Breast cancer risk factors and survival by tumor subtype: pooled analyses from the Breast Cancer Association Consortium

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title = "Breast cancer risk factors and survival by tumor subtype: pooled analyses from the Breast Cancer Association Consortium",
abstract = "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.",
author = "Anna Morra and Jung, {Audrey Y} and Sabine Behrens and Renske Keeman and Ahearn, {Thomas U} and Hoda Anton-Cluver and Volker Arndt and Annelie Augustinsson and Auvinen, {P{\"a}ivi K} and {Beane Freeman}, {Laura E} and Heiko Becher and Beckmann, {Matthias W} and Carl Bloomqvist and Bojesen, {Stig E} and Bolla, {Manjeet K} and Hermann Brenner and Ignacio Briceno and Brucker, {Sara Y} and Camp, {Nicola J} and Daniele Campa and Federico Canzian and Castelao, {Jose E} and Chanock, {Stephen J} and Ji-Yeob Choi and Clarke, {Christine L} and Couch, {Fergus J} and Angela Cox and Cross, {Simon S} and Kamila Czene and Thilo Dӧrk and Dunning, {Alison M} and Miriam Dwek and Easton, {Douglas F} and Eccles, {Diana M} and Egan, {Kathleen M} and Evans, {D Gareth} and Fasching, {Peter A} and Henrik Flyger and Manuela Gago-Dominguez and Gapstur, {Susan M} and Garcia-Saenz, {Jose A} and Gaudet, {Mia M} and Giles, {Graham G} and Mervi Grip and Pascal Gu{\'e}nel and Haiman, {Christopher A} and Niclas H{\aa}kansson and Per Hall and Ute Hamann and H{\aa}kan Olsson and {Breast Cancer Association Consortium}",
note = "Copyright {\textcopyright}2021, American Association for Cancer Research.",
year = "2021",
doi = "10.1158/1055-9965.EPI-20-0924",
language = "English",
volume = "30",
pages = "623--642",
journal = "Cancer Epidemiology Biomarkers and Prevention",
issn = "1538-7755",
publisher = "American Association for Cancer Research",
number = "4",