Skip to main content

Advertisement

SpringerLink
Log in

Health-related behaviors and mortality outcomes in women diagnosed with ductal carcinoma in situ

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Women diagnosed with ductal carcinoma in situ (DCIS) of the breast are at greater risk of dying from cardiovascular disease and other causes than from breast cancer, yet associations between health-related behaviors and mortality outcomes after DCIS have not been well studied.

Methods

We examined the association of body mass index, physical activity, alcohol consumption, and smoking with mortality among 1925 women with DCIS in the Wisconsin In Situ Cohort study. Behaviors were self-reported through baseline interviews and up to three follow-up questionnaires. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality after DCIS, with adjustment for patient sociodemographic, comorbidity, and treatment factors.

Results

Over a mean of 6.7 years of follow-up, 196 deaths occurred. All-cause mortality was elevated among women who were current smokers 1 year prior to diagnosis (HR = 2.17 [95% CI 1.48, 3.18] vs. never smokers) and reduced among women with greater physical activity levels prior to diagnosis (HR = 0.55 [95% CI: 0.35, 0.87] for ≥5 h per week vs. no activity). Moderate levels of post-diagnosis physical activity were associated with reduced all-cause mortality (HR = 0.31 [95% CI 0.14, 0.68] for 2–5 h per week vs. no activity). Cancer-specific mortality was elevated among smokers and cardiovascular disease mortality decreased with increasing physical activity levels.

Conclusions

There are numerous associations between health-related behaviors and mortality outcomes after a DCIS diagnosis.

Implications for cancer survivors

Women diagnosed with DCIS should be aware that their health-related behaviors are associated with mortality outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee RJ, Vallow LA, McLaughlin SA, Tzou KS, Hines SL, Perterson JL. Ductal carcinoma in situ of the breast. International Journal of Surgical Oncology. 2012. doi:10.1155/2012/123549

  2. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R. Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med. 2000;160(7):953–8. doi:10.1001/archinte.160.7.953.

    Article  CAS  PubMed  Google Scholar 

  3. Society AC. Cancer facts & figures 2015. Atlanta: American Cancer Society; 2015.

    Google Scholar 

  4. Sprague BL, Trentham-Dietz A. Prevalence of breast carcinoma in situ in the United States. J Am Med Assoc. 2009;302(8):846–8. doi:10.1001/jama.2009.1211.

    Article  CAS  Google Scholar 

  5. SEER Cancer Statistics Review, 1975-2012 (2015) National Cancer Institute. http://seer.cancer.gov/csr/1975_2012/. Accessed 2015 Jul 2

  6. Berkman A, Cole FB, Ades P, Dickey S, Higgins S, Trentham-Dietz A, et al. Racial differences in breast cancer, cardiovascular disease, and all-cause mortality among women with ductal carcinoma in situ of the breast. Breast Cancer Res Treat. 2014;148(2):407–13. doi:10.1007/s10549-014-3168-3.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sprague BL, Trentham-Dietz A, Nichols HB, Hampton JM, Newcomb PA. Change in lifesytle behaviors and medication use after a diagnosis of ductal carcinoma in situ. Breast Cancer Res Treat. 2010;124(2):487–95. doi:10.1007/s10549-010-0869-0.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Khadanga S, Hart V, Ba Y, Higgins ST, Ades PA, Trentham-Dietz A, et al. Living situation and socioeconomic factors are associated with change in health behavior after a diagnosis of ductal carcinoma in situ. Cancer Epidemiol Biomark Prev. 2015;25(1):1–7. doi:10.1158/1055-9965.EPI-15-0726.

    Google Scholar 

  9. Ligibel J, Partridge A, Giobbie-Hurder A, Golshan M, Emmons K, Winer E. Physical activity behaviors in women with newly diagnosed ductal carcinoma-in-situ. Ann Surg Oncol. 2009;16(1):106–12. doi:10.1245/s10434-008-0174-x.

    Article  PubMed  Google Scholar 

  10. McLaughlin VH, Trentham-Dietz A, Hampton JM, Newcomb PA, Sprague BL. Lifestyle factors and the risk of a second breast cancer after ductal carcinoma in situ. Cancer Epidemiol Biomark Prev. 2014;23(3):450–60. doi:10.1158/1055-9965.EPI-13-0899.

    Article  Google Scholar 

  11. Berkman A, Trentham-Dietz A, Dittus K, Hart V, Vatovec C, King J, James T, Lakoski S, Sprague B. Health behavior change following a diagnosis of ductal carcinoma in situ: an opportunity to improve health outcomes. Preventive Medicine. 2015. doi:10.1016/j.ypmed.2015.03.020

  12. Borch KB, Braaten T, Lund E, Weiderpass E. Physical activity and mortality among Norwegian women—the Norwegian Women and Cancer Study. Clin Epidemiol. 2011;3:229–35. doi:10.2147/CLEP.S22681.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gellert C, Schöttker B, Brenner H. Smoking and all-cause mortality in older people: systematic review and meta-analysis. Arch Intern Med. 2012;172(11):837–44. doi:10.1001/archinternmed.2012.1397.

    Article  PubMed  Google Scholar 

  14. Shaw BA, Agahi N. Smoking and physical inactivity patterns during midlife as predictors of all-cause mortality and disability: a 39-year prospective study. Eur J Ageing. 2014;11(3):195–204.

    Article  PubMed  Google Scholar 

  15. Hamilton MT, Hamilton DG, Zderic TW. Sedentary behavior as a mediator of type 2 diabetes. Med Sport Sci. 2014;60:11–26. doi:10.1159/000357332.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kim Y, Wilkens LR, Park SY, Goodman MT, Monroe KR, Kolonel LN. Association between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: the Multiethnic Cohort Study. Int J Epidemiol. 2013;42(4):1040–56. doi:10.1093/ije/dyt108.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vilablanca AC, McDonald JM, Rutledge JC. Smoking and cardiovascular disease. Clin Chest Med. 2000;21(1):159–72.

    Article  Google Scholar 

  18. George S, Irwin M, Smith A, Neuhouser M, Reedy J, McTiernan A, et al. Postdiagnosis diet quality, the combination of diet quality and recreational physical activity, and prognosis after early-stage breast cancer. Cancer Causes Control. 2011;22(4):589–98. doi:10.1007/s10552-011-9732-9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Jr HCW. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341(15):1097–105.

    Article  CAS  PubMed  Google Scholar 

  20. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122(7):481–6.

    Article  CAS  PubMed  Google Scholar 

  21. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, et al. Body weight and mortality among women. N Engl J Med. 1995;333(11):677–85.

    Article  CAS  PubMed  Google Scholar 

  22. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78.

    Article  PubMed  Google Scholar 

  23. Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162(16):1867–72.

    Article  PubMed  Google Scholar 

  24. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. J Am Med Assoc. 2007;298(17):2028–37.

    Article  CAS  Google Scholar 

  25. Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, et al. Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomark Prev. 2009;18(5):1409. doi:10.1158/1055-9965.EPI-08-1094.

    Article  Google Scholar 

  26. Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol. 2005;23(7):1370–8. doi:10.1200/JCO.2005.01.079.

    Article  PubMed  Google Scholar 

  27. Kawai M, Tomotaki A, Miyata H, Iwamoto T, Niikura N, Anan K, et al. Body mass index and survival after diagnosis of invasive breast cancer: a study based on the Japanese National Clinical Database-Breast Cancer Registry. Cancer Med. 2016. doi:10.1002/cam4.678.

    Google Scholar 

  28. Passarelli MN, Newcomb PA, Hampton JM, Trentham-Dietz A, Titus LJ, Egan KM, et al. Cigarette smoking before and after breast cancer diagnosis: mortality from breast cancer and smoking-related diseases. J Clin Oncol. 2016;34(11).

  29. Boone SD, Baumgartner KB, Baumgartner RN, Connor AE, John EM, Giuliano AR, et al. Active and passive cigarette smoking and mortality among Hispanic and non-Hispanic white women diagnosed with invasive breast cancer. Ann Epidemiol. 2015;25(11):824–31. doi:10.1016/j.annepidem.2015.08.007.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Braithwaite D, Izano M, Moore DH, Kwan ML, Tammemagi MC, Hiatt R, et al. Smoking and survival after breast cancer diagnosis: a prospective observational study and systematic review. Epidemiology. 2012;136(2):521–33. doi:10.1007/s10549-012-2276-1.

    Google Scholar 

  31. Wolf AM, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano KA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol. 1994;23(5):991–9.

    Article  CAS  PubMed  Google Scholar 

  32. Sprague B, McLaughlin V, Hampton J, Newcomb P, Trentham-Dietz A. Disease-free survival by treatment after a DCIS diagnosis in a population-based cohort study. Breast Cancer Res Treat. 2013;141(1):145–54. doi:10.1007/s10549-013-2670-3.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  PubMed  Google Scholar 

  34. Schafer JL. Analysis of incomplete multivariate data. London: Chapman and Hall; 1997.

    Book  Google Scholar 

  35. Holmes MD, Murin S, Chen WY, Kroenke CH, Spiegelman D, Colditz GA. Smoking and survival after breast cancer diagnosis. Int J Cancer. 2007;120(12):2672–7. doi:10.1002/ijc.22575.

    Article  CAS  PubMed  Google Scholar 

  36. Padron-Monedero A, Tannenbaum SL, Koru-Sengul T, Miao F, Hansra D, Lee DJ, et al. Smoking and survival in female breast cancer patients. Breast Cancer Res Treat. 2015;150(2):395–403. doi:10.1007/s10549-015-3317-3.

    Article  PubMed  Google Scholar 

  37. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28(3):753–65. doi:10.1007/s12032-010-9536-x.

    Article  PubMed  Google Scholar 

  38. Zhong S, Jiang T, Ma T, Zhang X, Tang J, Chen W, et al. Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. Eur J Epidemiol. 2014;29(6):391–404. doi:10.1007/s10654-014-9916-1.

    Article  PubMed  Google Scholar 

  39. Caan BJ, Kwan ML, Hartzell G, Castillo A, Slattery ML, Sternfeld B, et al. Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control. 2008;19(10):1319–28. doi:10.1007/s10552-008-9203-0.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kwan ML, Chen WY, Kroenke CH, Weltzien E, Beasley JM, Nechuta SJ, et al. Pre-diagnosis body mass index and survival after breast cancer in the After Breast Cancer Pooling Project. Breast Cancer Res Treat. 2012;132(2):729–39. doi:10.1007/s10549-011-1914-3.

    Article  PubMed  Google Scholar 

  41. Widschwendter P, Friedl TW, Schwentner L, Degregorio N, Jaeger B, Schramm A, et al. The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial. Breast Cancer Res. 2015;17(129):1–11.

    Google Scholar 

  42. Chan DS, Vieria A, Aune D, Bandera EV, Greenwood DC, McTiernan A, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25(10):1901–14. doi:10.1093/annonc/mdu042.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298(17):2028–37. doi:10.1001/jama.298.17.2028. [pii]. 298/17/2028.

    Article  CAS  PubMed  Google Scholar 

  44. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293(15):1861–7. doi:10.1001/jama.293.15.1861.

    Article  CAS  PubMed  Google Scholar 

  45. Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health. 2014;104(3):512–9. doi:10.2105/AJPH.2013.301597.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ades PA, Savage PD. The obesity paradox: perception vs knowledge. Mayo Clin Proc. 2010;85(2):112–4. doi:10.4065/mcp.2009.0777.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Flatt SW, Thomson CA, Gold EB, Nartarajan L, Rock CL, Al-Delaimy WK, et al. Low to moderate alcohol intake is not associated with increased mortality after breast cancer. Cancer Epidemiol Biomarkers Prev. 2010;19(3):681–8. doi:10.1158/1055-9965.EPI-09-0927.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Newcomb PA, Kampman E, Trentham-Dietz A, Egan KM, Titus LJ, Baron JA, et al. Alcohol consumption before and after breast cancer diagnosis: associations with survival from breast cancer, cardiovascular disease, and other causes. J Clin Oncol. 2013;31(16):1939–46. doi:10.1200/JCO.2012.46.5765.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This project was supported by grants from the National Institutes of Health (P20 GM103644, U54 CA163303, R01 CA067264, P50 DA036114, and P30 CA014520). The authors would like to express their gratitude to Julie McGregor, Kathy Peck, and Laura Stephenson for assistance with data collection and project management, and to Drs. Andreas Friedl, Kathleen Egan, Linda Titus, Hazel Nichols, Shaneda Warren Andersen, Elizabeth Burnside, and Thomas Ahern for advice and support for this project.

Author information

Authors and Affiliations

  1. Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA

    Christopher Thomas Veal, Vicki Hart & Brian L. Sprague

  2. Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA

    Christopher Thomas Veal, Vicki Hart, Susan G. Lakoski, Stephen T. Higgins, Amy Trentham-Dietz & Brian L. Sprague

  3. Department of Clinical Cancer Prevention & Cardiology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA

    Susan G. Lakoski

  4. Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA

    John M. Hampton, Ronald E. Gangnon & Amy Trentham-Dietz

  5. Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA

    Ronald E. Gangnon

  6. Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

    Polly A. Newcomb

  7. Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA

    Polly A. Newcomb

  8. Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, USA

    Stephen T. Higgins

  9. University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA

    Stephen T. Higgins & Brian L. Sprague

Authors
  1. Christopher Thomas Veal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vicki Hart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan G. Lakoski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John M. Hampton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ronald E. Gangnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Polly A. Newcomb
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephen T. Higgins
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amy Trentham-Dietz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Brian L. Sprague
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian L. Sprague.

Ethics declarations

Funding

This project was supported by grants from the National Institutes of Health (P20 GM103644, U54 CA163303, R01 CA067264, P50 DA036114, and P30 CA014520).

Conflict of interest

All authors report no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Veal, C.T., Hart, V., Lakoski, S.G. et al. Health-related behaviors and mortality outcomes in women diagnosed with ductal carcinoma in situ. J Cancer Surviv 11, 320–328 (2017). https://doi.org/10.1007/s11764-016-0590-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-016-0590-z

Keywords

Search

Navigation