Breast Cancer Survivors - WCRF International
World Cancer Research Fund InternationalContinuous Update Project ReportSystematic review on diet, nutrition, physicalactivity and survival and second cancers in breastcancer survivorsImperial College LondonContinuous Update Project Team MembersTeresa NoratDoris ChanAna Rita VieiraDagfinn AuneDeborah Navarro RosenblattSnieguole VingelieneLeila AbarRui VieiraWCRF Coordinator:Rachel ThompsonStatistical advisor:Darren C. GreenwoodDate completed:December 2012Final version:June 20141
Table of contentsBackground . 29A.Second expert report and CUP reports on cancer survivors . 29B.Modifications to the study protocol . 29C.Results of the search . 31C1. Randomised trials . 33C2. Observational studies . 33Results from randomised controlled trials . 36Results from observational studies by exposure. . 401 Patterns of diet . 40Dietary patterns derived “a posteriori” . 40Before diagnosis dietary patterns and all-cause mortality, mortality for breast cancer andfor other causes . 4112 months or more after diagnosis dietary pattern and all-cause mortality . 4312 months or more after diagnosis dietary pattern and mortality for breast cancer . 4312 months or more after diagnosis dietary pattern and mortality for other causes . 431.1 Indices of diet quality . 46Before diagnosis indices of data quality and all-cause mortality, mortality for breastcancer and for other causes . 4612 months or more after diagnosis Indices of diet quality and all-cause mortality,mortality for breast cancer and for other causes . 482 Fruit and vegetables . 50Fruit and vegetables intake and total mortality . 50Fruit and vegetables intake and breast cancer mortality . 502.1 Vegetable intake . 51Vegetable intake and total mortality . 51Vegetable intake before diagnosis and total mortality . 52Vegetable intake less than 12 months after diagnosis and total mortality . 58Vegetable intake 12 months or more after diagnosis and total mortality . 58Vegetable intake and breast cancer mortality . 582.2 Fruit intake. 59Fruit intake and total mortality. 59Fruit intake before diagnosis and total mortality . 59Fruit intake less than 12 months after diagnosis and total mortality . 652
Fruit intake 12 months or more after diagnosis and total mortality . 65Fruit intake and breast cancer mortality . 653 Alcohol intake . 66Alcohol and total mortality . 67Alcohol intake before breast cancer diagnosis and total mortality . 67Alcohol intake less than 12 months after diagnosis and total mortality . 74Alcohol intake 12 months or more after primary breast cancer diagnosis and totalmortality . 74Alcohol and breast cancer mortality . 81Alcohol before breast cancer diagnosis and breast cancer mortality . 81Alcohol less than 12 months after diagnosis and breast cancer mortality . 86Alcohol intake 12 months or more after primary breast cancer diagnosis and breastcancer mortality . 86Alcohol and second primary breast cancer . 90Alcohol before breast cancer diagnosis and second primary breast cancer . 90Alcohol less than 12 months after diagnosis and second primary breast cancer . 90Alcohol intake 12 months or more after breast cancer diagnosis and second primarybreast cancer . 904 Dietary constituents . 964.1 Carbohydrate intake . 96Carbohydrate intake and total mortality . 96Carbohydrate intake before diagnosis and total mortality . 96Carbohydrate intake less than 12 months after diagnosis and total mortality. 101Carbohydrate intake 12 months or more after diagnosis and total mortality. 101Carbohydrate intake and breast cancer mortality . 103Carbohydrate intake before diagnosis and breast cancer mortality . 103Carbohydrate intake less than 12 months after diagnosis and breast cancer mortality 103Carbohydrate intake 12 months or more after diagnosis and breast cancer mortality . 1034.2 Glycemic index, glycemic load, total mortality and breast cancer mortality . 1074.3 Fibre intake. 107Fibre intake and total mortality . 108Fibre intake before diagnosis and total mortality. 108Fibre intake less than 12 months after diagnosis and total mortality . 112Fibre intake 12 months or more after diagnosis and total mortality . 1123
Fibre intake and breast cancer mortality . 115Fibre intake before diagnosis and breast cancer mortality . 115Fibre intake less than 12 months after diagnosis and breast cancer mortality . 115Fibre intake 12 months or more after diagnosis and breast cancer mortality . 1154.4 Total fat intake . 119Total fat intake and total mortality . 119Total fat intake before diagnosis and total mortality . 119Total fat intake less than 12 months after diagnosis and total mortality . 125Total fat intake 12 months or more after diagnosis and total mortality . 125Total fat intake and breast cancer mortality . 127Total fat intake before diagnosis and breast cancer mortality . 127Total fat intake less than 12 months after diagnosis and breast cancer mortality . 131Total fat intake 12 months or more after diagnosis and breast cancer mortality . 1314.5 Saturated fat intake . 135Saturated fat intake and total mortality . 135Saturated fat intake before diagnosis and total mortality . 135Saturated fat intake less than 12 months after diagnosis and total mortality . 139Saturated fat intake 12 months or more after diagnosis and total mortality . 139Saturated fat intake and breast cancer mortality . 139Saturated fat intake before diagnosis and breast cancer mortality . 139Saturated fat intake less than 12 months after diagnosis and breast cancer mortality . 139Saturated fat intake 12 months or more after diagnosis and breast cancer mortality . 1394.6 Protein intake . 140Protein intake and total mortality . 140Protein intake before diagnosis and total mortality . 140Protein intake less than 12 months after diagnosis and total mortality . 143Protein intake 12 months or more after diagnosis and total mortality . 143Protein intake and breast cancer mortality . 143Animal protein intake and breast cancer mortality . 143Soy protein intake and total mortality . 1434.7 Folate . 144Dietary folate and total mortality . 144Dietary folate before diagnosis and total mortality . 1444
Dietary folate less than 12 months after diagnosis and total mortality . 148Dietary folate 12 months or more after diagnosis and total mortality. 148Dietary folate and breast cancer mortality . 148Total folate and total mortality . 148Total folate before diagnosis and total mortality . 148Total folate less than 12 months after diagnosis and total mortality . 152Total folate 12 months or more after diagnosis and total mortality . 152Total folate and breast cancer mortality . 1524.8 Dietary supplement use . 152Dietary supplement use and total mortality . 152Dietary supplement use before diagnosis and total mortality . 152Dietary supplement use less than 12 months after and cancer mortality . 153Dietary supplement use 12 months or more after diagnosis and total mortality . 158Dietary supplement use and breast cancer mortality . 163Dietary supplement use before diagnosis and breast cancer mortality . 163Dietary supplement use 12 months or more after diagnosis and breast cancer mortality. 1634.9 Complementary and alternative medicine (CAM) . 1704.10 Isoflavone intake. 171Isoflavones intake and total mortality . 171Isoflavones intake before diagnosis and total mortality . 171Isoflavones intake before diagnosis and total mortality . 174Isoflavones 12 months or more after diagnosis and total mortality . 174Isoflavones intake and breast cancer mortality . 178Isoflavones intake and second primary breast cancer . 1785 Physical activity . 178Physical activity and total mortality . 179Physical activity before diagnosis and total mortality . 179Total physical activity before diagnosis and total mortality. 179Recreational physical activity before diagnosis and total mortality . 179Physical activity less than 12 months after diagnosis and total mortality . 184Physical activity 12 months or more after diagnosis and total mortality . 184Total physical activity 12 months after or more after diagnosis and total mortality . 1845
Recreational physical activity 12 months or more after diagnosis and total mortality . 184Physical activity and breast cancer mortality . 194Physical activity before diagnosis and breast cancer mortality . 194Total physical activity before diagnosis and breast cancer mortality . 194Recreational physical activity before diagnosis and breast cancer mortality . 194Physical activity less than 12 months after diagnosis and breast cancer mortality . 199Physical activity 12 months or more after diagnosis and breast cancer mortality . 199Total physical activity 12 months or more after diagnosis and breast cancer mortality 199Recreational physical activity 12 months or more after diagnosis and breast cancermortality . 199Physical activity change from before to 12 months or more after diagnosis . 203Moderate to vigorous physical activity and total mortality . 203Moderate to vigorous before diagnosis . 203Moderate to vigorous physical activity 12 months or more after diagnosis . 2046 Energy balance . 2066.1 Total energy intake . 206Total energy intake and total mortality . 206Total energy intake before diagnosis and total mortality . 206Total energy intake less than 12 months after diagnosis and total mortality . 211Total energy intake 12 months or more after diagnosis and total mortality . 211Total energy intake and breast cancer mortality . 213Total energy intake before diagnosis and breast cancer mortality . 213Total energy intake less than 12 months after diagnosis and breast cancer mortality. 213Total energy intake more than 12 months after diagnosis and breast cancer mortality 2136.2 Percentage of energy intake from fat . 217Percentage energy intake from fat and total mortality . 217Percentage energy intake from fat before diagnosis and total mortality . 217Percentage energy intake from fat 12 months or more after diagnosis and total mortality. 221Percentage energy intake from fat and breast cancer mortality . 221Percentage energy intake from fat before diagnosis and breast cancer mortality . 221Percentage energy intake from fat less than 12 months after diagnosis and breastcancer mortality . 2216
Percentage energy intake from fat 12 months or more after diagnosis and breast cancermortality . 2217 Anthropometry . 2227.1 Body Mass Index . 222BMI and total mortality . 227Before diagnosis BMI and total mortality . 227BMI less than 12 months after diagnosis and total mortality . 24612 months or more after diagnosis BMI and total mortality . 276Body Mass Index (BMI) and breast cancer mortality . 282Before diagnosis BMI and breast cancer mortality. 282BMI less than 12 months after diagnosis and breast cancer mortality . 30112 months or more after diagnosis BMI and breast cancer mortality . 317BMI and cardiovascular disease mortality. 317Before diagnosis BMI and cardiovascular disease mortality . 317BMI less than 12 months after diagnosis and cardiovascular disease mortality . 31712 months or more after diagnosis BMI and cardiovascular disease mortality . 317BMI and mortality not related to breast cancer . 317Before diagnosis BMI and mortality not related to breast cancer . 317BMI less than 12 months after diagnosis and mortality not related to breast cancer . 31812 months or more after diagnosis BMI and mortality not related to breast cancer . 322BMI and (any) second primary cancer . 322Before diagnosis BMI and (any) second primary cancer. 322BMI 12 months or more after diagnosis and (any) second primary cancer . 32212 months or more after diagnosis BMI and (any) second primary cancer . 322BMI and second primary breast cancer/contralateral breast cancer. 322Before diagnosis BMI and second primary breast cancer/contralateral breast cancer . 322BMI less than 12 months after diagnosis and contralateral breast cancer . 32712 months or more after diagnosis BMI and second primary breast cancer/contralateralbreast cancer . 333BMI and second primary endometrial cancer . 333BMI before diagnosis and second primary endometrial cancer. 333BMI less than 12 months after diagnosis and second primary endometrial cancer . 33312 months or more after diagnosis BMI and second primary endometrial cancer . 337Before diagnosis BMI and second primary colorectal cancer . 3377
BMI less than 12 months after diagnosis and second primary colorectal cancer . 33712 months or more after diagnosis BMI and second primary colorectal cancer . 337Before diagnosis BMI and second primary ovarian cancer . 337BMI less than 12 months after diagnosis and second primary ovarian cancer . 33712 months or more after diagnosis BMI and second primary ovarian cancer . 3377.2 Other weight adjusted for height measures. 340Other weight adjusted for height measures before diagnosis and total mortality . 340Other weight adjusted for height measures less than 12 months after diagnosis and totalmortality . 340Other weight adjusted for height measures before diagnosis and breast cancer mortality. 342Other weight adjusted for height measures less than 12 months after diagnosis andbreast cancer mortality . 342Other weight adjusted for height measures 12 months or more after diagnosis andbreast cancer mortality . 3427.3 Weight . 344Weight and total mortality . 344Weight before diagnosis and total mortality . 344Weight less than 12 months after diagnosis and total mortality . 349Weight 12 months or more after diagnosis and total mortality . 355Weight and breast cancer mortality . 355Weight before diagnosis and breast cancer mortality . 355Weight less than 12 months after diagnosis and breast cancer mortality . 360Weight 12 months or more after diagnosis and breast cancer mortality . 365Weight and second primary breast cancer/contralateral breast cancer . 365Weight before diagnosis and second primary breast cancer/contralateral breast cancer. 365Weight less than 12 months after diagnosis and second primary breastcancer/contralateral breast cancer . 3657.4 Weight gain . 366Weight gain and total mortality . 366Weight gain during adulthood and total mortality . 366Weight gain before and 12 months or more after diagnosis/treatment and total mortality. 369Weight gain less than 12 months after diagnosis and total mortality . 3758
Weight gain and breast cancer mortality . 379Weight gain during adulthood and breast cancer mortality . 379Weight gain before and 12 months or more after diagnosis/treatment and breast cancermortality . 384Weight gain less than 12 months after diagnosis and breast cancer mortality . 3897.5 Weight loss . 389Weight loss and total mortality . 389Weight loss during adulthood and total mortality . 389Weight loss before and 12 months or more after diagnosis/treatment and total mortality. 390Weight loss less than 12 months after diagnosis and total mortality . 396Weight loss and breast cancer mortality . 396Weight loss during adulthood and breast cancer mortality . 396Weight loss before and 12 months or more after diagnosis/treatment and breast cancermortality . 396Weight loss less than 12 months after diagnosis and breast cancer mortality . 4017.6 Waist circumference . 401Waist circumference and total mortality . 401Waist circumference before diagnosis and total mortality . 401Waist circumference less than 12 months after diagnosis and total mortality . 401Waist circumference 12 months or more after diagnosis and total mortality . 405Waist circumference and breast cancer mortality . 4057.7 Hip circumference. 405Hip circumference and total mortality . 405Hip circumference before diagnosis and total mortality. 405Hip circumference less than 12 months after diagnosis and total mortality . 405Hip circumference 12 months or more after diagnosis and total mortality . 405Hip circumference and breast cancer mortality . 405Hip circumference before diagnosis and breast cancer mortality . 406Hip circumference less than 12 months after diagnosis and breast cancer mortality . 406Hip circumference 12 months or more after diagnosis and breast cancer mortality . 4067.8 Waist-hip ratio . 407Waist-hip ratio and total mortality . 407Waist-hip ratio before diagnosis and total mortality . 4079
Waist-hip ratio less than 12 months after diagnosis and total mortality . 407Waist-hip ratio 12 months or more after diagnosis and total mortality . 412Waist-hip ratio and breast cancer mortality . 412Waist-hip ratio before diagnosis and breast cancer mortality . 412Waist-hip ratio less than 12 months after diagnosis and breast cancer mortality . 412Waist-hip ratio
Alcohol before breast cancer diagnosis and breast cancer mortality . 81 Alcohol less than 12 months after diagnosis and breast cancer mortality . 86 Alcohol intake 12 months or more after primary breast cancer diagnosis and breast . Before diagnosis BMI and cardiovascular disease mortality . 317 BMI less than 12 months after .
4 Breast cancer Breast cancer: A summary of key information Introduction to breast cancer Breast cancer arises from cells in the breast that have grown abnormally and multiplied to form a lump or tumour. The earliest stage of breast cancer is non-invasive disease (Stage 0), which is contained within the ducts or lobules of the breast and has not spread into the healthy breast tissue .
Breast cancer development In the United States, breast cancer is the most common cancer diagnosed in women (excluding skin cancer). Men may also develop breast cancer, but less than 1% of all people with breast cancer are men. Breast cancer begins when healthy cells in the breast change and grow uncontrollably, forming a mass called a tumor.
breast cancer, metastases, advanced breast cancer, secondary tumours, secondaries or stage 4 breast cancer. For most people with secondary breast cancer in the brain, breast cancer has already spread to another part of the body such as the bones, liver or lungs. However, for some people, the brain may be the only area of secondary breast cancer.
the risk of having another diagnosis of breast cancer or dying from the disease. World Cancer Research Fund International's Continuous Update Project report on breast cancer survivors is the most rigorous, systematic, global analysis of the scientific research currently available on breast cancer survivors, and how certain lifestyle factors
cancer amongst breast cancer survivors is a metachro-nous contralateral breast cancer[7].Factors associated with an increased risk of a second breast cancer include an initial diagnosis of DCIS, stage IIB, hormone receptor negative cancers, and young age[8]. Breast pathology Proliferative breast disease is associated with an increased
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5 yrs of anti-hormone therapy reduces the risk of: – breast cancer coming back somewhere else in the body (metastases / secondaries) – breast cancer returning in the same breast – a new breast cancer in the opposite breast – death from breast cancer The benefits of anti-hormone therapy last well
(Bharat Law House, 27th Ed, 2013) Ratanlal vol [1/2] Sentencing Practice in the Subordinate Courts (LexisNexis, 2013, 3rd Ed) Sentencing Practice . 1 CHAPTER 1: INTRODUCTION SECTION 2: EXECUTIVE SUMMARY TERMS OF REFERENCE (1) The objectives of the Committee are: a. To conduct a thorough and comprehensive review of the Penal Code, and make recommendations on reforming the Penal Code; and b. To .
