Citation
Morra, Anna; Jung, Audrey; Behrens, Sabine; Keeman, Renske; Ahearn, Thomas U.; Anton-Culver, Hoda; Arndt, Volker; Augustinsson, Annelie; Auvinen, Päivi K.; & Beane Freeman, Laura E., et al. (2021). Breast Cancer Risk Factors and Survival by Tumor Subtype: Pooled Analyses from the Breast Cancer Association Consortium. Cancer Epidemiology, Biomarkers & Prevention, 30(4), 623-642. PMCID: PMC8026532Abstract
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.
URL
http://dx.doi.org/10.1158/1055-9965.Epi-20-0924Reference Type
Journal ArticleYear Published
2021Journal Title
Cancer Epidemiology, Biomarkers & PreventionAuthor(s)
Morra, AnnaJung, Audrey
Behrens, Sabine
Keeman, Renske
Ahearn, Thomas U.
Anton-Culver, Hoda
Arndt, Volker
Augustinsson, Annelie
Auvinen, Päivi K.
Beane Freeman, Laura E.
Becher, Heiko
Beckmann, Matthias W.
Bloomqvist, Carl
Bojesen, Stig Egil
Bolla, Manjeet K.
Brenner, Hermann
Briceno, Ignacio
Brucker, Sara Y.
Camp, Nicola J.
Campa, Daniele
Canzian, Federico
Castelao, Jose E.
Chanock, Stephen J.
Choi, Ji-Yeob
Clarke, Christine L.
Couch, Fergus J.
Cox, Angela
Cross, Simon S.
Czene, Kamila
D
ӧrk, Thilo
Dunning, Alison M.
Dwek, Miriam
Easton, Douglas F.
Eccles, Diana M.
Egan, Kathleen M.
Evans, D. Gareth
Fasching, Peter A.
Flyger, Henrik
Gago-Dominguez, Manuela
Gapstur, Susan M.
Garcia-Saenz, Jose A.
Gaudet, Mia M.
Giles, Graham G.
Grip, Mervi
Gu
énel, Pascal
Haiman, Christopher A.
Håkansson, Niclas
Hall, Per
Hamann, Ute
Han, Sileny N.
Hart, Steven N.
Hartman, Mikael
Heyworth, Jane S.
Hoppe, Reiner
Hopper, John L.
Hunter, David J.
Ito, Hidemi
Jager, Agnes
Jakimovska, Milena
Jakubowska, Anna
Janni, Wolfgang
Kaaks, Rudolf
Kang, Dae-Hee
Middha Kapoor, Pooja
Kitahara, Cari M.
Koutros, Stella
Kraft, Peter
Kristensen, Vessela N.
Lacey, James V.
Lambrechts, Diether
Le Marchand, Loic
Li, Jingmei
Lindblom, Annika
Lubi
ński, Jan
Lush, Michael
Mannermaa, Arto
Manoochehri, Mehdi
Margolin, Sara
Mariapun, Shivaani
Matsuo, Keitaro
Mavroudis, Dimitrios
Milne, Roger L.
Muranen, Taru A.
Newman, William G.
Noh, Dong-Young
Nordestgaard, B
ørge Grønne
Obi, Nadia
Olshan, Andrew F.
Olsson, Håkan
Park-Simon, Tjoung-Won
Petridis, Christos
Pharoah, Paul D. P.
Plaseska-Karanfilska, Dijana
Presneau, Nadege
Rashid, Muhammad U.
Rennert, Gad
Rennert, Hedy S.
Rhenius, Valerie
Romero, Atocha
Saloustros, Emmanouil
Sawyer, Elinor J.
Schneeweiss, Andreas
Schwentner, Lukas
Scott, Christopher
Shah, Mitul
Shen, Chen-Yang
Shu, Xiao-Ou
Southey, Melissa C.
Stram, Daniel O.
Tamimi, Rulla M.
Tapper, William J.
Tollenaar, Robert A. E. M.
Tomlinson, Ian
Torres, Diana
Troester, Melissa A.
Truong, Therese
Vachon, Celine M.
Wang, Qin
Wang, Sophia S.
Williams, Justin A.
Winqvist, Robert
Wolk, Alicja
Wu, Anna H.
Yoo, Keun-Young
Yu, Jyh-Cherng
Zheng, Wei
Ziogas, Argyrios
Yang, Xiaohong R.
Eliassen, A. Heather
Holmes, Michelle D.
Garcia-Closas, Montserrat
Teo, Soo Hwang
Schmidt, Marjanka K.
Chang-Claude, Jenny