Modifiable risk factors and survival in women diagnosed with primary breast cancer: results from a prospective cohort study

Abstract

This study examines the impact of smoking, body mass index, alcohol consumption, hormone replacement therapy, and physical activity on all-cause mortality among 528 Danish women diagnosed with primary breast cancer. Participants were women enrolled in the Copenhagen City Heart Study. Prospective self-reported exposure information was collected from four points of follow-up in 1976-1978, 1981-1983, 1991-1994, and 2001-2003. Kaplan-Meier survival curves and multivariate Cox regression analyses were performed adjusting for age, disease stage, adjuvant treatment, menopausal status, parity, alcohol intake, smoking, physical activity, body mass index, and hormone replacement therapy. The study shows that smoking for total mortality [hazard ratio, 1.16; 95% confidence interval, 1.05-1.29] and obesity for both total mortality (1.61; 1.12-2.33) and breast cancer-specific mortality (1.82; 1.11-2.99) were significantly associated with decreased survival after breast cancer diagnosis. A moderate alcohol intake of 1-6 units/week (0.85; 0.64-1.12), 7-14 units/week (0.77; 0.56-1.08), and treatment with hormone replacement therapy (0.79; 0.59-1.05) were less than 1, but not statistically significantly associated with prolonged survival. A moderate physical activity of 2-4 h/week (1.07; 0.77-1.49) and a high physical activity of more than 4 h/week (1.00; 0.69-1.45) showed no association with survival after breast cancer diagnosis.

Alcohol Consumption and Breast Cancer Survival: A Metaanalysis of Cohort Studies

“…After reading full-texts, we excluded studies that were not cohort studies (n =61) and not about survival (n=61). Finally, 25 cohort studies (Hebert et al, 1989;Ewertz et al, 1991;Rohan et al, 1993;Fuchs et al, 1995;Zhang et al, 1995;Thun et al, 1997;Holmes et al, 1999;Saxe et al, 1999;Jain et al, 2000;McDonald et al, 2002;Borugian et al, 2004;Barnett et al, 2008;Dal Maso et al, 2008;Reding et al, 2008;Franceschi et al, 2009;Flatt et al, 2010;Hellmann et al, 2010;Kwan et al, 2010;Allemani et al, 2011;Beasley et al, 2011;Breslow et al, 2011;Harris et al, 2012;Vrieling et al, 2012;Holm et al, 2013;Kwan et al, 2013;Newcomb et al, 2013) (patients) were included ( Figure 1). …”

“…Pooling all data from highest versus lowest comparisons, alcohol DOI:http://dx.doi.org/10.7314/APJCP.2013.14.8.4785 Alcohol Consumption and Breast Cancer Survival: A Meta- (Figure 3). 15 studies (Hebert et al, 1989;Zhang et al, 1995;Thun et al, 1997;Saxe et al, 1999;Jain et al, 2000;Barnett et al, 2008;Reding et al, 2008;Franceschi et al, 2009;Hellmann et al, 2010;Allemani et al, 2011;Breslow et al, 2011;Harris et al, 2012;Vrieling et al, 2012;Holm et al, 2013;Newcomb et al, 2013) evaluated the relationship of post-diagnostic alcohol consumption with breast cancer mortality and three studies (Hebert et al, 1989;Saxe et al, 1999;Holm et al, 2013) evaluated the relationship of post-diagnostic alcohol consumption with breast cancer recurrence. And the meta-analysis results showed prediagnostic alcohol consumption was not associated with increased breast cancer mortality (HR1.05, 95%CI 0.93 1.19, I 2 =36%) ( Figure 2) and recurrence (HR1.24, 95%CI 0.89 1.73, I 2 =31%) (Figure 3).…”

“…However, a recent study showed that women with breast cancer did not modify their alcohol use compared with cancer-free women (Bidstrup et al, (Barnett et al, 2008, Kwan et al, 2010, Kwan et al, 2013 0.98 (0.69 1.40) 0% (Kwan et al, 2010) 2.00 (0.96 4.15) ER positive (Barnett et al, 2008, Kwan et al, 2010, Kwan et al, 2013 1.03 (0.77 1.37) 37% (Kwan et al, 2010) 1.23 (0.89 1.71) Postmenopausal (Zhang et al, 1995, Borugian et al, 2004, Hellmann et al, 2010 17% (Kwan et al, 2010) 1.09 (0.78 1.52) Kwan et al, 2010, Vrieling et al, 2012, Kwan et al, 2013 premenopausal (Hebert et al, 1989, Borugian et al, 2004, Hellmann et al, 2010 (Ewertz et al, 1991, Rohan et al, 1993, Fuchs et al, 1995, Zhang et al, 1995, Holmes et al, 1999.94 (0.88 1.01) 10% (Saxe et al, 1999, 0.98 (0.88 1.11) 0% Saxe et al, 1999, Jain et al, 2000, Reding et al, 2008, Flatt et al, 2010, Hellmann et al, 2010, Kwan et al, 2010, Kwan et al, 2010, Breslow et al, 2011, Harris et al, 2012, Vrieling et al, 2012, Kwan et al, 2013 Kwan et al, 2013) >10g/d (Ewertz et al, 1991, Rohan et al, 1993, Fuchs et al, 1995, Thun et al, 1997, Holmes et al, 1999 1.03 (0.97 1.10) 51% ...…”

“…Both meta-analysis and pooled study showed that (Poli et al, 2012;Bagnardi et al, 2013) alcohol consumption increases risk of breast cancer. However, the information on whether alcohol consumption is related to breast cancer survival is mixed (Hebert et al, 1989;Ewertz et al, 1991;Rohan et al, 1993;Fuchs et al, 1995;Zhang et al, 1995;Thun et al, 1997;Holmes et al, 1999;Saxe et al, 1999;Jain et al, 2000;McDonald et al, 2002;Borugian et al, 2004;Barnett et al, 2008;Reding et al, 2008;Franceschi et al, 2009;Flatt et al, 2010;Hellmann et al, 2010;Kwan et al, 2010;Allemani et al, 2011;Beasley et al, 2011;Breslow et al, 2011;Harris et al, 2012;Vrieling et al, 2012;Holm et al, 2013; Newcomb et al, 2013). Some studies reported that alcohol consumption was associated with reduced breast cancer mortality (Barnett et al, 2008;Reding et al, 2008;Flatt et al, 2010), while other studies revealed that alcohol consumption was associated with increased breast cancer mortality (Hebert et al, 1989;Fuchs et al, 1995;Jain et al, 2000;McDonald et al, 2002;Allemani et al, 2011;Vrieling et al, 2012).…”

“…Some studies reported that alcohol consumption was associated with reduced breast cancer mortality (Barnett et al, 2008;Reding et al, 2008;Flatt et al, 2010), while other studies revealed that alcohol consumption was associated with increased breast cancer mortality (Hebert et al, 1989;Fuchs et al, 1995;Jain et al, 2000;McDonald et al, 2002;Allemani et al, 2011;Vrieling et al, 2012). Even though, most studies found no relationship between alcohol consumption and breast cancer mortality (Ewertz et al, 1991;Rohan et al, 1993;Zhang et al, 1995;Thun et al, 1997;Holmes et al, 1999;Saxe et al, 1999;Borugian et al, 2004;Franceschi et al, 2009;Hellmann et al, 2010;Kwan et al, 2010;Beasley et al, 2011;Breslow et al, 2011;Harris et al, 2012;Holm et al, 2013;Kwan et al, 2013;Newcomb et al, 2013). For the association of alcohol consumption with breast cancer recurrence, available evidence was also conflicted (Hebert et al, 1989;Saxe et al, 1999;Kwan et al, 2010;Holm et al, 2013;Kwan et al, 2013).…”