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Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors

  • Epidemiology
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Abstract

The purpose of this study was to examine post-diagnosis BMI, very low physical activity, and comorbidities, as predictors of breast cancer-specific and all-cause mortality. Data from three female US breast cancer survivor cohorts were harmonized in the After Breast Cancer Pooling Project (n = 9513). Delayed entry Cox proportional hazards models were used to examine the impact of three post-diagnosis lifestyle factors: body mass index (BMI), select comorbidities (diabetes only, hypertension only, or both), and very low physical activity (defined as physical activity <1.5 MET h/week) in individual models and together in multivariate models for breast cancer and all-cause mortality. For breast cancer mortality, the individual lifestyle models demonstrated a significant association with very low physical activity but not with the selected comorbidities or BMI. In the model that included all three lifestyle variables, very low physical activity was associated with a 22 % increased risk of breast cancer mortality (HR 1.22, 95 % CI 1.05, 1.42). For all-cause mortality, the three individual models demonstrated significant associations for all three lifestyle predictors. In the combined model, the strength and significance of the association of comorbidities (both hypertension and diabetes versus neither: HR 2.16, 95 % CI 1.79, 2.60) and very low physical activity (HR 1.35, 95 % CI 1.22, 1.51) remained unchanged, but the association with obesity was completely attenuated. These data indicate that after active treatment, very low physical activity, consistent with a sedentary lifestyle (and comorbidities for all-cause mortality), may account for the increased risk of mortality, with higher BMI, that is seen in other studies.

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Acknowledgments

This Pooling Project was supported by the National Cancer Institute at the National Institutes of Health (3R01 CA118229-03S1). Additional support was provided by the National Cancer Institute (1R03CA171013 and F31CA183125). Support for the individual cohorts included in the present report came from women’s healthy eating & living study (Susan G. Komen Foundation, KG100988); Life After Cancer Epidemiology Study (National Cancer Institute, R01 CA129059); and the Nurses’ Health Study (P01 CA87969 and UM1 CA186107).

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Authors and Affiliations

  1. Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA

    Sandahl H. Nelson, Catherine R. Marinac, Ruth E. Patterson, Shirley W. Flatt & John P. Pierce

  2. Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA

    Sandahl H. Nelson, Catherine R. Marinac, Ruth E. Patterson & John P. Pierce

  3. Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    Sarah J. Nechuta & Xiao-ou Shu

  4. Division of Research, Kaiser Permanente, Oakland, CA, USA

    Bette J. Caan & Marilyn L. Kwan

  5. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Elizabeth M. Poole & Wendy Y. Chen

  6. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Wendy Y. Chen

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  1. Sandahl H. Nelson
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Correspondence to John P. Pierce.

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

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Nelson, S.H., Marinac, C.R., Patterson, R.E. et al. Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors. Breast Cancer Res Treat 155, 551–557 (2016). https://doi.org/10.1007/s10549-016-3694-2

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  • DOI: https://doi.org/10.1007/s10549-016-3694-2

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