Healthy lifestyle impact on breast cancer-specific and all-cause mortality
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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.
KeywordsBreast 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.
This study complies with the current laws of the country in which it was performed.
- 1.Howlader N, et al. (2013) SEER Cancer Statistics Review, 1975–2010. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2010/, Based on November 2012 SEER data submission, posted to the SEER web site, April 2013
- 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
- 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
- 46.WHO (1992) International statistical classification of diseases and related health problems (10th Revision). World Health Organization, GenevaGoogle Scholar
- 47.Hoyert DL (2012) 75 years of mortality in the United States, 1935–2010. NCHS Data Brief 88:1–8Google Scholar
- 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
- 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