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

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T1 - Breast cancer risk factors and survival by tumor subtype

T2 - pooled analyses from the Breast Cancer Association Consortium

AU - Morra, Anna

AU - Jung, Audrey Y

AU - Behrens, Sabine

AU - Keeman, Renske

AU - Ahearn, Thomas U

AU - Anton-Cluver, Hoda

AU - Arndt, Volker

AU - Augustinsson, Annelie

AU - Auvinen, Päivi K

AU - Beane Freeman, Laura E

AU - Becher, Heiko

AU - Beckmann, Matthias W

AU - Bloomqvist, Carl

AU - Bojesen, Stig E

AU - Bolla, Manjeet K

AU - Brenner, Hermann

AU - Briceno, Ignacio

AU - Brucker, Sara Y

AU - Camp, Nicola J

AU - Campa, Daniele

AU - Canzian, Federico

AU - Castelao, Jose E

AU - Chanock, Stephen J

AU - Choi, Ji-Yeob

AU - Clarke, Christine L

AU - Couch, Fergus J

AU - Cox, Angela

AU - Cross, Simon S

AU - Czene, Kamila

AU - Dӧrk, Thilo

AU - Dunning, Alison M

AU - Dwek, Miriam

AU - Easton, Douglas F

AU - Eccles, Diana M

AU - Egan, Kathleen M

AU - Evans, D Gareth

AU - Fasching, Peter A

AU - Flyger, Henrik

AU - Gago-Dominguez, Manuela

AU - Gapstur, Susan M

AU - Garcia-Saenz, Jose A

AU - Gaudet, Mia M

AU - Giles, Graham G

AU - Grip, Mervi

AU - Guénel, Pascal

AU - Haiman, Christopher A

AU - Håkansson, Niclas

AU - Hall, Per

AU - Hamann, Ute

AU - Olsson, Håkan

AU - Breast Cancer Association Consortium

N1 - Copyright ©2021, American Association for Cancer Research.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

U2 - 10.1158/1055-9965.EPI-20-0924

DO - 10.1158/1055-9965.EPI-20-0924

M3 - Article

C2 - 33500318

VL - 30

SP - 623

EP - 642

JO - Cancer Epidemiology Biomarkers and Prevention

JF - Cancer Epidemiology Biomarkers and Prevention

SN - 1538-7755

IS - 4

ER -