Breast Cancer Research and Treatment

, Volume 167, Issue 1, pp 171–181 | Cite as

Healthy lifestyle impact on breast cancer-specific and all-cause mortality

  • Adaline E. Heitz
  • Richard N. Baumgartner
  • Kathy B. Baumgartner
  • Stephanie D. BooneEmail author



While several studies have evaluated the association of combined lifestyle factors on breast cancer-specific mortality, few have included Hispanic women. We constructed a “healthy behavior index” (HBI) and evaluated its associations with mortality in non-Hispanic White (NHW) and Hispanic women diagnosed with breast cancer from the southwestern U.S.


Diet and lifestyle questionnaires were analyzed for 837 women diagnosed with invasive breast cancer (1999–2004) in New Mexico as part of the 4-Corners Women’s Health Study. An HBI score ranging from 0 to 12 was based on dietary pattern, physical activity, smoking, alcohol consumption, and body size and shape, with increasing scores representing less healthy characteristics. Hazard ratios for mortality over 14 years of follow-up were estimated for HBI quartiles using Cox proportional hazards models adjusting for education and stratified by ethnicity and stage at diagnosis.


A significant increasing trend was observed across HBI quartiles among all women, NHW women, and those diagnosed with localized or regional/distant stage of disease for all-cause (AC) mortality (p-trend = 0.006, 0.002, 0.03, respectively). AC mortality was increased >2-fold for all women and NHW women in HBI Q4 versus Q1 (HR = 2.18, 2.65, respectively). The association was stronger in women with regional/distant than localized stage of disease (HR = 2.62, 1.94, respectively). Associations for Hispanics or breast cancer-specific mortality were not significant.


These findings indicate the associations between the HBI and AC mortality, which appear to differ by ethnicity and stage at diagnosis. Interventions for breast cancer survivors should address the combination of lifestyle factors on prognosis.


Breast cancer Breast cancer-specific mortality All-cause mortality Lifestyle recommendations Hispanic 



This research was supported by the University of Louisville Cancer Education Program, National Institute of Health (NIH)/National Cancer Institute (NCI) R25-CA134283, NIH/NCI R01-CA78762, the University of Louisville School of Public Health and Information Sciences, and the James Graham Brown Cancer Center.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study complies with the current laws of the country in which it was performed.


  1. 1.
    Howlader N, et al. (2013) SEER Cancer Statistics Review, 1975–2010. National Cancer Institute. Bethesda, MD,, Based on November 2012 SEER data submission, posted to the SEER web site, April 2013
  2. 2.
    Ingram D (1994) Diet and subsequent survival in women with breast cancer. Br J Cancer 69(3):592–595CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Saxe GA et al (1999) Diet and risk for breast cancer recurrence and survival. Breast Cancer Res Treat 53(3):241–253CrossRefPubMedGoogle Scholar
  4. 4.
    Jain M, Miller AB (1997) Tumor characteristics and survival of breast cancer patients in relation to premorbid diet and body size. Breast Cancer Res Treat 42(1):43–55CrossRefPubMedGoogle Scholar
  5. 5.
    Hebert JR, Hurley TG, Ma Y (1998) The effect of dietary exposures on recurrence and mortality in early stage breast cancer. Breast Cancer Res Treat 51(1):17–28CrossRefPubMedGoogle Scholar
  6. 6.
    Boone SD et al (2015) Active and passive cigarette smoking and mortality among Hispanic and non-Hispanic white women diagnosed with invasive breast cancer. Ann Epidemiol 25(11):824–831CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Pierce JP et al (2014) Lifetime cigarette smoking and breast cancer prognosis in the After Breast Cancer Pooling Project. J Natl Cancer Inst. 106(1):djt359CrossRefPubMedGoogle Scholar
  8. 8.
    Passarelli MN et al (2016) Cigarette smoking before and after breast cancer diagnosis: mortality from breast cancer and smoking-related diseases. J Clin Oncol 34(12):1315–1322CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Holmes MD et al (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293(20):2479–2486CrossRefPubMedGoogle Scholar
  10. 10.
    Holick CN et al (2008) Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev 17(2):379–386CrossRefPubMedGoogle Scholar
  11. 11.
    Irwin ML et al (2008) Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol 26(24):3958–3964CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Feigelson HS et al (2001) Alcohol consumption increases the risk of fatal breast cancer (United States). Cancer Causes Control 12(10):895–902CrossRefPubMedGoogle Scholar
  13. 13.
    Kwan ML et al (2013) Postdiagnosis alcohol consumption and breast cancer prognosis in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev 22(1):32–41CrossRefPubMedGoogle Scholar
  14. 14.
    Kwan ML et al (2010) Alcohol consumption and breast cancer recurrence and survival among women with early-stage breast cancer: the life after cancer epidemiology study. J Clin Oncol 28(29):4410–4416CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Dal Maso L et al (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123(9):2188–2194CrossRefGoogle Scholar
  16. 16.
    Connor AE et al (2013) Obesity and risk of breast cancer mortality in Hispanic and Non-Hispanic white women: the New Mexico Women’s Health Study. J Womens Health (Larchmt) 22(4):368–377CrossRefGoogle Scholar
  17. 17.
    Borugian MJ et al (2003) Waist-to-hip ratio and breast cancer mortality. Am J Epidemiol 158(10):963–968CrossRefPubMedGoogle Scholar
  18. 18.
    Kushi LH et al (2012) American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62(1):30–67CrossRefPubMedGoogle Scholar
  19. 19.
    Spring B et al (2015) Fostering multiple healthy lifestyle behaviors for primary prevention of cancer. Am Psychol 70(2):75–90CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Thomson CA et al (2014) Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women’s health initiative. Cancer Prev Res 7(1):42–53CrossRefGoogle Scholar
  21. 21.
    Kabat GC et al (2015) Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study. Am J Clin Nutr 101(3):558–569CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Hastert TA et al (2014) Adherence to the WCRF/AICR cancer prevention recommendations and cancer-specific mortality: results from the Vitamins and Lifestyle (VITAL) Study. Cancer Causes Control 25(5):541–552CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Makarem N et al (2015) Concordance with World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines for cancer prevention and obesity-related cancer risk in the Framingham Offspring cohort (1991–2008). Cancer Causes Control 26(2):277–286CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Harris HR, Bergkvist L, Wolk A (2016) Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and breast cancer risk. Int J Cancer 138(11):2657–2664CrossRefPubMedGoogle Scholar
  25. 25.
    Catsburg C, Miller AB, Rohan TE (2014) Adherence to cancer prevention guidelines and risk of breast cancer. Int J Cancer 135(10):2444–2452CrossRefPubMedGoogle Scholar
  26. 26.
    Romaguera D et al (2012) Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr 96(1):150–163CrossRefPubMedGoogle Scholar
  27. 27.
    Nomura SJ et al (2016) WCRF/AICR recommendation adherence and breast cancer incidence among postmenopausal women with and without non-modifiable risk factors. Int J Cancer 138(11):2602–2615CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Khaw KT et al (2008) Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med 5(1):e12CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    McCullough ML et al (2011) Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidemiol Biomarkers Prev 20(6):1089–1097CrossRefPubMedGoogle Scholar
  30. 30.
    Petersen KE et al (2015) The combined impact of adherence to five lifestyle factors on all-cause, cancer and cardiovascular mortality: a prospective cohort study among Danish men and women. Br J Nutr 113(5):849–858CrossRefPubMedGoogle Scholar
  31. 31.
    van Dam RM et al (2008) Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ 337:a1440CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Simpson ER, Brown KA (2013) Obesity and breast cancer: role of inflammation and aromatase. J Mol Endocrinol 51(3):T51–T59CrossRefPubMedGoogle Scholar
  33. 33.
    Slattery ML et al (2014) Diet and lifestyle factors modify immune/inflammation response genes to alter breast cancer risk and prognosis: the Breast Cancer Health Disparities Study. Mutat Res 770:19–28CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Malik S et al (2004) Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 110(10):1245–1250CrossRefPubMedGoogle Scholar
  35. 35.
    Mozaffarian D (2015) Nutrition and cardiovascular and metabolic disease. In: Bonow RO, Mann DL, Zipes DP, Libby P (eds) Braunwald’s heart disease: a textbook of cardiovascular medicine. Elsevier Saunders, PhiladelphiaGoogle Scholar
  36. 36.
    Benowitz NL (2003) Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment. Prog Cardiovasc Dis 46(1):91–111CrossRefPubMedGoogle Scholar
  37. 37.
    Boone SD et al (2014) The joint contribution of tumor phenotype and education to breast cancer survival disparity between Hispanic and non-Hispanic white women. Cancer Causes Control 25(3):273–282CrossRefPubMedGoogle Scholar
  38. 38.
    Hill DA et al (2010) Method of detection and breast cancer survival disparities in Hispanic women. Cancer Epidemiol Biomarkers Prev 19(10):2453–2460CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163(1):49–56CrossRefPubMedGoogle Scholar
  40. 40.
    Hines LM et al (2011) Ethnic disparities in breast tumor phenotypic subtypes in Hispanic and non-Hispanic white women. J Womens Health 20(10):1543–1550CrossRefGoogle Scholar
  41. 41.
    Connor AE et al (2013) Differences between Hispanic and non-Hispanic white women with breast cancer for clinical characteristics and their correlates. Ann Epidemiol 23(4):227–232CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Banegas MP, Li CI (2012) Breast cancer characteristics and outcomes among Hispanic Black and Hispanic White women. Breast Cancer Res Treat 134(3):1297–1304CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Slattery ML et al (2007) Body size, weight change, fat distribution and breast cancer risk in Hispanic and non-Hispanic white women. Breast Cancer Res Treat 102(1):85–101CrossRefPubMedGoogle Scholar
  44. 44.
    Sweeney C et al (2007) Recruiting Hispanic women for a population-based study: validity of surname search and characteristics of nonparticipants. Am J Epidemiol 166(10):1210–1219CrossRefPubMedGoogle Scholar
  45. 45.
    Murtaugh MA et al (2007) Diet composition and risk of overweight and obesity in women living in the southwestern United States. J Am Diet Assoc 107(8):1311–1321CrossRefPubMedGoogle Scholar
  46. 46.
    WHO (1992) International statistical classification of diseases and related health problems (10th Revision). World Health Organization, GenevaGoogle Scholar
  47. 47.
    Hoyert DL (2012) 75 years of mortality in the United States, 1935–2010. NCHS Data Brief 88:1–8Google Scholar
  48. 48.
    Kant S, Gupta B (2008) Role of lifestyle in the development of chronic obstructive pulmonary disease: a review. Lung India 25(2):95–101CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Kromhout D et al (2002) Prevention of coronary heart disease by diet and lifestyle: evidence from prospective cross-cultural, cohort, and intervention studies. Circulation 105(7):893–898CrossRefPubMedGoogle Scholar
  50. 50.
    Vergnaud AC et al (2013) Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study 1,4. Am J Clin Nutr 97(5):1107–1120CrossRefPubMedGoogle Scholar
  51. 51.
    Grann V et al (2006) Regional and racial disparities in breast cancer-specific mortality. Soc Sci Med 62(2):337–347CrossRefPubMedGoogle Scholar
  52. 52.
    Komenaka IK et al (2010) Race and ethnicity and breast cancer outcomes in an underinsured population. J Natl Cancer Inst 102(15):1178–1187CrossRefPubMedGoogle Scholar
  53. 53.
    Borrell LN, Lancet EA (2012) Race/ethnicity and all-cause mortality in US adults: revisiting the Hispanic paradox. Am J Public Health 102(5):836–843CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Harper S et al (2009) Trends in area-socioeconomic and race-ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987–2005). Cancer Epidemiol Biomarkers Prev 18(1):121–131CrossRefPubMedGoogle Scholar
  55. 55.
    Gonzalez EC et al (2001) Comorbid illness and the early detection of cancer. South Med J 94(9):913–920CrossRefPubMedGoogle Scholar
  56. 56.
    Burack RC, Liang J (1989) The acceptance and completion of mammography by older black women. Am J Public Health 79(6):721–726CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Kiefe CI et al (1998) Chronic disease as a barrier to breast and cervical cancer screening. J Gen Intern Med 13(6):357–365CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Darby SC et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368(11):987–998CrossRefPubMedGoogle Scholar
  59. 59.
    Swain SM, Whaley FS, Ewer MS (2003) Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 97(11):2869–2879CrossRefPubMedGoogle Scholar
  60. 60.
    Grossmann ME et al (2010) Obesity and breast cancer: status of leptin and adiponectin in pathological processes. Cancer Metastasis Rev 29(4):641–653CrossRefPubMedGoogle Scholar
  61. 61.
    Lautenbach A et al (2009) Obesity and the associated mediators leptin, estrogen and IGF-I enhance the cell proliferation and early tumorigenesis of breast cancer cells. Nutr Cancer 61(4):484–491CrossRefPubMedGoogle Scholar
  62. 62.
    Cleary MP (2013) Impact of obesity on development and progression of mammary tumors in preclinical models of breast cancer. J Mammary Gland Biol Neoplasia 18(3–4):333–343CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Rock CL, Demark-Wahnefried W (2002) Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 20(15):3302–3316CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    McTiernan A et al (2004) Effect of exercise on serum estrogens in postmenopausal women: a 12-month randomized clinical trial. Cancer Res 64(8):2923–2928CrossRefPubMedGoogle Scholar
  65. 65.
    McTiernan A et al (1998) Physical activity and cancer etiology: associations and mechanisms. Cancer Causes Control 9(5):487–509CrossRefPubMedGoogle Scholar
  66. 66.
    Chlebowski RT et al (2004) Insulin, physical activity, and caloric intake in postmenopausal women: breast cancer implications. J Clin Oncol 22(22):4507–4513CrossRefPubMedGoogle Scholar
  67. 67.
    Kaaks R, Lukanova A (2001) Energy balance and cancer: the role of insulin and insulin-like growth factor-I. Proc Nutr Soc 60(1):91–106CrossRefPubMedGoogle Scholar
  68. 68.
    He K et al (2004) Changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women. Int J Obes Relat Metab Disord 28(12):1569–1574CrossRefPubMedGoogle Scholar
  69. 69.
    Mozaffarian D et al (2011) Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 364(25):2392–2404CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Fink BN et al (2007) Dietary flavonoid intake and breast cancer survival among women on Long Island. Cancer Epidemiol Biomarkers Prev 16(11):2285–2292CrossRefPubMedGoogle Scholar
  71. 71.
    Lauber SN, Gooderham NJ (2011) The cooked meat-derived mammary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine promotes invasive behaviour of breast cancer cells. Toxicology 279(1–3):139–145CrossRefPubMedGoogle Scholar
  72. 72.
    Papaioannou MD, Koufaris C, Gooderham NJ (2014) The cooked meat-derived mammary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) elicits estrogenic-like microRNA responses in breast cancer cells. Toxicol Lett 229(1):9–16CrossRefPubMedGoogle Scholar
  73. 73.
    Purohit V (1998) Moderate alcohol consumption and estrogen levels in postmenopausal women: a review. Alcohol Clin Exp Res 22(5):994–997CrossRefPubMedGoogle Scholar
  74. 74.
    Endogenous H et al (2011) Circulating sex hormones and breast cancer risk factors in postmenopausal women: reanalysis of 13 studies. Br J Cancer 105(5):709–722CrossRefGoogle Scholar
  75. 75.
    Eliassen AH, Hankinson SE (2008) Endogenous hormone levels and risk of breast, endometrial and ovarian cancers: prospective studies. Adv Exp Med Biol 630:148–165CrossRefPubMedGoogle Scholar
  76. 76.
    Gu JW et al (2005) Ethanol stimulates tumor progression and expression of vascular endothelial growth factor in chick embryos. Cancer 103(2):422–431CrossRefPubMedGoogle Scholar
  77. 77.
    United States. Public Health Service. Office of the Surgeon General., How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. 2010, Rockville, MD. Washington, DC: U.S. Dept. of Health and Human Services, Public Health Service. p. 704Google Scholar
  78. 78.
    Daniell HW (1988) Increased lymph node metastases at mastectomy for breast cancer associated with host obesity, cigarette smoking, age, and large tumor size. Cancer 62(2):429–435CrossRefPubMedGoogle Scholar
  79. 79.
    Murin S, Inciardi J (2001) Cigarette smoking and the risk of pulmonary metastasis from breast cancer. Chest 119(6):1635–1640CrossRefPubMedGoogle Scholar
  80. 80.
    Manjer J et al (2001) Smoking associated with hormone receptor negative breast cancer. Int J Cancer 91(4):580–584CrossRefPubMedGoogle Scholar
  81. 81.
    Lesser GT, Deutsch S (1967) Measurement of adipose tissue blood flow and perfusion in man by uptake of 85Kr. J Appl Physiol 23(5):621–630CrossRefPubMedGoogle Scholar
  82. 82.
    Collis T et al (2001) Relations of stroke volume and cardiac output to body composition: the strong heart study. Circulation 103(6):820–825CrossRefPubMedGoogle Scholar
  83. 83.
    Mathew B et al (2008) Obesity: effects on cardiovascular disease and its diagnosis. J Am Board Fam Med 21(6):562–568CrossRefPubMedGoogle Scholar
  84. 84.
    Shamsuzzaman AS et al (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105(21):2462–2464CrossRefPubMedGoogle Scholar
  85. 85.
    Lundgren CH et al (1996) Elaboration of type-1 plasminogen activator inhibitor from adipocytes. A potential pathogenetic link between obesity and cardiovascular disease. Circulation 93(1):106–110CrossRefPubMedGoogle Scholar
  86. 86.
    Steppan CM et al (2001) The hormone resistin links obesity to diabetes. Nature 409(6818):307–312CrossRefPubMedGoogle Scholar
  87. 87.
    Mora S et al (2007) Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation 116(19):2110–2118CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Thijssen DH et al (2010) Impact of inactivity and exercise on the vasculature in humans. Eur J Appl Physiol 108(5):845–875CrossRefPubMedGoogle Scholar
  89. 89.
    Jacobs DR Jr, Tapsell LC (2007) Food, not nutrients, is the fundamental unit in nutrition. Nutr Rev 65(10):439–450PubMedGoogle Scholar
  90. 90.
    Mozaffarian D, Ludwig DS (2010) Dietary guidelines in the 21st century–a time for food. JAMA 304(6):681–682CrossRefPubMedGoogle Scholar
  91. 91.
    Mozaffarian D, Appel LJ, Van Horn L (2011) Components of a cardioprotective diet: new insights. Circulation 123(24):2870–2891CrossRefPubMedGoogle Scholar
  92. 92.
    Bradley KA, Donovan DM, Larson EB (1993) How much is too much? Advising patients about safe levels of alcohol consumption. Arch Intern Med 153(24):2734–2740CrossRefPubMedGoogle Scholar
  93. 93.
    Klatsky AL et al (1977) Alcohol consumption and blood pressure Kaiser-Permanente multiphasic health examination data. N Engl J Med 296(21):1194–1200CrossRefPubMedGoogle Scholar
  94. 94.
    Diamond I (1989) Alcoholic myopathy and cardiomyopathy. N Engl J Med 320(7):458–460CrossRefPubMedGoogle Scholar
  95. 95.
    Stampfer MJ et al (1988) A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med 319(5):267–273CrossRefPubMedGoogle Scholar
  96. 96.
    Pearson TA (1996) Alcohol and heart disease. Circulation 94(11):3023–3025CrossRefPubMedGoogle Scholar
  97. 97.
    Ambrose JA, Barua RS (2004) The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43(10):1731–1737CrossRefPubMedGoogle Scholar
  98. 98.
    Craig WY, Palomaki GE, Haddow JE (1989) Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. BMJ 298(6676):784–788CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    Reaven G, Tsao PS (2003) Insulin resistance and compensatory hyperinsulinemia: the key player between cigarette smoking and cardiovascular disease? J Am Coll Cardiol 41(6):1044–1047CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Adaline E. Heitz
    • 1
  • Richard N. Baumgartner
    • 1
  • Kathy B. Baumgartner
    • 1
  • Stephanie D. Boone
    • 1
    Email author
  1. 1.Department of Epidemiology and Population Health, School of Public Health and Information Sciences, James Graham Brown Cancer CenterUniversity of LouisvilleLouisvilleUSA

Personalised recommendations