Low-fat dietary pattern and breast cancer mortality by metabolic syndrome degree: Secondary analyses of the Women’s Health Initiative (WHI) Dietary Modification randomized trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1539-1539
Author(s):  
Kathy Pan ◽  
Aaron K Aragaki ◽  
Marian L Neuhouser ◽  
Michael S. Simon ◽  
Juhua Luo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Cancer Mortality ◽  
Dietary Intervention ◽  
Comparison Group ◽  
Breast Cancer Mortality ◽  
Low Fat ◽  
Hazard Ratios

1539 Background: The WHI Diet Modification (DM) trial randomized 48,835 postmenopausal women with no prior breast cancer to a low-fat dietary intervention or comparison group. After 16.1 years follow-up, the intervention was associated with an 18% reduction in risk of death after breast cancer (P =0.01), with greater reduction (29%) in those with waist circumference≥88 cm (J Clin Oncol 2017). To extend these findings, we examined the influence of the dietary intervention on breast cancer mortality in subgroups defined by number of metabolic syndrome (MS) components with 19.6 years median cumulative follow-up. Methods: WHI DM has been previously described. Four MS components were determined at entry: 1) waist circumference≥ 88 cm, 2) high blood pressure or anti-hypertensive use, 3) high cholesterol history and 4) diabetes history, with women categorized as having 0 (n=10,639), 1-2 (n=30,948), or 3-4 (n=4,246) MS components. Forest plots of hazard ratios (HRs) were generated with P-values for interaction between randomized group assignment and number of MS components. Results: Women with 3-4 MS components were more likely to be Black, be obese (BMI ≥30), and have diabetes (all P < 0.001). Breast cancers in women with 3-4 MS components were less likely to be local stage (P = 0.005) or well differentiated (P = 0.03). The magnitude of reduction in deaths from breast cancer in the dietary intervention vs comparison group increased as the number of MS components increased (interaction P = 0.01). Hazard ratios (HR) and 95% confidence intervals (CI) for death from breast cancer for intervention vs comparison groups for women with 0 MS components was 1.09 95% CI, 0.63-1.87, with risk low in both randomization groups (0.028% and 0.026%, respectively); for women with 1-2 MS components, HR 0.80 95% CI 0.62-1.02; and for women with 3-4 MS components, HR 0.31 95% CI, 0.14-0.69, with risk in the intervention group reduced to 0.026%. Conclusions: Adoption of a low-fat dietary pattern had a greater effect on reducing deaths from breast cancer in women with more MS components, suggesting that this is a high risk group more likely to benefit from the dietary intervention. Clinical trial information: NCT00000611.

scholarly journals Low-Fat Dietary Pattern and Cancer Mortality in the Women’s Health Initiative (WHI) Randomized Controlled Trial

2018 ◽  
Vol 2 (4) ◽  
Author(s):  
Rowan T Chlebowski ◽  
Garnet L Anderson ◽  
JoAnn E Manson ◽  
Ross L Prentice ◽  
Aaron K Aragaki ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Women's Health ◽  
Cancer Mortality ◽  
Dietary Pattern ◽  
Dietary Intervention ◽  
Low Fat ◽  
Women's Health Initiative ◽  
Health Initiative ◽  
The Women’S Health Initiative

Abstract Background In the Women’s Health Initiative Dietary Modification trial, a low-fat dietary pattern reduced deaths after breast cancer. Mortality from other cancer sites has not been reported. Methods A low-fat dietary pattern influence on deaths from and after site-specific cancers was examined during 8.5 years (median) of dietary intervention and cumulatively during 17.7 years (median) of follow-up. A total 48 835 postmenopausal women, ages 50–79 years, were randomly assigned from 1993 to 1998 at 40 US clinical centers to dietary intervention (40%, n = 19 541 or a usual diet comparison group (60%, n = 29 294). Dietary intervention influence on mortality from protocol-specified cancers (breast, colon and rectum, endometrium and ovary), individually and as a composite, represented the primary analyses. Results During the dietary intervention period, a reduction in deaths after breast cancer (HR = 0.65 95% CI = 0.45 to 0.94, P = .02) was the only statistically significant cancer mortality finding. During intervention, the HRs for deaths after the protocol-specified cancer composite were 0.90 (95% CI = 0.73 to 1.10) and 0.95 (95% CI = 0.85 to 1.06) for deaths after all cancers. During 17.7 years of follow-up with 3867 deaths after all cancers, reduction in deaths after breast cancer continued in the dietary intervention group (HR = 0.85, 95% CI = 0.74 to 0.99, P = .03). However, no dietary intervention influence on deaths from or after any other cancer or cancer composite was seen. Conclusions A low-fat dietary pattern reduced deaths after breast cancer. No reduction in mortality from or after any other cancer or cancer composite was seen.

Mammography Surveillance and Mortality in Older Breast Cancer Survivors

2007 ◽  
Vol 25 (21) ◽  
pp. 3001-3006 ◽  
Author(s):  
Timothy L. Lash ◽  
Matthew P. Fox ◽  
Diana S.M. Buist ◽  
Feifei Wei ◽  
Terry S. Field ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Mortality ◽  
Breast Cancer Survivors ◽  
Care Delivery ◽  
Breast Cancer Mortality ◽  
The United States ◽  
Stage I ◽  
Early Stage Disease

Purpose There are more than 2,000,000 breast cancer survivors in the United States today. While surveillance for asymptomatic recurrence and second primary is included in consensus recommendations, the effectiveness of this surveillance has not been well characterized. Our purpose is to estimate the effectiveness of surveillance mammography in a cohort of breast cancer survivors with complete ascertainment of surveillance mammograms and negligible losses to follow-up. Patients and Methods We enrolled 1,846 stage I and II breast cancer patients who were at least 65 years old at six integrated health care delivery systems. We used medical record review and existing databases to ascertain patient, tumor, and therapy characteristics, as well as receipt of surveillance mammograms. We linked personal identifiers to the National Death Index to ascertain date and cause of death. We matched four controls to each breast cancer decedent to estimate the association between receipt of surveillance mammogram and breast cancer mortality. Results One hundred seventy-eight women died of breast cancer during 5 years of follow-up. Each additional surveillance mammogram was associated with a 0.69-fold decrease in the odds of breast cancer mortality (95% CI, 0.52 to 0.92). The protective association was strongest among women with stage I disease, those who received mastectomy, and those in the oldest age group. Conclusion Given existing recommendations for post-therapy surveillance, trials to compare surveillance with no surveillance are unlikely. This large observational study provides support for the recommendations, suggesting that receipt of surveillance mammograms reduces the rate of breast cancer mortality in older patients diagnosed with early-stage disease.

Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II

2019 ◽  
Vol 177 (3) ◽  
pp. 679-689 ◽  
Author(s):  
Samantha Puvanesarajah ◽  
Susan M. Gapstur ◽  
Alpa V. Patel ◽  
Mark E. Sherman ◽  
W. Dana Flanders ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Prevention ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Tumor Characteristics ◽  
Prevention Study ◽  
Mode Of Detection

scholarly journals Hormone replacement therapy and mortality in 52- to 70-year-old women: the Kuopio Osteoporosis Risk Factor and Prevention Study

2006 ◽  
Vol 154 (1) ◽  
pp. 101-107 ◽  
Author(s):  
Kati Pentti ◽  
Risto Honkanen ◽  
Marjo T Tuppurainen ◽  
Lorenzo Sandini ◽  
Heikki Kröger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factor ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Cancer Mortality ◽  
Hormone Replacement ◽  
Breast Cancer Mortality ◽  
Prevention Study ◽  
Osteoporosis Risk

Objectives: To analyze prospectively the association between hormone replacement therapy (HRT) and mortality in women before old age. Design and methods: A group of 11 667 women (91% of the age cohort of the area) aged 52–62 years from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study were followed for 7 years in 1994–2001. Information about HRT use and health events was obtained from two repeated questionnaires in 1989 and 1994. Information about deaths and causes of death from the follow-up period was obtained from the Statistics Finland. Cox’s proportional-hazards models were used to calculate risk of death related to the use of HRT. Results: At the start of follow-up, 2203 women had used HRT >5 years, 3945 women ≤5 years and 5519 women had never used it. During the follow-up, 361 deaths occurred. Compared with non-users of HRT, the adjusted hazard ratio (HR) of death from any cause was 1.05 (95% confidence interval (CI) 0.80–1.36) in women who used HRT ≤5 years and 1.06 (95% CI 0.78–1.46) in women who used HRT >5 years. The adjusted HR for coronary heart disease (CHD) mortality in women who used HRT ≤5 years was 0.79 (95% CI 0.36–1.73), and in women who used HRT >5 years, 2.16 (95% CI 0.93–4.98). For breast cancer mortality the adjusted HR for ≤5 years of HRT use was 0.96 (95% CI 0.32–2.82) and 2.62 (95% CI 0.98–7.00) for >5 years of HRT use. Conclusions: History of HRT use does not affect overall or CHD mortality in women. More than 5 years of HRT use may increase the risk of breast cancer mortality.

scholarly journals Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype

2018 ◽  
Vol 174 (1) ◽  
pp. 209-218 ◽  
Author(s):  
Daniel T. Dibaba ◽  
Kemi Ogunsina ◽  
Dejana Braithwaite ◽  
Tomi Akinyemiju
Keyword(s):  
Breast Cancer ◽  
Metabolic Syndrome ◽  
Cancer Mortality ◽  
Breast Cancer Mortality

scholarly journals Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes

2019 ◽  
Vol 149 (9) ◽  
pp. 1565-1574 ◽  
Author(s):  
Ross L Prentice ◽  
Aaron K Aragaki ◽  
Barbara V Howard ◽  
Rowan T Chlebowski ◽  
Cynthia A Thomson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Dietary Fat ◽  
Dietary Pattern ◽  
Cancer Colorectal ◽  
Comparison Group ◽  
Intervention Group ◽  
Intervention Period ◽  
Low Fat

ABSTRACT Background The preferred macronutrient dietary composition, and the health consequences of dietary fat reduction specifically, have been debated for decades. Here we provide a comprehensive overview of long-term health outcomes in the Women's Health Initiative Dietary Modification (DM) trial. Objective The DM trial aimed to examine whether a low-fat dietary pattern would reduce the risk of invasive breast cancer, colorectal cancer, and, secondarily, coronary heart disease (CHD), with various other health outcomes also considered. Methods The DM trial is a randomized controlled trial conducted at 40 centers in the US, among 48,835 postmenopausal women aged 50–79 y with baseline intake of ≥32% energy from fat. Participants were randomly assigned to a low-fat dietary pattern intervention group or to a usual-diet comparison group, during 1993–1998. Intervention goals were to reduce fat intake from ∼35% to 20% of total energy, in conjunction with increasing vegetables and fruit to 5 servings/d and grains to 6 servings/d. Results Over an 8.5-y (median) intervention period, intervention and comparison group differences included lower fat by 8–10%, and higher carbohydrate by 8–10%, of total energy, in conjunction with higher consumption of vegetables, fruit, and grains. Time-to-outcome analyses did not show significant differences between intervention and comparison groups for invasive breast cancer, colorectal cancer, or CHD, either over the intervention period or over longer-term cumulative follow-up. Additional analyses showed significant intervention group benefits related to breast cancer, CHD, and diabetes, without adverse effects. Over a 19.6-y (median) follow-up period, HRs (95% CIs) were 0.84 (0.74, 0.96) for breast cancer followed by death, and 0.87 (0.77, 0.98) for diabetes requiring insulin. Conclusions Reduction in dietary fat with corresponding increase in vegetables, fruit, and grains led to benefits related to breast cancer, CHD, and diabetes, without adverse effects, among healthy postmenopausal US women. This trial was registered at clinicaltrials.gov as NCT00000611.

scholarly journals Mammography Screening: Keeping Women Alive

2011 ◽  
Vol 7 (6) ◽  
pp. 631-633 ◽  
Author(s):  
André LM Verbeek
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Interval Cancer ◽  
Positive Outcome ◽  
Mammographic Screening ◽  
Breast Cancer Death ◽  
Human Cost ◽  
The Uk

Evaluation of: Tabár L, Vitak B, Chen TH et al. Swedish Two-County Trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology 260(3), 658–663 (2011). In the 1980s, the periodic invitation of women aged 40–69 years for mammographic screening in the Swedish Two-County Trial showed a strong 30% reduction in breast cancer mortality. The result of 2–3-yearly mammographic examinations has persisted throughout the long follow-up of three decades. Through the richness of the collected and verified data, the trial has also demonstrated a substantial and absolute reduction in mortality risk. For each 414 women screened for 7 years (approximately four screening examinations), one breast cancer death was prevented. Transferring these outcomes to, for example, the national program of the UK, for every 1000 women aged 47–73 years attending the 3-yearly screenings (nine screening examinations) at least five to seven breast cancer deaths would be prevented. In recent follow-up papers by the Swedish trial group, the major human cost of screening (false-positive outcome, occurrence of interval cancer, overdiagnosis and radiation exposure) were judged to be in balance with the accurately demonstrated mortality benefit.

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