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The impact of cancer prevention guideline adherence on overall mortality in a high-risk cohort of women from the New York site of the Breast Cancer Family Registry.

Cloud AJ, Thai A, Liao Y, Terry MB - Breast Cancer Res. Treat. (2015)

Bottom Line: We used Cox regression to examine the relation between adherence to ACS guidelines and overall mortality and examined effect modification by race, age, and BRCA status.These associations remained after stratification by age, race, and BRCA status {e.g., BRCA1 and/or BRCA2 carriers [HR 0.39, 95 % CI (0.16-0.97)]}.These results support that women at high risk, similar to women at average risk, may also have substantial benefits from maintaining the ACS guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Rm724A, New York, NY, 10032, USA, asj2117@columbia.edu.

ABSTRACT
The American Cancer Society (ACS) recommends at least 150 min of moderate intensity physical activity per week, alcohol intake of ≤1 drink per day, and maintaining a body mass index (BMI) of <25 kg/m(2) for breast cancer prevention. Adherence to these guidelines has been linked to lower overall mortality in average-risk populations, it is not known if mortality reduction extends to women at higher risk given their family history of breast cancer. We followed 2,905 women from a high-risk Breast Cancer Family Registry in New York, of which 77 % were white non-Hispanic and 23 % were Hispanic. We collected information on BMI, physical activity, and alcohol intake at baseline and prospectively followed our cohort for outcomes based on questionnaires and National Death Index linkage. We used Cox regression to examine the relation between adherence to ACS guidelines and overall mortality and examined effect modification by race, age, and BRCA status. There were 312 deaths after an average of 9.2 ± 4.1 years of follow-up. Adherence to all three ACS recommendations was associated with 44-53 % lower mortality in women unaffected with breast cancer at baseline [Hazard Ratio (HR) 0.56, 95 % CI (0.33-0.93)] and in women affected with breast cancer at baseline [HR 0.47, 95 % CI (0.30-0.74)]. These associations remained after stratification by age, race, and BRCA status {e.g., BRCA1 and/or BRCA2 carriers [HR 0.39, 95 % CI (0.16-0.97)]}. These results support that women at high risk, similar to women at average risk, may also have substantial benefits from maintaining the ACS guidelines.

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Related in: MedlinePlus

Multivariable models examining ACS adherence at baseline and overall survival by age in women at the NY site of the BCFR
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Related In: Results  -  Collection


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Fig1: Multivariable models examining ACS adherence at baseline and overall survival by age in women at the NY site of the BCFR

Mentions: After adjusting for age and education, we observed a 44–53 % reduction in rate of overall mortality in the unaffected (HR 0.56; 95 %CI (0.33–0.93)) and affected groups (HR 0.47; 95 %CI (0.30–0.74) (Table 3). We did not observe confounding by the other factors considered (age at baseline, education, smoking, number of relatives with breast cancer, mammogram history, and HRT use). The inverse associations with adherence and mortality remained after stratification by age but the association was only statistically significant in unaffected women ≥50 years (HR 0.45; 95 % CI (0.24–0.84) and in affected women <50 years [HR 0.19; 95 %CI (0.08–0.47); Fig. 1]. Adherence to all three guidelines was associated with a 27 % reduced mortality 95 % CI (0.28–1.89) in unaffected women <50 years and 32 % reduced mortality 95 % CI (0.41–1.12) in affected women >50 years. The inverse association with adherence remained in all groups except for unaffected Hispanic women, after stratification by race and ethnicity (Table 3). Stratification by BRCA carrier status showed that adherence to all three recommendations was associated with a 61 % lower mortality [HR in carriers = 0.39; 95 % CI (0.16–0.97)]; adherence to all three recommendations in non-carriers was associated with a 50 % lower mortality [HR in non-carriers = 0.50; 95 %CI (0.36–0.70)] (Fig. 2).Table 3


The impact of cancer prevention guideline adherence on overall mortality in a high-risk cohort of women from the New York site of the Breast Cancer Family Registry.

Cloud AJ, Thai A, Liao Y, Terry MB - Breast Cancer Res. Treat. (2015)

Multivariable models examining ACS adherence at baseline and overall survival by age in women at the NY site of the BCFR
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4308644&req=5

Fig1: Multivariable models examining ACS adherence at baseline and overall survival by age in women at the NY site of the BCFR
Mentions: After adjusting for age and education, we observed a 44–53 % reduction in rate of overall mortality in the unaffected (HR 0.56; 95 %CI (0.33–0.93)) and affected groups (HR 0.47; 95 %CI (0.30–0.74) (Table 3). We did not observe confounding by the other factors considered (age at baseline, education, smoking, number of relatives with breast cancer, mammogram history, and HRT use). The inverse associations with adherence and mortality remained after stratification by age but the association was only statistically significant in unaffected women ≥50 years (HR 0.45; 95 % CI (0.24–0.84) and in affected women <50 years [HR 0.19; 95 %CI (0.08–0.47); Fig. 1]. Adherence to all three guidelines was associated with a 27 % reduced mortality 95 % CI (0.28–1.89) in unaffected women <50 years and 32 % reduced mortality 95 % CI (0.41–1.12) in affected women >50 years. The inverse association with adherence remained in all groups except for unaffected Hispanic women, after stratification by race and ethnicity (Table 3). Stratification by BRCA carrier status showed that adherence to all three recommendations was associated with a 61 % lower mortality [HR in carriers = 0.39; 95 % CI (0.16–0.97)]; adherence to all three recommendations in non-carriers was associated with a 50 % lower mortality [HR in non-carriers = 0.50; 95 %CI (0.36–0.70)] (Fig. 2).Table 3

Bottom Line: We used Cox regression to examine the relation between adherence to ACS guidelines and overall mortality and examined effect modification by race, age, and BRCA status.These associations remained after stratification by age, race, and BRCA status {e.g., BRCA1 and/or BRCA2 carriers [HR 0.39, 95 % CI (0.16-0.97)]}.These results support that women at high risk, similar to women at average risk, may also have substantial benefits from maintaining the ACS guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Rm724A, New York, NY, 10032, USA, asj2117@columbia.edu.

ABSTRACT
The American Cancer Society (ACS) recommends at least 150 min of moderate intensity physical activity per week, alcohol intake of ≤1 drink per day, and maintaining a body mass index (BMI) of <25 kg/m(2) for breast cancer prevention. Adherence to these guidelines has been linked to lower overall mortality in average-risk populations, it is not known if mortality reduction extends to women at higher risk given their family history of breast cancer. We followed 2,905 women from a high-risk Breast Cancer Family Registry in New York, of which 77 % were white non-Hispanic and 23 % were Hispanic. We collected information on BMI, physical activity, and alcohol intake at baseline and prospectively followed our cohort for outcomes based on questionnaires and National Death Index linkage. We used Cox regression to examine the relation between adherence to ACS guidelines and overall mortality and examined effect modification by race, age, and BRCA status. There were 312 deaths after an average of 9.2 ± 4.1 years of follow-up. Adherence to all three ACS recommendations was associated with 44-53 % lower mortality in women unaffected with breast cancer at baseline [Hazard Ratio (HR) 0.56, 95 % CI (0.33-0.93)] and in women affected with breast cancer at baseline [HR 0.47, 95 % CI (0.30-0.74)]. These associations remained after stratification by age, race, and BRCA status {e.g., BRCA1 and/or BRCA2 carriers [HR 0.39, 95 % CI (0.16-0.97)]}. These results support that women at high risk, similar to women at average risk, may also have substantial benefits from maintaining the ACS guidelines.

Show MeSH
Related in: MedlinePlus