Breast Cancer Risk Factors and Survival by Tumor Subtype: Pooled Analyses from the Breast Cancer Association Consortium

Morra A, Jung AY, Behrens S, Keeman R, Ahearn TU, Anton-Culver H, Arndt V, Augustinsson A, Auvinen PK, Beane Freeman LE, Becher H, Beckmann M, Blomqvist C, Bojesen SE, Bolla MK, Brenner H, Briceno I, Brucker SY, Camp NJ, Campa D, Canzian F, Castelao JE, Chanock SJ, Choi JY, Clarke CL, Couch FJ, Cox A, Cross SS, Czene K, Dörk T, Dunning AM, Dwek M, Easton DF, Eccles DM, Egan KM, Evans DG, Fasching P, Flyger H, Gago-Dominguez M, Gapstur SM, García-Sáenz JA, Gaudet MM, Giles GG, Grip M, Guénel P, Haiman CA, Håkansson N, Hall P, Hamann U, Han SN, Hart SN, Hartman M, Heyworth JS, Hoppe R, Hopper JL, Hunter DJ, Ito H, Jager A, Jakimovska M, Jakubowska A, Janni W, Kaaks R, Kang D, Kapoor PM, Kitahara CM, Koutros S, Kraft P, Kristensen VN, Lacey JV, Lambrechts D, Le Marchand L, Li J, Lindblom A, Lubiński J, Lush M, Mannermaa A, Manoochehri M, Margolin S, Mariapun S, Matsuo K, Mavroudis D, Milne RL, Muranen TA, Newman WG, Noh DY, Nordestgaard BG, Obi N, Olshan AF, Olsson H, Park-Simon TW, Petridis C, Pharoah PD, Plaseska-Karanfilska D, Presneau N, Rashid MU, Rennert G, Rennert HS, Rhenius V, Romero A, Saloustros E, Sawyer EJ, Schneeweiss A, Schwentner L, Scott C, Shah M, Shen CY, Shu XO, Southey MC, Stram DO, Tamimi RM, Tapper W, Tollenaar RA, Tomlinson I, Torres D, Troester MA, Truong T, Vachon CM, Wang Q, Wang SS, Williams JA, Winqvist R, Wolk A, Wu AH, Yoo KY, Yu JC, Zheng W, Ziogas A, Yang XR, Eliassen AH, Holmes MD, García-Closas M, Teo SH, Schmidt MK, Chang-Claude J (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Book Volume: 30

Pages Range: 623-642

Journal Issue: 4

DOI: 10.1158/1055-9965.EPI-20-0924

Abstract

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 (Padj > 0.30). The strongest associations were between all-cause mortality and BMI ≥30 versus 18.5-25 kg/m2 [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.

Authors with CRIS profile

Involved external institutions

Cancer Council Victoria Australia (AU) Deutsches Krebsforschungszentrum (DKFZ) Germany (DE) National Cancer Institute (NCI) United States (USA) (US) University of California Irvine United States (USA) (US) National University Health System (NUHS) Singapore (SG) Eberhard Karls Universität Tübingen Germany (DE) Universidad de La Sabana Colombia (CO) Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI / NKI-AVL) Netherlands (NL) University of Western Australia (UWA) Australia (AU) Hospital Clínico San Carlos Spain (ES) University of Cambridge United Kingdom (GB) Karolinska Institute Sweden (SE) Mayo Clinic United States (USA) (US) Oulun Yliopisto / University of Oulo Finland (FI) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) University of Westminster United Kingdom (GB) Lund University / Lunds universitet Sweden (SE) Fundación Pública Galega de Medicina Xenómica Spain (ES) Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) Finland (FI) Herlev Hospital Denmark (DK) University of Eastern Finland Finland (FI) American Cancer Society United States (USA) (US) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) École Polytechnique - Université Paris-Saclay France (FR) University of Sheffield United Kingdom (GB) Cancer Research Initiatives Foundation (CARIF) / Cancer Research Malaysia (CRM) Malaysia (MY) University of Hawaiʻi at Mānoa United States (USA) (US) Harvard T.H. Chan School of Public Health United States (USA) (US) Universitätsklinikum Ulm Germany (DE) Keck School of Medicine of USC United States (USA) (US) University of North Carolina at Chapel Hill United States (USA) (US) Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie Germany (DE) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) University of Birmingham United Kingdom (GB) University General Hospital of Heraklion Greece (GR) Melbourne School of Population and Global Health Australia (AU) Aichi Cancer Center Research Institute Japan (JP) Leiden University Medical Center Netherlands (NL) Erasmus University Medical Center (MC) Netherlands (NL) University of Oxford United Kingdom (GB) Genome Institute of Singapore Singapore (SG) Pomeranian Medical University / Pomorski Uniwersytet Medyczny w Szczecinie (PMU) Poland (PL) University of Southampton United Kingdom (GB) Flanders Institute for Biotechnology / Vlaams Instituut voor Biotechnologie (VIB) Belgium (BE) University of Manchester United Kingdom (GB) Technion - Israel Institute of Technology Israel (IL) Vanderbilt University Medical Center United States (USA) (US) H. Lee Moffitt Cancer Center & Research Institute United States (USA) (US) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Guy's and St Thomas' (NHS Foundation Trust) United Kingdom (GB) King’s College London United Kingdom (GB) Academia Sinica / 中央研究院 Taiwan (TW) General University Hospital of Larissa Greece (GR) Hospital Universitario Puerta de Hierro - Majadahonda Spain (ES) Huntsman Cancer Institute United States (USA) (US) Instituto de Investigación Sanitaria Galicia Sur Spain (ES) Tri-Service General Hospital (TSGH) / 三軍總醫院 Taiwan (TW)

How to cite

APA:

Morra, A., Jung, A.Y., Behrens, S., Keeman, R., Ahearn, T.U., Anton-Culver, H.,... Chang-Claude, J. (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. https://doi.org/10.1158/1055-9965.EPI-20-0924

MLA:

Morra, Anna, et al. "Breast Cancer Risk Factors and Survival by Tumor Subtype: Pooled Analyses from the Breast Cancer Association Consortium." Cancer Epidemiology Biomarkers & Prevention 30.4 (2021): 623-642.

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