before cancer diagnosis at study entry (pre-diagnostic) and after diagnosis at study follow-up interviews (post-diagnostic). We used Cox regression to estimate the association between pre- and post-diagnostic exposures and survival after colorectal cancer diagnosis.
Among women diagnosed with colorectal cancer, 265 (13%) deaths occurred during a median study follow-up of 11.9 years, of which 171 (65%) were attributed to colorectal cancer. Compared with women reporting no pre-diagnostic recreational physical activity, those reporting activity levels of ≥18 MET-hours/week had significantly lower colorectal cancer-specific mortality (hazard ratio (HR)=0.68; 95% confidence interval (CI): 0.41–1.13) and all-cause mortality (HR=0.63; 95% CI: 0.42–0.96). Similar inverse associations were seen for post-diagnostic recreational physical activity. Neither pre- nor post-diagnostic BMI were associated with mortality after colorectal cancer diagnosis.
Recreational physical activity before and after CR colorectal cancer C diagnosis, but not BMI, is associated with more favourable survival.
Physical activity; body mass index; colorectal cancer; survival; postmenopausal
Recreational physical activity has been consistently associated with lower breast cancer risk, but there is a need to study the intensity and duration of activity that are critical to reduce the risk. The aim of this study was to examine the influence of moderate and vigorous intensity of recreational physical activity performed at different age periods on breast cancer risk.
Material and methods
The case-control study included 858 women with histological confirmation of invasive breast cancer and 1085 women free of any cancer diagnosis, residents of the region of Western Pomerania, aged 28–79 years. The frequency, duration and intensity of lifetime household, occupational and recreational physical activity, sociodemographic characteristics, reproductive factors, family history of breast cancer, current weight and height, and lifestyle habits were measured using a self-administered questionnaire. Unconditional logistic regression analyses were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The risk estimates were controlled for potential risk factors and lifetime household and occupational activities.
We found a risk reduction for recreational activity done early in life (age periods 14–20, 21–34, 35–50 years), particularly at ages 14–20 and 21–34 years, regardless of intensity. Active women engaging in more than 4.5 hours per week of moderate activity during ages 14–20 years had, on average, a 36% lower risk (OR = 0.64, 95% CI: 0.45–0.89) than women who were never or rarely active. For the women who reported 4.5 hours per week of vigorous activity during this period we found about 64% risk reduction (OR = 0.36, 95% CI: 0.26–0.51). For the period after 50 years of age, recreational activity of moderate or vigorous intensity was not significantly associated with the risk.
Recreational physical activity of moderate or vigorous intensity done during adolescence, early and middle adulthood, particularly at ages 14–20 and 21–34 years, is associated with significantly decreased breast cancer risk.
breast cancer; physical activity; prevention; age; intensity; case-control study
Although studies have shown that physically active breast cancer survivors have lower all-cause mortality, the association between change in physical activity from before to after diagnosis and mortality is not clear. We examined associations among pre- and postdiagnosis physical activity, change in pre- to postdiagnosis physical activity, and all-cause and breast cancer–specific mortality in post-menopausal women. A longitudinal study of 4,643 women diagnosed with invasive breast cancer after entry into the Women’s Health Initiative study of postmenopausal women. Physical activity from recreation and walking was determined at baseline (prediagnosis) and after diagnosis (assessed at the 3 or 6 years post-baseline visit). Women participating in 9 MET-h/wk or more (~3 h/wk of fast walking) of physical activity before diagnosis had a lower all-cause mortality (HR = 0.61; 95% CI, 0.44–0.87; P = 0.01) compared with inactive women in multivariable adjusted analyses. Women participating in ≥9 or more MET-h/wk of physical activity after diagnosis had lower breast cancer mortality (HR = 0.61; 95% CI, 0.35–0.99; P = 0.049) and lower all-cause mortality (HR = 0.54; 95% CI, 0.38–0.79; P < 0.01). Women who increased or maintained physical activity of 9 or more MET-h/wk after diagnosis had lower all-cause mortality (HR = 0.67; 95% CI, 0.46–0.96) even if they were inactive before diagnosis. High levels of physical activity may improve survival in postmenopausal women with breast cancer, even among those reporting low physical activity prior to diagnosis. Women diagnosed with breast cancer should be encouraged to initiate and maintain a program of physical activity.
Identifying modifiable factors that reduce the risk of recurrence and improve survival in breast cancer survivors is a pressing concern. The purpose of this study was to examine the association of physical activity following diagnosis and treatment with the risk of breast cancer recurrence and mortality and all-cause mortality in women with early-stage breast cancer.
Materials and Methods
The sample consisted of 1,970 women from the Life After Cancer Epidemiology study, a prospective investigation of behavioral risk factors and health outcomes. Self-reported frequency and duration of work-related, household and caregiving, recreational, and transportation-related activities during the six months prior to enrollment were assessed. Outcomes were ascertained from electronic or paper medical charts. Hazard ratios and 95% confidence intervals were estimated from delayed entry Cox proportional hazards models.
Although age-adjusted results suggested that higher levels of physical activity were associated with reduced risk of recurrence and breast cancer mortality (P for trend = 0.05 and 0.07, respectively for highest versus lowest level of hours per week of moderate physical activity), these associations were attenuated after adjustment for prognostic factors and other confounding variables (P for trend = 0.36 and 0.26). In contrast, a statistically significant protective association between physical activity and all-cause mortality remained in multivariable analyses (hazard ratio, 0.66; 95% confidence interval, 0.42–1.03; P for trend = 0.04).
These findings do not support a protective effect of physical activity on breast cancer recurrence or mortality but do suggest that regular physical activity is beneficial for breast cancer survivors in terms of total mortality.
Regular recreational physical activity has been found to be associated with a decrease in breast cancer risk in women in the majority of epidemiologic studies, but research findings are inconsistent regarding the intensity of activity and timing in life. To address these issues the relations of moderate and vigorous intensity recreational physical activity during ages 14-20, 21-34, 35-50, and over age 50 years to pre- and postmenopausal breast cancer risk were examined. A case-control study of 858 women, with histological confirmation of invasive breast cancer, and 1085 controls, free of any cancer diagnosis, all subjects aged 28-79 years was conducted in the Region of Western Pomerania (Poland). Physical activity was assessed using a self-administered questionnaire with questions on type of activity, duration, frequency, and intensity for each type of activity. Odds ratios (OR) and 95% confidence intervals (CI) of breast cancer associated with physical activity were calculated using unconditional logistic regression. Vigorous physical activity at ages 14-20 and 21-34 years lowered breast cancer risk by at least 35% in premenopausal women and by at least 51% in postmenopausal women for the highest versus lowest quartiles of the activity. The risk was also reduced in postmenopausal women who reported on average more than 1.74 hours per week of vigorous intensity recreational activity in ages >50 years (OR = 0.58; 95%CI = 0.27-0.97; P for trend = 0.013). For moderate activity the relationships remained statistically significant only in postmenopausal women active during ages 14- 20 years. The results indicate also a plausible risk reduction among premeno-pausal women. These results support the hypothesis that recrea-tional activity, particularly done early in life, is associated with a decrease in the invasive breast cancer risk in postmenopausal women. Among premenopausal women, only vigorous forms of activity may significantly decrease the risk.
Key pointsRecreational physical activity of vigorous intensity during ages 14-20 and 21-34 years protect against breast cancer regardless of menopausal status.Vigorous recreational physical activity at ages >50 years was also associated with reduced postmeno-pausal breast cancer risk.The risk reduction was also observed among post-menopausal women engaged in recreational physical activity of moderate intensity at ages 14-20 years.
Exercise; breast cancer; case-control study; prevention
Recreational physical activity (RPA) is associated with a reduced risk of developing breast cancer, but there is limited research on whether prediagnostic RPA influences survival after breast cancer diagnosis.
We evaluated the association between prediagnostic RPA and risk of death in 1,508 women with a first breast cancer diagnosis between 1996 and 1997 in the population-based Long Island Breast Cancer Study Project. Five-year mortality through the end of 2002 was assessed using the National Death Index (N=196). An in-person interview was completed shortly after diagnosis to obtain information on lifetime RPA, which was expressed as metabolic equivalent task hours per week (MET-h/wk).
A lower risk of all-cause death was observed for women who engaged in an average of ≥9 MET-h/wk of RPA from menarche to diagnosis compared with women who did not exercise (age and BMI adjusted hazard ratio [HR]=0.57; 95% confidence interval [CI]=0.39–0.83), an association that was similar when evaluated according to menopausal status. Decreased all-cause mortality was found for women with any moderate intensity lifetime RPA (>0 MET-h/wk) (HR=0.62; 95% CI=0.46-0.84) and breast cancer-specific mortality (HR=0.64; 95% CI=0.43-0.93) risk than women who engaged in no moderate RPA. Among postmenopausal women, RPA that took place after menopause resulted in a decrease in overall mortality, whereas no association was observed for RPA which took place prior to menopause (>0 MET-h/wk of RPA vs. no RPA: HR=0.61; 95% CI=0.39-0.94; and HR=1.00; 95% CI=0.65-1.54, respectively).
This study provides support that RPA prior to breast cancer diagnosis improves survival.
Physical activity; exercise; breast cancer; survival; prevention; epidemiology
Research suggests that physical activity is associated with improved breast cancer survival, yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes. The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality.
A total of 2,361 post-treatment breast cancer survivors (Stage I–III) enrolled in a randomized controlled trial of dietary change completed physical activity measures at baseline and one year. Physical activity variables (total, moderate–vigorous, and adherence to guidelines) were calculated for each time point. Median follow-up was 7.1 years. Outcomes were invasive breast cancer events and all-cause mortality.
Those who were most active at baseline had a 53% lower mortality risk compared to the least active women (HR = 0.47; 95% CI: 0.26, 0.84; p = .01). Adherence to activity guidelines was associated with a 35% lower mortality risk (HR = 0.65, 95% CI: 0.47, 0.91; p < .01). Neither baseline nor 1-year change in activity was associated with additional breast cancer events.
Higher baseline (post-treatment) physical activity was associated with improved survival. However, change in activity over the following year was not associated with outcomes. These data suggest that long-term physical activity levels are important for breast cancer prognosis.
Exercise; Recurrence; Survival; Behavior; Lifestyle
The 2008 Physical Activity (PA) Guidelines recommend engaging in at least 2.5 hours (10 MET-hours/week) of moderate intensity PA per week (defined as 4 METs) to reduce risk of morbidity and mortality. This analysis was conducted to investigate whether this recommendation can be extended to breast cancer survivors. Data from four studies of breast cancer survivors measuring recreational PA from semi-quantitative questionnaires a median of 23 months post-diagnosis (interquartile range 18 to 32 months) were pooled in the After Breast Cancer Pooling Project (n=13,302). Delayed entry Cox proportional hazards models were applied in data analysis with adjustment for age, post-diagnosis body mass index, race/ethnicity, menopausal status, TNM stage, cancer treatment, and smoking history. Engaging in at least 10 MET-hours/week of PA was associated with a 27% reduction in all-cause mortality (n=1,468 events, Hazard Ratio (HR) = 0.73, 95% CI, 0.66–0.82) and a 25% reduction in breast cancer mortality (n=971 events, HR=0.75, 95% CI 0.65–0.85) compared to women who did not meet the PA Guidelines (< 10 MET-hours/week). Risk of breast cancer recurrence (n=1,421 events) was not associated with meeting the PA Guidelines (HR=0.96, 95% CI, 0.86–1.06). These data suggest that adhering to the PA Guidelines may be an important intervention target for reducing mortality among breast cancer survivors.
physical activity guidelines; breast cancer survival; mortality; epidemiology
The frequency, in women with breast cancer, of mutations and other variants in the susceptibility gene, BRCA1, was investigated using a population-based case–control-family study. Cases were women living in Melbourne or Sydney, Australia, with histologically confirmed, first primary, invasive breast cancer, diagnosed before the age of 40 years, recorded on the state Cancer Registries. Controls were women without breast cancer, frequency-matched for age, randomly selected from electoral rolls. Full manual sequencing of the coding region of BRCA1 was conducted in a randomly stratified sample of 91 cases; 47 with, and 44 without, a family history of breast cancer in a first- or second-degree relative. All detected variants were tested in a random sample of 67 controls. Three cases with a (protein-truncating) mutation were detected. Only one case had a family history; her mother had breast cancer, but did not carry the mutation. The proportion of Australian women with breast cancer before age 40 who carry a germline mutation in BRCA1 was estimated to be 3.8% (95% Cl 0.3–12.6%). Seven rare variants were also detected, but for none was there evidence of a strong effect on breast cancer susceptibility. Therefore, on a population basis, rare variants are likely to contribute little to breast cancer incidence. © 1999 Cancer Research Campaign
BRCA1; breast cancer; DNA sequencing; mutations; population prevalence; variants
Triple-negative breast cancer, characterized by a lack of hormone receptor and HER2 expression, is associated with a particularly poor prognosis. Focusing on potentially modifiable breast cancer risk factors, we examined the relationship between body size, physical activity, and triple-negative disease risk.
Using data from 155,723 women enrolled in the Women’s Health Initiative (median follow-up 7.9 years), we assessed associations between baseline body mass index (BMI), BMI in earlier adulthood, waist and hip circumference, waist-hip ratio (WHR), recreational physical activity, and risk of triple-negative (N=307) and estrogen receptor-positive (ER+, N=2,610) breast cancers.
Women in the highest versus lowest BMI quartile had 1.35-fold [95% confidence interval (CI): 0.92–1.99] and 1.39-fold (95% CI: 1.22–1.58) increased risks of triple-negative and ER+ breast cancers, respectively. Waist and hip circumferences were positively associated with risk of ER+ breast cancer (p for trend=0.01 for both measures) but were not associated with triple-negative breast cancer. Compared to women who reported no recreational physical activity, women in the highest activity tertile had similarly lower risks of triple-negative and ER+ breast cancers [hazard ratio (HR)=0.77, 95% CI: 0.51–1.13 and HR=0.85, 95% CI: 0.74–0.98, respectively].
Despite biological and clinical differences, triple-negative and ER+ breast cancers are similarly associated with BMI and recreational physical activity in postmenopausal women. The biological mechanisms underlying these similarities are uncertain and these modest associations require further investigation.
If confirmed, these results suggest potential ways postmenopausal women might modify their risk of both ER+ and triple-negative breast cancers.
triple-negative; breast cancer; physical activity; body mass index
Although modifiable risk factors have been included in previous models that estimate or project breast cancer risk, there remains a need to estimate the effects of changes in modifiable risk factors on the absolute risk of breast cancer.
Using data from a case–control study of women in Italy (2569 case patients and 2588 control subjects studied from June 1, 1991, to April 1, 1994) and incidence and mortality data from the Florence Registries, we developed a model to predict the absolute risk of breast cancer that included five non-modifiable risk factors (reproductive characteristics, education, occupational activity, family history, and biopsy history) and three modifiable risk factors (alcohol consumption, leisure physical activity, and body mass index). The model was validated using independent data, and the percent risk reduction was calculated in high-risk subgroups identified by use of the Lorenz curve.
The model was reasonably well calibrated (ratio of expected to observed cancers = 1.10, 95% confidence interval [CI] = 0.96 to 1.26), but the discriminatory accuracy was modest. The absolute risk reduction from exposure modifications was nearly proportional to the risk before modifying the risk factors and increased with age and risk projection time span. Mean 20-year reductions in absolute risk among women aged 65 years were 1.6% (95% CI = 0.9% to 2.3%) in the entire population, 3.2% (95% CI = 1.8% to 4.8%) among women with a positive family history of breast cancer, and 4.1% (95% CI = 2.5% to 6.8%) among women who accounted for the highest 10% of the total population risk, as determined from the Lorenz curve.
These data give perspective on the potential reductions in absolute breast cancer risk from preventative strategies based on lifestyle changes. Our methods are also useful for calculating sample sizes required for trials to test lifestyle interventions.
To pilot test a physical activity intervention targeted towards women with a first-degree relative with breast cancer.
Sedentary women (n=27) with at least 1 first-degree relative with breast cancer but no personal breast cancer diagnosis received a print-based physical activity intervention. The intervention was a 12-week theory-based and individually tailored physical activity intervention targeted towards women with a family history of breast cancer. Participants' minutes of physical activity, worry about breast cancer, perceived risk of developing breast cancer and perceived control over breast cancer risk were assessed at baseline and 12-weeks.
There was a significant increase in minutes of moderate to vigorous intensity physical activity from baseline to 12 weeks (t=4.93, p<.001), with a mean increase in physical activity of 130.56 min/week (sd=137.50). At 12 weeks, 41% met ACSM criteria of engaging in 150 minutes or more of moderate intensity activity. Regression models indicate that change in perceived risk of breast cancer was significantly associated with change in physical activity (t=− 2.36, p=0.03, r=.34), with decreases in perceived risk associated with increases in physical activity over time.
Findings suggest that a targeted intervention can increase physical activity and decrease perceived risk of breast cancer.
Physical activity; intervention; breast cancer risk; Cancer; Oncology
Observational studies demonstrate an association between physical activity and improved outcomes in breast and colon cancer survivors. To test these observations with a large, randomized clinical trial, an intervention that significantly impacts physical activity in these patients is needed. The Active After Cancer Trial (AACT) was a multicenter pilot study evaluating the feasibility of a telephone-based exercise intervention in a cooperative group setting.
Sedentary (engaging in < 60 minutes of recreational activity/week) breast and colorectal cancer survivors were randomized to a telephone-based exercise intervention or usual care control group. The intervention was delivered through the University of California at San Diego; participants received 10 phone calls over the course of the 16-week intervention. All participants underwent assessment of physical activity, fitness, physical functioning, fatigue and exercise self-efficacy at baseline and after the 16-week intervention.
One hundred and twenty-one patients were enrolled through 10 Cancer and Leukemia Group B (CALGB) institutions; 100 patients had breast cancer and 21 had colorectal cancer. Participants randomized to the exercise group increased physical activity by more than 100%, vs. 22% in controls (54.5 vs. 14.6 minutes, p=0.13), and experienced significant increases in fitness (increased 6-minute walk test distance by 186.9 vs. 81.9 ft, p=0.006) and physical functioning (7.1 vs. 2.6, p=0.04) as compared to the control group.
Breast and colorectal cancer survivors enrolled in a multicenter, telephone-based physical activity intervention increased physical activity and experienced significant improvements in fitness and physical functioning. Lifestyle intervention research is feasible in a cooperative group setting.
Breast cancer; exercise; cooperative group; intervention; physical functioning
Many studies suggest increased body mass index (BMI) is associated with worse breast cancer outcomes, but few account for variability in screening, access to treatment, and tumor differences. We examined the association between BMI and risk of breast cancer recurrence, breast cancer-specific mortality, and all-cause mortality, and evaluated whether tumor characteristics differ by BMI among a mammographically-screened population with access to treatment.
Using a retrospective cohort study design, we followed 485 women aged ≥40 years diagnosed with stage I/II breast cancer within 24 months of a screening mammogram occurring between 1988 and 1993 for 10-year outcomes. BMI before diagnosis was categorized as normal (<25 kg/m2), overweight (25–29.9 kg/m2), and obese (≥30 kg/m2). Tumor marker expression was assessed via immunohistochemistry using tissue collected before adjuvant treatment. Medical records were abstracted to identify treatment, recurrence, and mortality. We used Cox proportional hazards to separately model the hazard ratios (HR) of our three outcomes by BMI while adjusting for age, stage, and tamoxifen use.
Relative to normal weight women, obese women experienced increased risk of recurrence (HR-2.43; 95%CI-1.34–4.41) and breast cancer death (HR-2.41; 95%CI-1.00–5.81) within 10 years of diagnosis. There was no association between BMI and all-cause mortality. Obese women had significantly faster growing tumors, as measured by Ki-67.
Our findings add to the growing evidence that obesity may contribute to poorer breast cancer outcomes, and also suggest that increased tumor proliferation among obese women is a pathway that explains part of their excess risk of adverse outcomes.
breast cancer recurrence; breast cancer specific mortality; tumor characteristics; obesity; body mass index
We examined the impact of metropolitan racial residential segregation on stage at diagnosis and all-cause and breast cancer-specific survival between and within black and white women diagnosed with breast cancer in California between 1996 and 2004.
We merged data from the California Cancer Registry with Census indices of five dimensions of racial residential segregation, quantifying segregation among Blacks relative to Whites; block group (“neighborhood”) measures of the percentage of Blacks and a composite measure of socioeconomic status. We also examined simultaneous segregation on at least two measures (“hypersegregation”). Using logistic regression we examined effects of these measures on stage at diagnosis and Cox proportional hazards regression for survival.
For all-cause and breast-cancer specific mortality, living in neighborhoods with more Blacks was associated with lower mortality among black women, but higher mortality among Whites. However, neighborhood racial composition and metropolitan segregation did not explain differences in stage or survival between Black and White women.
Future research should identify mechanisms by which these measures impact breast cancer diagnosis and outcomes among Black women.
Breast cancer; Survival; Stage at diagnosis; Residential segregation; Race
Increased body weight at breast cancer diagnosis has been associated with an increased risk of recurrence and reduced survival. Weight gain is also common following diagnosis. Increasing physical activity (PA) after diagnosis may minimize these adverse outcomes. This study investigated whether PA levels after diagnosis declined from pre-diagnosis levels, and whether any changes in PA varied by disease stage, treatment, age, and body mass index (BMI) in 812 incident population-based stage 0–3a breast cancer patients.
Types of sports and household activities and their frequency and duration for the year prior to diagnosis and for the month prior to the interview (i.e., 4–12 months post-diagnosis) were assessed during a baseline interview.
Patients decreased their total PA by an estimated 2.0 hrs/week from pre- to post-diagnosis, an 11% decrease (p < .05). Greater decreases in sports PA were observed among women treated with radiation and chemotherapy (50% decrease) than women having surgery only (24% decrease) or treated with radiation only (23%) (p < .05). Greater decreases in sports PA were observed among obese patients (41% decrease) than normal weight (24% decrease) patients (p < .05).
PA levels were significantly reduced following breast cancer diagnosis. Greater decreases in PA observed among heavier patients implies a potential for greater weight gain among already overweight women. Randomized controlled trials are needed to evaluate how PA may improve breast cancer prognosis.
exercise; prognosis; treatment; stage; body weight; obesity
To investigate, among women with breast cancer, how postdiagnosis diet quality and the combination of diet quality and recreational physical activity are associated with prognosis.
This multiethnic, prospective observational cohort included 670 women diagnosed with local or regional breast cancer. Thirty months after diagnosis, women completed self-report assessments on diet and physical activity and were followed for 6 years. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals for death from any cause and breast cancer death.
Women consuming better-quality diets, as defined by higher Healthy Eating Index-2005 scores, had a 60% reduced risk of death from any cause (HRQ4:Q1: 0.40, 95% CI: 0.17, 0.94) and an 88% reduced risk of death from breast cancer (HRQ4:Q1: 0.12, 95% CI: 0.02, 0.99). Compared with inactive survivors consuming poor-quality diets, survivors engaging in any recreational physical activity and consuming better-quality diets had an 89% reduced risk of death from any cause (HR: 0.11, 95% CI: 0.04, 0.36) and a 91% reduced risk of death from breast cancer (HR: 0.09, 95% CI: 0.01, 0.89). Associations observed were independent of obesity status.
Women diagnosed with localized or regional breast cancer may improve prognosis by adopting better-quality dietary patterns and regular recreational physical activity. Lifestyle interventions emphasizing postdiagnosis behavior changes are advisable in breast cancer survivors.
Diet; Exercise; Breast neoplasm; Prognosis
Health-related quality of life (HRQOL), body mass index (BMI), and physical activity (PA) levels have all been associated with prognosis following breast cancer and may partially explain higher mortality for breast cancer in certain race/ethnic sub-groups. In this study, we examined associations between PA, BMI, and HRQOL by race in a sample of breast cancer survivors.
Measures of PA, BMI, and HRQOL as well as demographic and medical characteristics of women (N=3013, 13% nonwhite) who participated in the Women’s Healthy Eating and Living Study were assessed at baseline. Analysis of covariance was used to examine the relationship between PA and obesity with HRQOL outcomes. Statistical tests were two-sided.
African-American women were less likely to meet guidelines for PA and more likely to be obese than women from other ethnic groups (P < 0.05). In adjusted models, women who met guidelines for PA reported significantly higher physical health composite (point differences ranged from 10.5 to 21.2 points, all P <0.05) and vitality (point differences ranged from 9.9 to 16.5 points, all P <0.05) scores than those who did not, regardless of race/ethnicity. Associations between obesity and HRQOL were mixed with fewer associations for Asian-American and African-American women and stronger associations for whites.
Breast cancer survivors from racially and ethnically diverse populations have lower levels of PA and higher rates of obesity that are generally associated with poorer HRQOL. Culturally sensitive PA and weight loss interventions may improve these lifestyle characteristics and result in improved HRQOL.
breast neoplasm; African American; disparities; Hispanic; obesity; quality of life; cancer survivors
To assess the accessibility and suitability of schools as recreational sites and to determine whether they are associated with young adolescent girls’ weekend metabolic equivalent-weighted moderate-to-vigorous (MW-MVPA) physical activity and body mass index (BMI).
We drew a half-mile (0.805 km) radius around the residences of participants in Trial of Activity for Adolescent Girls (n=1556) in Maryland, South Carolina, Minnesota, Louisiana, California, and Arizona. We visited all schools and parks within the defined distance and documented their amenities and accessibility on Saturdays in Spring 2003. Staff gathered data on each girls’ height and weight and used accelerometers to record weekend MW-MVPA.
Schools represented 44% of potential neighborhood sites for physical activity. However, a third of schools were inaccessible on the Saturday we visited. Neighborhoods with locked schools were primarily non-white, older, more densely populated, and of lower socioeconomic status. Though there was no relationship between school accessibility on Saturdays and weekend MW-MVPA, the number of locked schools was associated with significantly higher BMI.
The lack of relationship between MW-MVPA and school accessibility may imply that young adolescent girls do not identify schools as recreational resources. However, due to the association between BMI and locked schools, efforts to stem the obesity epidemic should include making schools more accessible.
bmi; obesity; physical activity; built environment; schools; parks
Recent reports have shown that physical activity improves the outcome of patients with colorectal cancer as well as breast and prostate cancer. However, the mechanisms whereby physical activity reduces cancer mortality are not well established.
Incident cases of colorectal cancer were identified among participants of the Melbourne Collaborative Cohort Study, a prospective cohort study of 41 528 Australians recruited from 1990 to 1994. Information on tumour site and stage, treatments given, recurrences, and deaths were obtained from systematic review of the medical records. Baseline assessments of physical activity and body size were made, and cases with available plasma had pre‐diagnosis insulin‐like growth factor 1 (IGF‐1) and insulin‐like growth factor binding protein 3 (IGFBP‐3) levels measured. We assessed associations between these hormones and colorectal cancer specific deaths with respect to physical activity.
A total of 526 cases of colorectal cancer were identified, of which 443 had IGF‐1/IGFBP‐3 levels measured. Median follow up among survivors was 5.6 years. For the physically active, increasing IGFBP‐3 by 26.2 nmol/l was associated with a 48% reduction in colorectal cancer specific deaths (adjusted hazard ratio (HR) 0.52 (0.33–0.83); p = 0.006). No association was seen for IGF‐1 (adjusted HR 0.90 (0.55–1.45); p = 0.65). For the physically inactive, neither IGF‐1 nor IGFBP‐3 was associated with disease specific survival.
This study supports the hypothesis that the beneficial effects of physical activity in reducing colorectal cancer mortality may occur through interactions with the insulin‐like growth factor axis and in particular IGFBP‐3.
colorectal cancer; physical activity; insulin‐like growth factor 1; insulin‐like growth factor binding protein 3
The authors evaluated the prognostic effects of obesity and weight change after breast cancer diagnosis. A total of 5042 breast cancer patients aged 20–75 were identified through the population-based Shanghai Cancer Registry approximately 6 months after cancer diagnosis and recruited into the study between 2002 and 2006. Participants were followed by in-person interviews supplemented by record linkage with the Shanghai Vital Statistics Registry database. Anthropometric measurements were taken and information on sociodemographic, clinical, and lifestyle factors was collected through in-person interviews. During the median follow-up of 46 months, 442 deaths and 534 relapses/breast cancer-specific deaths were documented. Women with body mass index (BMI) ≥30 at diagnosis had higher mortality than women with 18.5≤BMI<25; the multivariate adjusted hazard ratios (HRs) were 1.55 (95% confidence interval (95% CI): 1.10–2.17) for total mortality and 1.44 (95% CI: 1.02–2.03) for relapse/disease-specific mortality. Similar results were found for pre- and post-diagnostic obesity. Women who gained ≥5kg or lost >1kg had higher mortality than those who maintained their weight. No association was observed between waist-to-hip ratio and mortality. Our study suggests that obesity and weight change after diagnosis are inversely associated with breast cancer prognosis. Weight control is important among women with breast cancer.
Body mass index; central obesity; weight change; breast cancer; survival
This study tested the hypothesis that physician supply thresholds are associated with breast cancer survival in Ontario.
The 5-year survival of 17,820 female breast cancer patients diagnosed between 1995 and 1997 was surveilled until 2003 for all-cause mortality. Physician supply densities in 1991 and 2001 were computed for 49 Ontario regions.
There were independent threshold effects for general practitioners (GP; 7.25 per 10,000) and obstetrician/gynecologists (OB/GYN; 6 per 100,000) at or above which women with breast cancer were more likely to survive for 5 years. The respective risk of living in areas undersupplied with OB/GYN and GP increased 30% to nearly 5-fold during the 1990s. Five-year survival tended to be lower in provincial areas outside of Toronto, which experienced GP (odds ratio, 0.83; 90% CI, 0.70–0.99) and OB/GYN (odds ratio, 0.76; 95% CI, 0.61–0.96) supply decreases.
As they do in America, primary care physician supplies in Canada seem to matter in the effective provision of cancer care. Community resources such as health care service endowments, including physician supplies, may be particularly critical to the performance of health care systems such as Canada’s, which aim to provide medically necessary care for all.
PMID: 20051549 CAMSID: cams1408
OBJECTIVES: Some studies of white women suggest that exercise reduces the incidence of breast cancer. There are no data on black women. We assessed the relationship between strenuous physical activity and prevalent breast cancer among participants in the Black Women's Health Study. METHODS: Data on strenuous recreational physical activity at various ages and other factors were collected in 1995 by mail questionnaire from 64,524 United States black women aged 21 to 69 years. The 704 women who reported breast cancer (cases) were matched on age and on menopausal status at the time of the breast cancer diagnosis with 1408 women who did not report breast cancer (controls). Odds ratios for levels of physical activity at various ages were derived from conditional logistic regression with control for potential confounding factors. RESULTS: Odds ratios for > or =7 h per week relative to < 1 were significantly reduced for strenuous activity at age 21 for breast cancer overall and premenopausal breast cancer, at age 30 for breast cancer overall, and at age 40 for postmenopausal breast cancer. There was no evidence of a reduction associated with exercise in high school. CONCLUSIONS: The findings of the present study suggest that strenuous physical activity in early adulthood is associated with a reduced risk of breast cancer in African-American women.