In the study, we analyzed role of p53 in predicting outcome in visceral metastasis breast cancer (VMBC) patients. 97 consecutive VMBC patients were studied. P53 positivity rate was 29.9%. In the p53-negative group, median disease free survival (DFS), and time from primary breast cancer diagnosis to death (OS1), time from metastases to death (OS2) were 25, 42.5, and 13.5 months, respectively. In the p53-positive group, they were 10, 22, and 8 months, respectively. Statistically significant differences in DFS and OS1 were detected between the p53-negative and p53-positive subtypes. However, p53 appears to have no influence on OS2. In Cox regression analysis, p53 expression and TNM stage were predictive factors of DFS. In the multivariate analysis, p53 expression and the duration of DFS correlated with OS1, but not for OS2. Taken together, our data indicate p53 showing predicting role in OS1 for VMBC, but not for OS2.

PURPOSE: Adjuvant therapy is associated with improved survival for women with breast cancer, but not all women who could benefit initiate treatment. Women's belief systems are related to treatment initiation. It has been hypothesized that complementary and alternative (CAM) use is associated with decreased initiation of standard oncology treatments because patients may be exploring alternative treatment approaches. However, there are limited data on the association between CAM use and cancer treatment initiation. We examined the association between CAM use and initiation of adjuvant breast cancer chemotherapy in a prospective cohort of early stage breast cancer patients. PATIENTS AND METHODS: Subjects participated in a multi-center prospective cohort study of women with early stage invasive breast cancer (n=1,156). National Comprehensive Cancer Network guidelines were used to define groups based on whether chemotherapy was indicated. Three subgroups were created: chemotherapy indicated for subjects <70 years, chemotherapy discretionary for subjects <70 years, and chemotherapy discretionary for subjects ≥70 years. CAM use was assessed based upon self-reported use of 5 CAM modalities, including vitamin/mineral supplements, herbal supplements, other over-the-counter natural products, mind-body based approaches, and body/energy-based treatments. Psychosocial factors potentially related to chemotherapy initiation were assessed. Multivariable logistic regression models evaluated the associations between CAM use and chemotherapy initiation, adjusted for demographic, clinical and psychosocial factors. RESULTS: Current CAM use was reported by 87% of women and 38% reporting current use of ≥3 modalities. The most commonly used CAM modalities were mind body therapies (63%) and other natural products (41%). In bivariate analyses, among women <70 years where chemotherapy was indicated, women who reported current use of vitamins/minerals or current use of all 5 CAM modalities were less likely to initiate chemotherapy compared to non-users (P<.0001), but this was not observed among women for whom chemotherapy was discretionary. Psychosocial factors were also associated with high levels of current CAM use in this group, including higher expectations of adverse effects from chemotherapy, more concerns about the physical effects of chemotherapy, lower beliefs in the benefits of chemotherapy, and lower positive decision balance while making chemotherapy decisions (all P<.05). Among women age <70 years for whom chemotherapy was indicated, 89% initiated treatment, and current use of all 5 CAM modalities was inversely associated with initiation in multivariable analyses adjusted for demographic and clinical factors (OR=0.08, CI: 0.02-0.32). The association remained after separately adjusting for psychosocial factors (all P<.05), except for positive decision balance, which was no longer statistically significant. CONCLUSIONS: High use of CAM was associated with decreased chemotherapy initiation among women with breast cancer for whom chemotherapy was indicated. It is important for oncologists to discuss CAM use with their patients, especially since high CAM use is associated with negative expectations and beliefs about chemotherapy. Citation Format: Greenlee H, Neugut AI, Falci L, Hillyer GC, Buono D, Roh JM, Ergas IJ, Kwan ML, Lee M, Tsai WY, Shi Z, Lamerato L, Mandelblatt JS, Kushi LH, Hershman DL. Complementary and alternative medicine use and breast cancer chemotherapy initiation: The BQUAL study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-05.

Background: A large body of evidence dating back over 30 years suggests that obese women have poorer survival after a breast cancer (BC) diagnosis compared to non-obese women. Despite most studies supporting an association of elevated risk of overall mortality with obesity, the relationship of obesity with risk of BC recurrence, BC mortality and non-BC mortality remains unclear. Furthermore, reports suggest that the association of BMI with BC outcomes may be U or J shaped, prompting the necessity of examining underweight and more severely obese women as independent groups. We conducted a pooled investigation of pre-diagnosis BMI and BC recurrence and survival using data from the After Breast Cancer Pooling Project (ABCPP). Materials and Methods: The ABCPP includes 14,950 BC survivors from four prospective cohorts (three US and one Shanghai, China) diagnosed from 1990–2006 with invasive primary AJCC Stage I-III BC at ages 20–83 years. A random effects meta-analysis was conducted to assess heterogeneity across studies and poolability of data. Delayed entry Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations of pre-diagnosis BMI (underweight <18.5 kg/m2, normal 18.5-<25 kg/m2, overweight 25-<30 kg/m2, obese ≥30 kg/m2) with BC recurrence, BC death, non-BC death, and overall death, adjusted for age at diagnosis, stage, race/ethnicity, menopausal status, hormone receptor status, number of positive lymph nodes, treatment, smoking history, and comorbidity (diabetes, hypertension, and/or CVD). Subgroup analyses further divided the obesity group into obese (30-<35 kg/m2), severely obese (35-<40 kg/m2), and morbidly obese (≥40 kg/m2) categories. Results: No heterogeneity in effect estimates by study was found. 2104 deaths (1416 BC-related) and 2320 recurrences were observed after a mean (SD) of 7.66 (3.95) years of follow-up. Both underweight and obese women had a statistically significant increased risk of overall death compared to normal-weight women (underweight HR=1.69; 95% CI: 1.25, 2.28 and obese HR=1.22; 95% CI: 1.08, 1.38; p for nonlinear association<0.01). Similar associations were found for non-BC death. Obese but not underweight was associated with increased risk of BC death (HR=1.17; 95% CI: 1.01, 1.36) and recurrence (HR=1.11; 95% CI: 0.98, 1.26). When examining finer obesity categories, the morbidly obese women had the greatest risk for all outcomes (overall death HR=1.90; 95% CI: 1.48, 2.45; non-BC death HR= 3.27; 95% CI: 2.25, 4.77; BC death HR = 1.47; 95% CI: 1.05, 2.06; recurrence HR = 1.27; 95% CI: 0.95, 1.71). No effect modification was observed by menopausal status, hormone receptor status, chemotherapy, and smoking. In all analyses, overweight women had similar risk of outcomes compared to normal-weight women. Discussion: In this large pooling study of nearly 15,000 BC survivors, we found that the association between BMI and BC outcomes, specifically overall death and non-BC death, was U shaped with both underweight and obese women at greatest risk. Morbidly obese women were at even greater risk compared to other obesity groups. Maintaining a healthy weight throughout adult life may be beneficial for BC prognosis and survival. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-02.

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Background: Compared to healthy populations, breast cancer patients are more frequent users of multivitamins (57-62% compared to 38% in NHANES 1999-2000), yet no studies to date have examined the association between multivitamin use and breast cancer outcomes. Material and Methods: Women primarily from the Kaiser Permanente Northern California (KPNC) Cancer Registry diagnosed from 1997 to 2000 with early stage primary breast cancer (Stage I ≥1 cm, II, or IIIA), were age 18 to 70 years at study enrollment, and completed breast cancer treatment entered the LACE cohort on average two years post-diagnosis. Information on multivitamin (MV) use since breast cancer diagnosis (including duration and frequency) and five years before diagnosis (ever or never use ≥3 times/wk for ≥1 year), as well as demographic and other lifestyle factors, were collected from a mailed questionnaire. Tumor and treatment characteristics were obtained from the KPNC Cancer Registry and clinical databases. Outcomes, including recurrence and all-cause mortality, were ascertained yearly by mailed questionnaire and verified by medical record review. Recurrence was defined as local/regional and distant disease, new contralateral breast cancer, and breast cancer death if no previous recurrence was recorded. All-cause death included death from any cause. Among 2,240 women, 363 recurrences, 202 breast cancer deaths, and 372 overall deaths were confirmed as of 7 May 2010. Delayed entry Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusting for age at diagnosis, positive nodes, stage, treatment, and hormone receptor status in the recurrence models, with further adjustment for smoking history, physical activity, diet, and race/ethnicity in the mortality models. Follow-up began at date of study entry and ended at date of first cancer recurrence or death, depending on the analysis, or were censored at date of last contact for women with no event. Results: 49% and 65% reported using MV with minerals (MVM) and 13% and 19% MV without minerals (MVNM), pre-and post-diagnosis, respectively. Compared to never use, ever use of MVM after diagnosis was associated with decreased risk of recurrence (HR = 0.80; 95% CI: 0.65-1.00) and breast cancer death (HR = 0.71; 95% CI: 0.53, 0.95). Continual use of MVM from pre-to post-diagnosis at least 3 times/wk compared to never use was associated with decreased risk of recurrence (HR = 0.69; 95% CI: 0.53, 0.89) and breast cancer death (HR = 0.58; 95% CI: 0.41, 0.82), and possibly limited to women who had radiation therapy. An inverse trend of increasing frequency of post-diagnosis MVM use up to 6-7 d/wk with decreasing risk of recurrence (p=0.07) and death (p=0.04) was observed; a similar trend of increasing duration up to ≥12 months with decreasing risk of breast cancer death (p=0.04), but not recurrence (p=0.17), was apparent. No associations were found for MVM and overall mortality, and MVNM and all endpoints. Conclusion: Multivitamin use appears to be beneficial in decreasing a woman's risk of breast cancer recurrence and death. Funded by NCI R01 CA129059 Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-11-07.