Adiposity and cancer survival: a systematic review and meta-analysis

Cheng, En; Kirley, Jocelyn; Feliciano, Elizabeth M. Cespedes; Caan, Bette J.

doi:10.1007/s10552-022-01613-7

Cited by 25 publications

(24 citation statements)

References 273 publications

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“…Conversely, strongest adherence to the alcohol and BMI recommendations was not significantly associated with improved outcomes, but overweight was associated with significantly improved survival. These findings are not entirely unexpected, because conflicting evidence and competing hypotheses regarding associations of alcohol and BMI with survival exist and associations may not be linear . For example, overweight is often associated with improved BC survival in the extant literature (ie, an overweight paradox) .…”

Section: Discussionmentioning

confidence: 94%

“…These findings are not entirely unexpected, because conflicting evidence and competing hypotheses regarding associations of alcohol and BMI with survival exist and associations may not be linear. 13,15,[41][42][43][44][45][46][47][48][49][50] For example, overweight is often associated with improved BC survival in the extant literature (ie, an overweight paradox). [48][49][50] Although viable biological pathways have been proposed, methodologic issues, such as reliance on BMI as a proxy for adiposity or collider bias, may underly observed survival advantages among patients with overweight herein and in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…13,15,[41][42][43][44][45][46][47][48][49][50] For example, overweight is often associated with improved BC survival in the extant literature (ie, an overweight paradox). [48][49][50] Although viable biological pathways have been proposed, methodologic issues, such as reliance on BMI as a proxy for adiposity or collider bias, may underly observed survival advantages among patients with overweight herein and in the literature. [48][49][50][51] positive percent change in effect, indicating that the HR representing the association of the lifestyle index with survival was attenuated when that factor was excluded (ie, the HR increased).…”

Section: Discussionmentioning

confidence: 99%

“…[48][49][50] Although viable biological pathways have been proposed, methodologic issues, such as reliance on BMI as a proxy for adiposity or collider bias, may underly observed survival advantages among patients with overweight herein and in the literature. [48][49][50][51] positive percent change in effect, indicating that the HR representing the association of the lifestyle index with survival was attenuated when that factor was excluded (ie, the HR increased). A negative percent change indicates the HR decreased (ie, the association was strengthened) when the factor was excluded.…”

Section: Discussionmentioning

confidence: 99%

“…For example, overweight is often associated with improved BC survival in the extant literature (ie, an overweight paradox) . Although viable biological pathways have been proposed, methodologic issues, such as reliance on BMI as a proxy for adiposity or collider bias, may underly observed survival advantages among patients with overweight herein and in the literature …”

Section: Discussionmentioning

confidence: 99%

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Adherence to Cancer Prevention Lifestyle Recommendations Before, During, and 2 Years After Treatment for High-risk Breast Cancer

et al. 2023

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ImportanceThe American Institute for Cancer Research and American Cancer Society regularly publish modifiable lifestyle recommendations for cancer prevention. Whether these recommendations have an impact on high-risk breast cancer survival remains unknown.ObjectiveTo investigate whether adherence to cancer prevention recommendations before, during, and 1 and 2 years after breast cancer treatment was associated with disease recurrence or mortality.Design, Setting, and ParticipantsThe Diet, Exercise, Lifestyles, and Cancer Prognosis Study (DELCaP) was a prospective, observational cohort study designed to assess lifestyles before diagnosis, during treatment, and at 1 and 2 years after treatment completion, implemented ancillary to the Southwest Oncology Group (SWOG) S0221 trial, a multicenter trial that compared chemotherapy regimens in breast cancer. Participants were chemotherapy-naive patients with pathologic stage I to III high-risk breast cancer, defined as node-positive disease with hormone receptor–negative tumors larger than 1 cm or any tumor larger than 2 cm. Patients with poor performance status and comorbidities were excluded from S0221. The study was conducted from January 1, 2005, to December 31, 2010; mean (SD) follow-up time for those not experiencing an event was 7.7 (2.1) years through December 31, 2018. The analyses reported herein were performed from March 2022 to January 2023.ExposureAn aggregated lifestyle index score comprising data from 4 time points and 7 lifestyles, including (1) physical activity, (2) body mass index, (3) fruit and vegetable consumption, (4) red and processed meat intake, (5) sugar-sweetened beverage consumption, (6) alcohol consumption, and (7) smoking. Higher scores indicated healthier lifestyle.Main Outcomes and MeasuresDisease recurrence and all-cause mortality.ResultsA total of 1340 women (mean [SD] age, 51.3 [9.9] years) completed the baseline questionnaire. Most patients were diagnosed with hormone-receptor positive breast cancer (873 [65.3%]) and completed some education beyond high school (954 [71.2%]). In time-dependent multivariable analyses, patients with highest vs lowest lifestyle index scores experienced a 37.0% reduction in disease recurrence (hazard ratio, 0.63; 95% CI, 0.48-0.82) and a 58.0% reduction in mortality (hazard ratio, 0.42; 95% CI, 0.30-0.59).Conclusions and RelevanceIn this observational study of patients with high-risk breast cancer, strongest collective adherence to cancer prevention lifestyle recommendations was associated with significant reductions in disease recurrence and mortality. Education and implementation strategies to help patients adhere to cancer prevention recommendations throughout the cancer care continuum may be warranted in breast cancer.

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Section: Discussionmentioning

confidence: 94%