Animal and in vitro studies suggest that aspirin may inhibit breast cancer metastasis. We studied whether aspirin use among women with breast cancer decreased their risk of death from breast cancer.
...This was a prospective observational study based on responses from 4,164 female registered nurses in the Nurses' Health Study who were diagnosed with stages I, II, or III breast cancer between 1976 and 2002 and were observed until death or June 2006, whichever came first. The main outcome was breast cancer mortality risk according to number of days per week of aspirin use (0, 1, 2 to 5, or 6 to 7 days) first assessed at least 12 months after diagnosis and updated.
There were 341 breast cancer deaths. Aspirin use was associated with a decreased risk of breast cancer death. The adjusted relative risks (RRs) for 1, 2 to 5, and 6 to 7 days of aspirin use per week compared with no use were 1.07 (95% CI, 0.70 to 1.63), 0.29 (95% CI, 0.16 to 0.52), and 0.36 (95% CI, 0.24 to 0.54), respectively (test for linear trend, P < .001). This association did not differ appreciably by stage, menopausal status, body mass index, or estrogen receptor status. Results were similar for distant recurrence. The adjusted RRs were 0.91 (95% CI, 0.62 to 1.33), 0.40 (95% CI, 0.24 to 0.65), and 0.57 (95% CI, 0.39 to 0.82; test for trend, P = .03) for 1, 2 to 5, and 6 to 7 days of aspirin use, respectively.
Among women living at least 1 year after a breast cancer diagnosis, aspirin use was associated with a decreased risk of distant recurrence and breast cancer death.
Holmes and Peng discuss the article by Bitsie et al. entitled "Dietary vitamin A and breast cancer risk in Black women: the AMBER Consortium," which is published within the issue. They state that the ...article is important because it hints at a possible way to reduce racial disparities in breast cancer incidence. These investigators found that, in this population of Black women, increased intake of vitamin A was associated with a reduced risk of developing breast cancer.
CONTEXT Physical activity has been shown to decrease the incidence of breast
cancer, but the effect on recurrence or survival after a breast cancer diagnosis
is not known. OBJECTIVE To determine ...whether physical activity among women with breast cancer
decreases their risk of death from breast cancer compared with more sedentary
women. DESIGN, SETTING, AND PARTICIPANTS Prospective observational study based on responses from 2987 female
registered nurses in the Nurses’ Health Study who were diagnosed with
stage I, II, or III breast cancer between 1984 and 1998 and who were followed
up until death or June 2002, whichever came first. MAIN OUTCOME MEASURE Breast cancer mortality risk according to physical activity category
(<3, 3-8.9, 9-14.9, 15-23.9, or ≥24 metabolic equivalent task MET
hours per week). RESULTS Compared with women who engaged in less than 3 MET-hours per week of
physical activity, the adjusted relative risk (RR) of death from breast cancer
was 0.80 (95% confidence interval CI, 0.60-1.06) for 3 to 8.9 MET-hours
per week; 0.50 (95% CI, 0.31-0.82) for 9 to 14.9 MET-hours per week; 0.56
(95% CI, 0.38-0.84) for 15 to 23.9 MET-hours per week; and 0.60 (95% CI, 0.40-0.89)
for 24 or more MET-hours per week (P for trend =
.004). Three MET-hours is equivalent to walking at average pace of 2 to 2.9
mph for 1 hour. The benefit of physical activity was particularly apparent
among women with hormone-responsive tumors. The RR of breast cancer death
for women with hormone-responsive tumors who engaged in 9 or more MET-hours
per week of activity compared with women with hormone-responsive tumors who
engaged in less than 9 MET-hours per week was 0.50 (95% CI, 0.34-0.74). Compared
with women who engaged in less than 3 MET-hours per week of activity, the
absolute unadjusted mortality risk reduction was 6% at 10 years for women
who engaged in 9 or more MET-hours per week. CONCLUSIONS Physical activity after a breast cancer diagnosis may reduce the risk
of death from this disease. The greatest benefit occurred in women who performed
the equivalent of walking 3 to 5 hours per week at an average pace, with little
evidence of a correlation between increased benefit and greater energy expenditure.
Women with breast cancer who follow US physical activity recommendations may
improve their survival.
Androgen receptor (AR) is commonly expressed in breast cancers. However, the association between tumor AR status and breast cancer survival is uncertain. Hence, we examined the association between AR ...status and breast cancer survival in the Nurses' Health Study (NHS).
It was a prospective study of postmenopausal women enrolled in the Nurses' Health Study with stage I to III breast cancer diagnosed between 1976 and 1997 and followed from the date of diagnosis until January 1, 2008 or death. Analyses were conducted using Kaplan-Meier methods and Cox proportional hazard models, to determine the association of AR status with survival outcomes adjusting for covariates.
Among 1467 breast cancers, 78.7% were AR-positive (AR+). Among 1,164 estrogen receptor (ER)-positive cases, 88.0% were AR+. AR positivity was associated with a significant reduction in breast cancer mortality (HR, 0.68; 95% CI, 0.47-0.99) and overall mortality (HR, 0.70; 95% CI, 0.53-0.91) after adjustment for covariates. In contrast, among women with ER-negative tumors (303 cases), 42.9% were AR+. There was a nonsignificant association between AR status and breast cancer death (HR, 1.59; 95% CI, 0.94-2.68).
The association of AR status and breast cancer survival is dependent on ER status. In particular, AR expression was associated with a more favorable prognosis among women with ER-positive tumors. Thus, determination of AR status may provide additional information on prognosis for postmenopausal women with breast cancer, and provide novel opportunities for targeted therapy.
We prospectively examined social ties and survival after breast cancer diagnosis.
Participants included 2,835 women from the Nurses' Health Study who were diagnosed with stages 1 to 4 breast cancer ...between 1992 and 2002. Of these women, 224 deaths (107 of these related to breast cancer) accrued to the year 2004. Social networks were assessed in 1992, 1996, and 2000 with the Berkman-Syme Social Networks Index. Social support was assessed in 1992 and 2000 as the presence and availability of a confidant. Cox proportional hazards models were used in prospective analyses of social networks and support, both before and following diagnosis, and subsequent survival.
In multivariate-adjusted analyses, women who were socially isolated before diagnosis had a subsequent 66% increased risk of all-cause mortality (HR = 1.66; 95% CI, 1.04 to 2.65) and a two-fold increased risk of breast cancer mortality (HR = 2.14; 95% CI, 1.11 to 4.12) compared with women who were socially integrated. Women without close relatives (HR = 2.65; 95% CI, 1.03 to 6.82), friends (HR = 4.06; 95% CI, 1.40 to 11.75), or living children (HR = 5.62; 95% CI, 1.20 to 26.46) had elevated risks of breast cancer mortality and of all-cause mortality compared with those with the most social ties. Neither participation in religious or community activities nor having a confidant was related to outcomes. Effect estimates were similar in analyses of postdiagnosis networks.
Socially isolated women had an elevated risk of mortality after a diagnosis of breast cancer, likely because of a lack of access to care, specifically beneficial caregiving from friends, relatives, and adult children.
•Neighborhood socioeconomic status is associated with lower inflammation.•Concentration of high-income residents is associated with lower inflammation.•Higher neighborhood greenness is associated ...with lower inflammation in women.•Neighborhood context may affect inflammation independently of lifestyles.
Neighborhood deprivation is linked with inflammation, which may explain poorer health across populations. Behavioral risk factors are assumed to largely mediate these relationships, but few studies have examined this. We examined three neighborhood contextual factors that could exert direct effects on inflammation: (1) neighborhood socioeconomic status, (2) an index of concentration at extremes (that measures segregation), and (3) surrounding vegetation (greenness).
Using blood samples and addresses collected from prospective cohorts of 7,930 male (1990–1994) and 16,183 female (1986–1990) health professionals with at least one inflammatory marker, we prospectively linked neighborhood contextual factors to inflammatory biomarkers (adiponectin, C-reactive protein, interleukin-6, soluble tumor necrosis factor receptor-2). Log-transformed, z-scaled component measures were used to calculate an inflammation score. Neighborhood socioeconomic status and index of concentration of extremes were obtained from the 1990 decennial census and linked to participant addresses. Surrounding greenness was assessed from satellite data and focal statistics were applied to generate exposures within 270 m and 1230 m of the participants’ address. We fit multiple linear regression models adjusting for demographic, clinical, and behavioral risk factors.
Higher neighborhood socioeconomic status was associated with lower inflammation score in women (β for interquartile range increase = −27.7%, 95% CI: −34.9%, −19.8%) and men (β = −21.2%, 95% CI: −31.0%, −10.1%). Similarly, participants in neighborhoods with higher concentrations of high-income households were associated with lower inflammation score in women (β = −27.8%, 95% CI: −35.8%, −18.7%) and men (β = -16.4%, 95% CI: −29.7%, −0.56%). Surrounding greenness within 270 m of each participant’s address was associated with lower inflammation score in women (β = -18.9%, 95% CI: −28.9%, −7.4%) but not men. Results were robust to sensitivity analyses to assess unmeasured confounding and selection bias.
Our findings support the hypothesis that adverse neighborhood environments may contribute to inflammation through pathways independent of behavioral risk factors, including psychosocial stress and toxic environments.
Background Sub-Saharan Africa (SSA) has a disproportionate burden of both infectious and chronic diseases compared with other world regions. Current disease estimates for SSA are based on sparse ...data, but projections indicate increases in non-communicable diseases (NCDs) caused by demographic and epidemiologic transitions. We review the literature on NCDs in SSA and summarize data from the World Health Organization and International Agency for Research on Cancer on the prevalence and incidence of cardiovascular diseases, diabetes mellitus Type 2, cancer and their risk factors.
Methods We searched the PubMed database for studies on each condition, and included those that were community based, conducted in any SSA country and reported on disease or risk factor prevalence, incidence or mortality.
Results We found few community-based studies and some countries (such as South Africa) were over-represented. The prevalence of NCDs and risk factors varied considerably between countries, urban/rural location and other sub-populations. The prevalence of stroke ranged from 0.07 to 0.3%, diabetes mellitus from 0 to 16%, hypertension from 6 to 48%, obesity from 0.4 to 43% and current smoking from 0.4 to 71%. Hypertension prevalence was consistently similar among men and women, whereas women were more frequently obese and men were more frequently current smokers.
Conclusions The prevalence of NCDs and their risk factors is high in some SSA settings. With the lack of vital statistics systems, epidemiologic studies with a variety of designs (cross-sectional, longitudinal and interventional) capable of in-depth analyses of risk factors could provide a better understanding of NCDs in SSA, and inform health-care policy to mitigate the oncoming NCD epidemic.
Hydroxylation of 25(OH)D to 1,25-dihydroxyvitamin D and signaling through the vitamin D receptor occur in various tissues not traditionally involved in calcium homeostasis. Laboratory studies ...indicate that 1,25-dihydroxyvitamin D suppresses renin expression and vascular smooth muscle cell proliferation; clinical studies demonstrate an inverse association between ultraviolet radiation, a surrogate marker for vitamin D synthesis, and blood pressure. We prospectively studied the independent association between measured plasma 25-hydroxyvitamin D 25(OH)D levels and risk of incident hypertension and also the association between predicted plasma 25(OH)D levels and risk of incident hypertension. Two prospective cohort studies including 613 men from the Health Professionals’ Follow-Up Study and 1198 women from the Nurses’ Health Study with measured 25(OH)D levels were followed for 4 to 8 years. In addition, 2 prospective cohort studies including 38 388 men and 77 531 women with predicted 25(OH)D levels were followed for 16 to 18 years. During 4 years of follow-up, the multivariable relative risk of incident hypertension among men whose measured plasma 25(OH)D levels were <15 ng/mL (ie, vitamin D deficiency) compared with those whose levels were ≥30 ng/mL was 6.13 (95% confidence interval CI1.00 to 37.8). Among women, the same comparison yielded a relative risk of 2.67 (95% CI1.05 to 6.79). The pooled relative risk combining men and women with measured 25(OH)D levels using the random-effects model was 3.18 (95% CI1.39 to 7.29). Using predicted 25(OH)D levels in the larger cohorts, the multivariable relative risks comparing the lowest to highest deciles were 2.31 (95% CI2.03 to 2.63) in men and 1.57 (95% CI1.44 to 1.72) in women. Plasma 25(OH)D levels are inversely associated with risk of incident hypertension.
Background
Associations between fiber intake and breast cancer risk have been evaluated in prospective studies, but overall, the evidence is inconsistent. The authors performed a systematic review ...and meta‐analysis of prospective studies to investigate the relation between intake of total and types of fiber with breast cancer incidence.
Methods
The MEDLINE and Excerpta Medica dataBASE (EMBASE) databases were searched through July 2019 for prospective studies that reported on the association between fiber consumption and incident breast cancer. The pooled relative risk (RR) and 95% confidence intervals (95% CI) were estimated comparing the highest versus the lowest category of total and types of fiber consumption, using a random‐effects meta‐analysis.
Results
The authors identified 17 cohort studies, 2 nested case‐control studies, and 1 clinical trial study. Total fiber consumption was associated with an 8% lower risk of breast cancer (comparing the highest versus the lowest category, pooled RR, 0.92; 95% CI, 0.88‐0.95 I2 = 12.6%). Soluble fiber was found to be significantly inversely associated with risk of breast cancer (pooled RR, 0.90 95% CI, 0.84‐0.96; I2 = 12.6%) and insoluble fiber was found to be suggestively inversely associated with risk of breast cancer (pooled RR, 0.93 95% CI, 0.86‐1.00; I2 = 33.4%). Higher total fiber intake was associated with a lower risk of both premenopausal and postmenopausal breast cancers (pooled RR, 0.82 95% CI, 0.67‐0.99; I2 = 35.2% and pooled RR, 0.91 95% CI, 0.88‐0.95; I2 = 0.0%, respectively). Furthermore, the authors observed a nonsignificant inverse association between intake of total fiber and risk of both estrogen and progesterone receptor–positive and estrogen and progesterone receptor–negative breast cancers.
Conclusions
A random‐effects meta‐analysis of prospective observational studies demonstrated that high total fiber consumption was associated with a reduced risk of breast cancer. This finding was consistent for soluble fiber as well as for women with premenopausal and postmenopausal breast cancer.
A random‐effects meta‐analysis of prospective observational studies demonstrates that high total fiber consumption is associated with a reduced risk of breast cancer. This finding appears to be consistent for soluble fiber as well as for women with premenopausal and postmenopausal breast cancer.
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