The Effect of Pre-Diagnostic Alcohol Consumption on Survival after Breast Cancer in Young Women.

Background: Alcohol consumption has been comprehensively investigated as an etiologic risk factor for breast cancer but has received little attention in terms of its impact on prognosis after breast cancer, particularly for young women. Methods: 1286 women diagnosed with invasive breast cancer at or before 45 years of age from two population-based case-control studies in the Seattle-Puget Sound region were followed from their diagnosis of breast cancer (between January 1983 and December 1992) for survival through June 2002, during which time 364 women had died. Cox proportional hazards modeling was used to assess the effect of pre-diagnostic alcohol consumption on the risk of dying. Results: After adjusting for age and diagnosis year, compared to non-drinkers, women who consumed alcohol in the 5 years prior to diagnosis had a decreased risk of death [>0 to <3 drinks per week: HR(hazard ratio) = 0.7 (95% CI: 0.6-0.95); 3 to <7 drinks per week: RR = 0.6 (95% CI: 0.4-0.8); ≥ 7 drinks per week: RR = 0.7 (95% CI: 0.5-0.9)]. This association was unchanged upon additional adjustment for potential confounders including most notably treatment, stage at diagnosis, and mammogram history. Conclusion: These results suggest that women who consume alcohol prior to a diagnosis of breast cancer have improved survival which does not appear to be attributable to differences in stage, screening or treatment

Genetic polymorphisms in the catechol estrogen metabolism pathway and breast cancer risk

Background: This study investigated whether single nucleotide polymorphisms (SNPs) in genes within the catechol estrogen metabolism pathway altered the risk of breast cancer alone or in combination, as well as whether menopausal hormone therapy (HT) modified the effect of these SNPs on breast cancer risk. Methods: In a population-based case-control study of breast cancer, 891 cases and 878 controls were genotyped for six functional SNPs in the COMT, CYP1B1, GSTM1, GSTP1, and GSTT1 genes. Results: Women homozygous with the T allele in CYP1B1*2 (Ser119; rs1056827) were at 1.69 (95% confidence interval [CI]: 1.17-2.46) times the risk of women homozygous with the G allele; women homozygous with the G allele in GSTP1 (Val105; rs1695) were at 0.73 (95% CI: 0.54-0.99) times the risk of breast cancer compared to women homozygous with the A allele. No other SNPs tested were associated with breast cancer to any appreciable degree. Potential gene-gene and gene-HT interactions were investigated. Conclusion: With the exception of GSTP1 and possibly CYP1B1*2, our findings do not provide support for the role of genetic variation in the catechol estrogen metabolism pathway and breast cancer risk in post-menopausal women

A review of research on the intersection between breast cancer and cardiovascular research in the Women’s Health Initiative (WHI)

Both obesity and metabolic syndrome are linked to increased incidence of type 2 diabetes, cardiovascular disease (CVD), and cancers of the breast (post-menopausal), and other obesity-related cancers. Over the past 50 years, the worldwide prevalence of obesity and metabolic syndrome has increased, with a concomitant higher incidence of associated co-morbidities and mortality. The precise mechanism linking metabolic syndrome to increased cancer incidence is incompletely understood, however, individual components of metabolic syndrome have been linked to increased breast cancer incidence and worse survival. There is a bidirectional relationship between the risk of CVD and cancer due to a high burden of shared risk factors and higher rates of CVD among cancer survivors, which may be impacted by the pro-inflammatory microenvironment associated with metabolic syndrome and cancer-directed therapies. The Women’s Health Initiative (WHI) is an excellent resource to study a dual relationship between cancer and CVD (cardio-oncology) with extensive information on risk factors and long-term outcomes. The purpose of this review is to provide an overview of research on cardio-oncology conducted utilizing WHI data with focus on studies evaluating both breast cancer and CVD including shared risk factors and outcomes after cancer. The review also includes results on other obesity related cancers which were included in the analyses of breast cancer, articles looking at cancer after heart disease (reverse cardio-oncology) and the role of Clonal Hematopoiesis of Indeterminate Potential (CHIP) as a shared risk factor between CVD and cancer. A summary of pertinent WHI literature helps to delineate the direction of future research evaluating the relationship between CVD and other cancer sites, and provides information on the opportunity for other novel analyses within the WHI

Factors associated with long-term gastrointestinal symptoms in colorectal cancer survivors in the women's health initiatives (WHI study).

PurposeColorectal cancer (CRC) survivors often experience long-term symptoms after cancer treatments. But gastrointestinal (GI) symptom experiences are under-investigated in CRC survivors. We described persistent GI symptoms after cancer treatments in female CRC survivors and assessed GI symptoms' risk and life-impact factors.MethodsA cross-sectional study utilized data from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study that recruited postmenopausal women. Correlation analyses and multivariable linear regression models were used.ResultsCRC survivors after cancer treatments were included (N = 413, mean age 71.2 years old, mean time since diagnosis = 8.1 years). 81% of CRC survivors experienced persistent GI symptoms. Bloating/gas was the most prevalent (54.2%± 0.88) and severe GI symptom, followed by constipation (44.1%±1.06), diarrhea (33.4%±0.76), and abdominal/pelvic pain (28.6%±0.62). Significant risk factors for GI symptoms include time since cancer diagnosis (ConclusionsWomen CRC survivors experience a high GI symptom burden, highlighting the need to inform policy and improve the QOL of cancer survivors. Our findings will aid in identifying those more vulnerable to symptoms, and inform future survivorship care interventions (i.e., community-based cancer symptom management) by considering multiple risk factors (e.g., psychological distress)

Fruit intake associated with urinary estrogen metabolites in healthy premenopausal women

Urinary concentrations of 2:16-hydroxyestrone (2:16-OHE(1)) approximate concentrations of 2-OHE(1) and 16α -OHE(1) in breast tissue. As estrogens are purported to be involved in breast cancer development, the 2:16-OHE(1) ratio can provide an indication of estrogen metabolite exposure in the breast. With prior studies observing associations between urinary estrogen metabolites and dietary intake of fruits, vegetables, and fiber ascertained from food questionnaires, we examined associations between dietary factors ascertained through 3-day food records and urinary 2:16-OHE(1) in 191 pre-menopausal healthy women. Fruit consumption was positively associated with 2:16-OHE(1) after adjustment for total energy, ethnicity, body mass index, parity, smoking history, and serum estradiol (p= 0.003). Fruit consumption was positively associated with 2- OHE(1) concentrations (p=0.006), but was not associated with 16α-OHE(1) (p=0.92). The Musaceae botanical grouping (comprised primarily of bananas) was positively associated with the 2:16-OHE(1) ratio, and Rosaceae (comprised of citrus fruits) and Musaceae botanical groupings were positively associated with 2-OHE(1) (but not 16α-OHE(1)) concentrations, after adjustment for confounders. Our data suggest that dietary fruit intake is associated with urinary 2- OHE(1) and the 2:16-OHE(1) ratio and that breast tissue exposure to estrogen metabolites may thus be influenced by diet

Fruit intake associated with urinary estrogen metabolites in healthy premenopausal women

Urinary concentrations of 2:16-hydroxyestrone (2:16-OHE(1)) approximate concentrations of 2-OHE(1) and 16α -OHE(1) in breast tissue. As estrogens are purported to be involved in breast cancer development, the 2:16-OHE(1) ratio can provide an indication of estrogen metabolite exposure in the breast. With prior studies observing associations between urinary estrogen metabolites and dietary intake of fruits, vegetables, and fiber ascertained from food questionnaires, we examined associations between dietary factors ascertained through 3-day food records and urinary 2:16-OHE(1) in 191 pre-menopausal healthy women. Fruit consumption was positively associated with 2:16-OHE(1) after adjustment for total energy, ethnicity, body mass index, parity, smoking history, and serum estradiol (p= 0.003). Fruit consumption was positively associated with 2- OHE(1) concentrations (p=0.006), but was not associated with 16α-OHE(1) (p=0.92). The Musaceae botanical grouping (comprised primarily of bananas) was positively associated with the 2:16-OHE(1) ratio, and Rosaceae (comprised of citrus fruits) and Musaceae botanical groupings were positively associated with 2-OHE(1) (but not 16α-OHE(1)) concentrations, after adjustment for confounders. Our data suggest that dietary fruit intake is associated with urinary 2- OHE(1) and the 2:16-OHE(1) ratio and that breast tissue exposure to estrogen metabolites may thus be influenced by diet