Impact of Lifestyle Factors on Prognosis Among Breast Cancer Survivors in the USA

Table 1.  Large-scale studies evaluating the effects of diet on breast cancer mortality and recurrence.

Study	Type	Participants	Dietary factor(s)	Results	Ref.
NHS	PC	1982	Fat intake	No association	[19]
		2619	Prudent versus Western diet	No association	[21]
		2729	Four dietary quality indices	No association	[22]
LACE	PC	2321	>100 foods, beverages, nutritional supplements and medicinal herbs	No association	[23]
		1901	Prudent versus Western diet	No association	[24]
HEAL	PC	670	Quality versus poor diet	Reduced risk of breast cancer mortality with quality diet	[25]
		746	Quality versus poor diet	Lower CRP levels with quality diet	[26]
		688	Fiber, carbohydrates, glycemic index and glycemic load	Nonsignificant relationship between dietary fiber and breast cancer recurrence and mortality	[27]
WINS	RCT	975 cases; 1462 controls	Low-fat diet versus minimal nutritional counseling	Cases had higher relapse-free survival	[28]
WHEL	RCT	1537 cases; 1551 controls	High-fruit/vegetable versus 5-A-Day for Better Health Program diet	No association	[29]

CRP: C-reactive protein; NHS: Nurses' Health Study; PC: Prospective cohort; RCT: Randomized controlled trial.

†All physical activities were self-reported.
MET: Metabolic equivalent task; NHS: Nurses' Health Study; PC: Prospective cohort; WHI: Women's Health Inititative.

Authors and Disclosures

Rachel E Ellsworth¹, Allyson L Valente², Craig D Shriver³, Barry Bittman⁴ and Darrell L Ellsworth*<sup>2

1</sup>Clinical Breast Care Project, Henry M Jackson Foundation for the Advancement of Military Medicine, 620 Seventh Street, Windber, PA 15963, USA
²Clinical Breast Care Project, Windber Research Institute, 620 Seventh Street, Windber, PA 15963, USA
³Clinical Breast Care Project, Walter Reed National Military Medical Center, 8901 Rockville Pike, Building 19, 3rd floor, Bethesda, MD 20889, USA
⁴Mind–Body Wellness Center, 18201 Conneaut Lake Road Meadville, PA 16335, USA

Disclaimer
The opinion and assertions contained herein are the private views of the authors and are not to be construed as official or as representing the views of the Department of the Army or the Department of Defense.

*Author for correspondence
Tel.: +1 814 361 6911 Fax: +1 814 467 6334 d.ellsworth@wriwindber.org

Sidebar

Key Issues

• Due mainly to advances in early detection and treatment, there are an estimated 2.5 million breast cancer survivors in the USA alone, and this number is projected to increase to 3.4 million within the next 4 years. Behavioral modification has great potential to improve prognosis and quality of life in breast cancer survivors.

• Achieving or maintaining a healthy weight after diagnosis is associated with improved prognosis. A healthy diet may not affect breast cancer prognosis but has been associated with increased overall survival.

• Limited research suggests that certain types of alcohol, vitamin supplements, soy and green tea may have some beneficial properties for breast cancer survivors; however, large-scale studies are needed to provide conclusive results and specific recommendations for consumption.

• Moderate physical activity can ameliorate side effects during treatment, and improve breast cancer prognosis and overall survival after treatment.

• Contrary to the long-held belief that patients affected with, or at-risk for, lymphedema should limit use of the affected/at-risk arm, progressive supervised strength training can decrease symptoms and improve outcomes.

• Stress-reduction techniques such as group support and yoga have shown promising results in improving outcomes and quality of life, but further research is essential for quantifying potential benefits in breast cancer patients.

• As more effective healthy lifestyle interventions evolve, important issues such as who will derive the most benefit, when lifestyle interventions should be initiated, how and where programs should be facilitated, and who will pay for healthy lifestyle programs, must be resolved in order for lifestyle modification to have a meaningful impact on the lives of breast cancer survivors.