Stephanie M George1, Rachel Ballard-Barbash, James M Shikany, Bette J Caan, Jo L Freudenheim, Candyce H Kroenke, Mara Z Vitolins, Shirley A Beresford, Marian L Neuhouser. 1. Authors' Affiliations: Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Research, Kaiser Permanente of Northern California, Oakland, California; Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, North Carolina; and Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Abstract
BACKGROUND: Few studies have evaluated whether adherence to dietary recommendations is associated with mortality among cancer survivors. In breast cancer survivors, we examined how postdiagnosis Healthy Eating Index (HEI)-2005 scores were associated with all-cause and cause-specific mortality. METHODS: Our prospective cohort study included 2,317 postmenopausal women, ages 50 to 79 years, in the Women's Health Initiative's Dietary Modification Trial (n = 1,205) and Observational Study (n = 1,112), who were diagnosed with invasive breast cancer and completed a food frequency questionnaire after being diagnosed. We followed women from this assessment forward. We used Cox proportional hazards models to estimate multivariate-adjusted HRs and 95% confidence intervals (CI) for death from any cause, breast cancer, and causes other than breast cancer, according to HEI-2005 quintiles. RESULTS: Over 9.6 years, 415 deaths occurred. After adjustment for key covariates, women consuming better quality diets had a 26% lower risk of death from any cause (HRQ4:Q1, 0.74; 95% CI, 0.55-0.99; Ptrend = 0.043) and a 42% lower risk of death from non-breast cancer causes (HRQ4:Q1, 0.58; 95% CI, 0.38-0.87; Ptrend = 0.011). HEI-2005 score was not associated with breast cancer death (HRQ4:Q1, 0.91; 95% CI, 0.60-1.40; Ptrend = 0.627). In analyses stratified by tumor estrogen receptor (ER) status, better diet quality was associated with a reduced risk of all-cause mortality among women with ER(+) tumors (n = 1,758; HRQ4:Q1, 0.55; 95% CI, 0.38-0.79; Ptrend = 0.0009). CONCLUSION: Better postdiagnosis diet quality was associated with reduced risk of death, particularly from non-breast cancer causes. IMPACT: Breast cancer survivors may experience improved survival by adhering to U.S. dietary guidelines.
BACKGROUND: Few studies have evaluated whether adherence to dietary recommendations is associated with mortality among cancer survivors. In breast cancer survivors, we examined how postdiagnosis Healthy Eating Index (HEI)-2005 scores were associated with all-cause and cause-specific mortality. METHODS: Our prospective cohort study included 2,317 postmenopausal women, ages 50 to 79 years, in the Women's Health Initiative's Dietary Modification Trial (n = 1,205) and Observational Study (n = 1,112), who were diagnosed with invasive breast cancer and completed a food frequency questionnaire after being diagnosed. We followed women from this assessment forward. We used Cox proportional hazards models to estimate multivariate-adjusted HRs and 95% confidence intervals (CI) for death from any cause, breast cancer, and causes other than breast cancer, according to HEI-2005 quintiles. RESULTS: Over 9.6 years, 415 deaths occurred. After adjustment for key covariates, women consuming better quality diets had a 26% lower risk of death from any cause (HRQ4:Q1, 0.74; 95% CI, 0.55-0.99; Ptrend = 0.043) and a 42% lower risk of death from non-breast cancer causes (HRQ4:Q1, 0.58; 95% CI, 0.38-0.87; Ptrend = 0.011). HEI-2005 score was not associated with breast cancer death (HRQ4:Q1, 0.91; 95% CI, 0.60-1.40; Ptrend = 0.627). In analyses stratified by tumorestrogen receptor (ER) status, better diet quality was associated with a reduced risk of all-cause mortality among women with ER(+) tumors (n = 1,758; HRQ4:Q1, 0.55; 95% CI, 0.38-0.79; Ptrend = 0.0009). CONCLUSION: Better postdiagnosis diet quality was associated with reduced risk of death, particularly from non-breast cancer causes. IMPACT: Breast cancer survivors may experience improved survival by adhering to U.S. dietary guidelines.
Authors: Jennifer Hays; Julie R Hunt; F Allan Hubbell; Garnet L Anderson; Marian Limacher; Catherine Allen; Jacques E Rossouw Journal: Ann Epidemiol Date: 2003-10 Impact factor: 3.797
Authors: Robert D Langer; Emily White; Cora E Lewis; Jane M Kotchen; Susan L Hendrix; Maurizio Trevisan Journal: Ann Epidemiol Date: 2003-10 Impact factor: 3.797
Authors: Hannah Arem; Jill Reedy; Josh Sampson; Li Jiao; Albert R Hollenbeck; Harvey Risch; Susan T Mayne; Rachael Z Stolzenberg-Solomon Journal: J Natl Cancer Inst Date: 2013-08-15 Impact factor: 13.506
Authors: Katherine W Reeves; Mary Díaz Santana; JoAnn E Manson; Susan E Hankinson; R Thomas Zoeller; Carol Bigelow; Lifang Hou; Jean Wactawski-Wende; Simin Liu; Lesley Tinker; Antonia M Calafat Journal: Environ Res Date: 2018-10-30 Impact factor: 6.498
Authors: Jiali Zheng; Fred K Tabung; Jiajia Zhang; Angela D Liese; Nitin Shivappa; Judith K Ockene; Bette Caan; Candyce H Kroenke; James R Hébert; Susan E Steck Journal: Cancer Epidemiol Biomarkers Prev Date: 2018-01-22 Impact factor: 4.254
Authors: Stephanie M George; Rachel Ballard-Barbash; JoAnn E Manson; Jill Reedy; James M Shikany; Amy F Subar; Lesley F Tinker; Mara Vitolins; Marian L Neuhouser Journal: Am J Epidemiol Date: 2014-07-17 Impact factor: 4.897
Authors: Stephanie M George; Catherine M Alfano; Marian L Neuhouser; Ashley W Smith; Richard N Baumgartner; Kathy B Baumgartner; Leslie Bernstein; Rachel Ballard-Barbash Journal: J Cancer Surviv Date: 2014-07-08 Impact factor: 4.442