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. 2018 Jan;167(1):171-181.
doi: 10.1007/s10549-017-4467-2. Epub 2017 Aug 31.

Healthy lifestyle impact on breast cancer-specific and all-cause mortality

Adaline E Heitz  1 , Richard N Baumgartner  1 , Kathy B Baumgartner  1 , Stephanie D Boone  2
Affiliations

Healthy lifestyle impact on breast cancer-specific and all-cause mortality

Adaline E Heitz et al. Breast Cancer Res Treat. 2018 Jan.

Abstract

Purpose: While several studies have evaluated the association of combined lifestyle factors on breast cancer-specific mortality, few have included Hispanic women. We constructed a "healthy behavior index" (HBI) and evaluated its associations with mortality in non-Hispanic White (NHW) and Hispanic women diagnosed with breast cancer from the southwestern U.S.

Methods: Diet and lifestyle questionnaires were analyzed for 837 women diagnosed with invasive breast cancer (1999-2004) in New Mexico as part of the 4-Corners Women's Health Study. An HBI score ranging from 0 to 12 was based on dietary pattern, physical activity, smoking, alcohol consumption, and body size and shape, with increasing scores representing less healthy characteristics. Hazard ratios for mortality over 14 years of follow-up were estimated for HBI quartiles using Cox proportional hazards models adjusting for education and stratified by ethnicity and stage at diagnosis.

Results: A significant increasing trend was observed across HBI quartiles among all women, NHW women, and those diagnosed with localized or regional/distant stage of disease for all-cause (AC) mortality (p-trend = 0.006, 0.002, 0.03, respectively). AC mortality was increased >2-fold for all women and NHW women in HBI Q4 versus Q1 (HR = 2.18, 2.65, respectively). The association was stronger in women with regional/distant than localized stage of disease (HR = 2.62, 1.94, respectively). Associations for Hispanics or breast cancer-specific mortality were not significant.

Conclusions: These findings indicate the associations between the HBI and AC mortality, which appear to differ by ethnicity and stage at diagnosis. Interventions for breast cancer survivors should address the combination of lifestyle factors on prognosis.

Keywords: All-cause mortality; Breast cancer; Breast cancer-specific mortality; Hispanic; Lifestyle recommendations.

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Figures

Fig. 1
Fig. 1
Breast cancer survival by healthy behavior index quartiles (Q). Survival curves adjusted for stage at diagnosis and education level; Q1 and Q2 overlap
Fig. 2
Fig. 2
Overall survival by healthy behavior index quartiles (Q). Survival curves adjusted for stage at diagnosis and education level; Q2 and Q3 overlap
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