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Breast cancer risk factors and survival by tumor subtype : pooled analyses from the Breast Cancer Association Consortium

Morra, Anna ; Jung, Audrey Y ; Behrens, Sabine ; Keeman, Renske ; Ahearn, Thomas U ; Anton-Cluver, Hoda ; Arndt, Volker ; Augustinsson, Annelie LU ; Auvinen, Päivi K and Beane Freeman, Laura E , et al. (2021) In Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 30(4). p.623-642
Abstract

BACKGROUND: It is not known if modifiable lifestyle factors that predict survival after invasive breast cancer differ by subtype.

METHODS: We analyzed data for 121,435 women diagnosed with breast cancer from 67 studies in the Breast Cancer Association Consortium with 16,890 deaths (8,554 breast cancer-specific) over 10 years. Cox regression was used to estimate associations between risk factors and 10-year all-cause mortality and breast cancer-specific mortality overall, by estrogen receptor (ER) status, and by intrinsic-like subtype.

RESULTS: There was no evidence of heterogeneous associations between risk factors and mortality by subtype (adjusted p>0.30). The strongest associations were between all-cause mortality and... (More)

BACKGROUND: It is not known if modifiable lifestyle factors that predict survival after invasive breast cancer differ by subtype.

METHODS: We analyzed data for 121,435 women diagnosed with breast cancer from 67 studies in the Breast Cancer Association Consortium with 16,890 deaths (8,554 breast cancer-specific) over 10 years. Cox regression was used to estimate associations between risk factors and 10-year all-cause mortality and breast cancer-specific mortality overall, by estrogen receptor (ER) status, and by intrinsic-like subtype.

RESULTS: There was no evidence of heterogeneous associations between risk factors and mortality by subtype (adjusted p>0.30). The strongest associations were between all-cause mortality and BMI {greater than or equal to}30 vs 18.5-25 kg/m2 (HR (95%CI): 1.19 (1.06,1.34)); current vs never smoking (1.37 (1.27,1.47)), high vs low physical activity (0.43 (0.21,0.86)), age {greater than or equal to}30 years vs <20 years at first pregnancy (0.79 (0.72,0.86)); >0 to <5 years vs {greater than or equal to}10 years since last full term birth (1.31 (1.11,1.55)); ever vs never use of oral contraceptives (0.91 (0.87,0.96)); ever vs never use of menopausal hormone therapy, including current estrogen-progestin therapy (0.61 (0.54,0.69)). Similar associations with breast cancer mortality were weaker; e.g. 1.11 (1.02,1.21) for current vs never smoking.

CONCLUSIONS: We confirm associations between modifiable lifestyle factors and 10-year all-cause mortality. There was no strong evidence that associations differed by ER status or intrinsic-like subtype.

IMPACT: Given the large dataset and lack of evidence that associations between modifiable risk factors and 10-year mortality differed by subtype, these associations could be cautiously used in prognostication models to inform patient-centered care.

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publication status
published
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in
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
volume
30
issue
4
pages
623 - 642
publisher
American Association for Cancer Research
external identifiers
  • pmid:33500318
ISSN
1538-7755
DOI
10.1158/1055-9965.EPI-20-0924
language
English
LU publication?
yes
additional info
Copyright ©2021, American Association for Cancer Research.
id
b084d326-9b3d-4c76-a36e-32c8b2853d80
date added to LUP
2021-02-01 00:56:23
date last changed
2021-04-16 18:02:52
@article{b084d326-9b3d-4c76-a36e-32c8b2853d80,
  abstract     = {<p>BACKGROUND: It is not known if modifiable lifestyle factors that predict survival after invasive breast cancer differ by subtype.</p><p>METHODS: We analyzed data for 121,435 women diagnosed with breast cancer from 67 studies in the Breast Cancer Association Consortium with 16,890 deaths (8,554 breast cancer-specific) over 10 years. Cox regression was used to estimate associations between risk factors and 10-year all-cause mortality and breast cancer-specific mortality overall, by estrogen receptor (ER) status, and by intrinsic-like subtype.</p><p>RESULTS: There was no evidence of heterogeneous associations between risk factors and mortality by subtype (adjusted p&gt;0.30). The strongest associations were between all-cause mortality and BMI {greater than or equal to}30 vs 18.5-25 kg/m2 (HR (95%CI): 1.19 (1.06,1.34)); current vs never smoking (1.37 (1.27,1.47)), high vs low physical activity (0.43 (0.21,0.86)), age {greater than or equal to}30 years vs &lt;20 years at first pregnancy (0.79 (0.72,0.86)); &gt;0 to &lt;5 years vs {greater than or equal to}10 years since last full term birth (1.31 (1.11,1.55)); ever vs never use of oral contraceptives (0.91 (0.87,0.96)); ever vs never use of menopausal hormone therapy, including current estrogen-progestin therapy (0.61 (0.54,0.69)). Similar associations with breast cancer mortality were weaker; e.g. 1.11 (1.02,1.21) for current vs never smoking.</p><p>CONCLUSIONS: We confirm associations between modifiable lifestyle factors and 10-year all-cause mortality. There was no strong evidence that associations differed by ER status or intrinsic-like subtype.</p><p>IMPACT: Given the large dataset and lack of evidence that associations between modifiable risk factors and 10-year mortality differed by subtype, these associations could be cautiously used in prognostication models to inform patient-centered care.</p>},
  author       = {Morra, Anna and Jung, Audrey Y and Behrens, Sabine and Keeman, Renske and Ahearn, Thomas U and Anton-Cluver, Hoda and Arndt, Volker and Augustinsson, Annelie and Auvinen, Päivi K and Beane Freeman, Laura E and Becher, Heiko and Beckmann, Matthias W and Bloomqvist, Carl and Bojesen, Stig E and Bolla, Manjeet K and Brenner, Hermann and Briceno, Ignacio and Brucker, Sara Y and Camp, Nicola J and Campa, Daniele and Canzian, Federico and Castelao, Jose E and Chanock, Stephen J and Choi, Ji-Yeob and Clarke, Christine L and Couch, Fergus J and Cox, Angela and Cross, Simon S and Czene, Kamila and Dӧrk, Thilo and Dunning, Alison M and Dwek, Miriam and Easton, Douglas F and Eccles, Diana M and Egan, Kathleen M and Evans, D Gareth and Fasching, Peter A and Flyger, Henrik and Gago-Dominguez, Manuela and Gapstur, Susan M and Garcia-Saenz, Jose A and Gaudet, Mia M and Giles, Graham G and Grip, Mervi and Guénel, Pascal and Haiman, Christopher A and Håkansson, Niclas and Hall, Per and Hamann, Ute and Olsson, Håkan},
  issn         = {1538-7755},
  language     = {eng},
  month        = {01},
  number       = {4},
  pages        = {623--642},
  publisher    = {American Association for Cancer Research},
  series       = {Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology},
  title        = {Breast cancer risk factors and survival by tumor subtype : pooled analyses from the Breast Cancer Association Consortium},
  url          = {http://dx.doi.org/10.1158/1055-9965.EPI-20-0924},
  doi          = {10.1158/1055-9965.EPI-20-0924},
  volume       = {30},
  year         = {2021},
}