Exploring the effects of lifestyle on breast cancer risk, age at diagnosis, and survival: the EBBA-Life study

Lofterød, Trygve; Frydenberg, Hanne; Flote, Vidar Gordon; Eggen, Anne Elise; McTiernan, Anne; Mortensen, Elin; Akslen, Lars A.; Reitan, Jon B.; Wilsgaard, Tom; Thune, Inger

doi:10.1007/s10549-020-05679-2

Cited by 43 publications

(37 citation statements)

References 72 publications

(80 reference statements)

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“…SEV is expressed on a scale from 0% to 100% to reflect the risk-weighted prevalence. We focused our risk factor analysis (see analysis below) on specific BC risk factors, 22 , 23 , 24 , 25 , 26 including high low-density lipoprotein-cholesterol (LDL-c), smoking habits and high body mass index (BMI), as defined by the latest GBD 2017 methodology. Regarding uncertainty levels, the GBD study reports 95% uncertainty intervals that are derived from 1000 draws from the posterior distribution of each step in the estimation process.…”

Section: Methodsmentioning

confidence: 99%

Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries

et al. 2021

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Background Multiple studies over the past 4 decades have shown the significant benefit of breast cancer screening (BCS) in reducing mortality rates from breast cancer (BC). However, significant debate exists about the role of BCS in this regard, with some studies also showing no benefit in terms of mortality along with issues such as overdiagnosis, health care utilisation costs, psychological distress or overtreatment. To date, no BCS study has focused on disability. Hence the aim of this study is to evaluate the relative contribution of BCS approaches to age-standardized mortality and disability-adjusted life years (DALYs) rates along with other related risk factors, from a country-level perspective. Patients and methods This study created a country-dataset by merging information from the Global Burden of Disease study regarding female age-standardized BC mortality, DALYs rates and other risk factors with the BCS programme availability at the national or regional level (versus no or only pilot such programme), BCS type (mammography, digital screening, breast self-examination and clinical breast examination) and other BCS-related information among 130 countries. Mixed-effect multilevel regression models were run to examine the associations of interest. Results The most important factor predictive of lower mortality was the more advanced type of BCS programme availability [mammography: −4.16, 95% CI −6.76 to −1.55; digital mammography/ultrasound: −3.64, 95% CI −6.59 to −0.70] when compared with self- or clinical breast examinations. High levels of low-density lipoprotein cholesterol (LDL-c) and smoking were also related to higher mortality and DALYs from BC. In terms of BC DALYs, BCS had a 21.9 to 22.3-fold increase in the magnitude of effect compared with that in terms of mortality. Data on mortality and DALYs in relation to BCS programmes were also calculated for high-, middle- and low-income countries. Conclusions These data further support the positive effects of BCS in relation to age-standardized BC mortality rates, and for the first time show the impact of BCS on DALYs too. Additional factors, such as diabetes, high levels of LDL-c or smoking seemed to be related to BC mortality and disability, and could be considered as additional components of possible interventions to be used alongside BCS to optimize the BCS benefit on patients.

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Section: Methodsmentioning

confidence: 99%

Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries

et al. 2021

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“…The increase in BC incidence and the high survival rates among BC patients indicate the importance of targeting health-related quality of life (HRQoL) and understanding its relationship with lifestyle including diet and physical activity. Healthy lifestyles have been associated with better quality of life [4] which is in turn associated with favorable prognosis and lower mortality [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…This can reduce compliance to oncologic treatment with adverse consequences on cancer prognosis and mortality [13,14]. Diet has been shown to improve quality of life in BC survivors [6,[15][16][17][18] and a greater adherence to the Mediterranean diet has been associated with higher physical functioning and health status in women recently diagnosed with BC [4].…”

Section: Introductionmentioning

confidence: 99%

Quality of Life in Women Diagnosed with Breast Cancer after a 12-Month Treatment of Lifestyle Modifications

et al. 2020

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Healthy lifestyles are associated with better health-related quality of life (HRQoL), favorable prognosis and lower mortality in breast cancer (BC) survivors. We investigated changes in HRQoL after a 12-month lifestyle modification program in 227 BC survivors participating in DEDiCa trial (Mediterranean diet, exercise, vitamin D). HRQoL was evaluated through validated questionnaires: EQ-5D-3L, EORTC-QLQ-C30 and EORTC QLQ-BR23. Baseline changes were tested using analysis of variance. Multiple regression analyses were performed to assess treatment effects on HRQoL. Increases were observed in global health status (p < 0.001), physical (p = 0.003), role (p = 0.002) and social functioning (p < 0.001), body image (p < 0.001), future perspective (p < 0.001), well-being (p = 0.001), and reductions in fatigue (p < 0.001), nausea and vomiting (p = 0.015), dyspnea (p = 0.001), constipation (p = 0.049), financial problems (p = 0.012), sexual functioning (p = 0.025), systematic therapy side effects (p < 0.001) and breast symptoms (p = 0.004). Multiple regression analyses found inverse associations between changes in BMI and global health status (p = 0.048) and between serum 25(OH)D levels and breast symptoms (p = 0.002). A healthy lifestyle treatment of traditional Mediterranean diet and exercise may impact positively on HRQoL in BC survivors possibly through reductions in body weight while vitamin D sufficiency may improve BC-related symptoms. These findings are relevant to BC survivors whose lower HRQoL negatively affects treatment compliance and disease outcomes.

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“…One study from the Third National Health and Nutrition Examination Survey (NHANES III) investigated the association between combined lifestyle behaviors and overall mortality in cancer survivors, but did not specify the cancer types [36]. To our knowledge, only one study has explored the joint effect of lifestyle factors on breast cancer survival [37], but the role of HLI in relation to breast cancer survival remains ambiguous. Therefore, based on World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) guidelines [38], we created a comprehensive HLI score combining myriad lifestyle factors, including diet, physical activity, body mass index (BMI), smoking, alcohol consumption and breastfeeding.…”

Section: Introductionmentioning

confidence: 99%

The Associations Of Healthy Lifestyle Index With Breast Cancer Incidence And Mortality In A Population-Based Study

Lesseur

Neugut

et al. 2021

Preprint

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Purpose: To investigate how a healthy lifestyle index (HLI) is associated with breast cancer risk and survival in a population-based breast cancer study.Methods: The study included 1,319 breast cancer cases and 1,310 controls from the population-based Long Island Breast Cancer Study Project, and its follow-up study of mortality. We determined vital status using the National Death Index (521 deaths, 210 from breast cancer; median follow-up 214.5 months). A healthy lifestyle index (HLI) score, was generated from information on body fatness, physical activity, intake of plant and animal foods, alcohol consumption, breastfeeding and smoking, with higher values representing engagement in healthier behaviors. Multivariable logistic and Cox regression were used to estimate breast cancer odds ratios (ORs) mortality hazards ratios (HRs), respectively.Results: Compared to women in the low HLI tertile, women in the intermediate (OR=0.78, 95%CI=0.65-0.94) and high (OR=0.68, 95%CI=0.56-0.83) tertiles had a decreased odds of breast cancer, and a one-point increase in HLI score was associated a reduction in breast cancer risk (OR=0.85, 95%CI=0.79–0.92). Women in the intermediate (HR=0.75, 95%CI=0.61-0.91) and high (HR=0.74, 95%CI=0.60-0.92) tertiles had a decreased rate of all-cause mortality, and a one-point increase in HLI score was associated with a reduction in all-cause mortality (HR=0.83, 95%CI =0.76-0.91). These associations were significant among postmenopausal.Conclusion: A healthy lifestyle may be beneficial in reducing breast cancer risk and improving overall survival after breast cancer diagnosis, especially among postmenopausal women.

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Exploring the effects of lifestyle on breast cancer risk, age at diagnosis, and survival: the EBBA-Life study

Cited by 43 publications

References 72 publications

Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries

Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries

Quality of Life in Women Diagnosed with Breast Cancer after a 12-Month Treatment of Lifestyle Modifications

The Associations Of Healthy Lifestyle Index With Breast Cancer Incidence And Mortality In A Population-Based Study

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