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Breast cancer risk factors and survival by tumor subtype: Pooled analyses from the breast cancer association consortium

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  • Anna Morra
  • Audrey Y. Jung
  • Sabine Behrens
  • Renske Keeman
  • Thomas U. Ahearn
  • Hoda Anton-Culver
  • Volker Arndt
  • Annelie Augustinsson
  • Päivi K. Auvinen
  • Laura E. Beane Freeman
  • Heiko Becher
  • Matthias W. Beckmann
  • Carl Blomqvist
  • Stig E. Bojesen
  • Manjeet K. Bolla
  • Hermann Brenner
  • Ignacio Briceno
  • Sara Y. Brucker
  • Nicola J. Camp
  • Daniele Campa
  • Federico Canzian
  • Jose E. Castelao
  • Stephen J. Chanock
  • Ji Yeob Choi
  • Christine L. Clarke
  • Fergus J. Couch
  • Angela Cox
  • Simon S. Cross
  • Kamila Czene
  • Thilo Dörk
  • Alison M. Dunning
  • Miriam Dwek
  • Douglas F. Easton
  • Diana M. Eccles
  • Kathleen M. Egan
  • D. Gareth Evans
  • Peter A. Fasching
  • Henrik Flyger
  • Manuela Gago-Dominguez
  • Susan M. Gapstur
  • José A. García-Sáenz
  • Mia M. Gaudet
  • Graham G. Giles
  • Mervi Grip
  • Pascal Guénel
  • Christopher A. Haiman
  • Niclas Håkansson
  • Per Hall
  • Ute Hamann
  • Børge G. Nordestgaard
  • The ABCTB Investigators
  • The NBCS Collaborators
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BACKGROUND: It is not known whether 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 ( P adj > 0.30). The strongest associations were between all-cause mortality and BMI ≥30 versus 18.5-25 kg/m 2 [HR (95% confidence interval (CI), 1.19 (1.06-1.34)]; current versus never smoking [1.37 (1.27-1.47)], high versus low physical activity [0.43 (0.21-0.86)], age ≥30 years versus <20 years at first pregnancy [0.79 (0.72-0.86)]; >0-<5 years versus ≥10 years since last full-term birth [1.31 (1.11-1.55)]; ever versus never use of oral contraceptives [0.91 (0.87-0.96)]; ever versus 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; for example, 1.11 (1.02-1.21) for current versus 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.

Original languageEnglish
JournalCancer Epidemiology Biomarkers and Prevention
Volume30
Issue number4
Pages (from-to)623-642
Number of pages20
ISSN1055-9965
DOIs
Publication statusPublished - Apr 2021

    Research areas

  • Adult, Aged, Breast Neoplasms/mortality, Cause of Death, Female, Humans, Life Style, Middle Aged, Neoplasm Invasiveness/pathology, Neoplasm Staging, Prospective Studies, Risk Factors, Survival Analysis

ID: 66208379