Greater Survival Breast Ca Physically Active&High Veg-Fruit Intake

John P. Pierce, Marcia L. Stefanick, Shirley W. Flatt, Loki Natarajan, Barbara Sternfeld, Lisa Madlensky, Wael K. Al-Delaimy, Cynthia A. Thomson, Sheila Kealey, Richard Hajek, Barbara A. Parker, Vicky A. Newman, Bette Caan, and Cheryl L. Rock

Single-variable analyses have associated physical activity, diet, and obesity with survival after breast cancer. This report investigates interactions among these variables.

Patients and Methods

A prospective study was performed of 1,490 women diagnosed and treated for early-stage breast cancer between 1991 and 2000. Enrollment was an average of 2 years postdiagnosis. Only seven women were lost to follow-up through December 2005.


In univariate analysis, reduced mortality was weakly associated with higher vegetable-fruit consumption, increased physical activity, and a body mass index that was neither low weight nor obese.

In a multivariate Cox model, only the combination of consuming five or more daily servings of vegetables-fruits, and accumulating 540 metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk), was associated with a significant survival advantage (hazard ratio, 0.56; 95% CI, 0.31 to 0.98).

The approximate 50% reduction in risk associated with these healthy lifestyle behaviors was observed in both obese and nonobese women, although fewer obese women were physically active with a healthy dietary pattern (16% v 30%). Among those who adhered to this healthy lifestyle, there was no apparent effect of obesity on survival. The effect was stronger in women who had hormone receptor–positive cancers.


A minority of breast cancer survivors follow a healthy lifestyle that includes both recommended intakes of vegetables-fruits and moderate levels of physical activity.

The strong protective effect observed suggests a need for additional investigation of the effect of the combined influence of diet and physical activity on breast cancer survival.

J Clin Oncol 25:2345-2351.

Ann's NOTE: Within the study the authors mention that 30% of the study participants ate the recommended 5 fruit/vegetable servings per day (actually achieving 7) AND exercised at the desired level - expressed as metabolic equivalent tasks (MET). Mortality in this group was at 4.8%.

22% achieved about 3 servings daily but HIGH exercise levels. Mortality was at 10.4% An additional 18% ate 7 or more servings but with little exercise - their mortality was 10.79%. 30% were both low consumption of fruits and vegetables AND low levels of exercise. Their mortality was 11.5%.

According to the authors "A difference in mortality observed across categories was statistically significant (P =.01).

Another interesting finding was that both very slim and obese women tended toward a higher mortality rate (UNLESS they ate in the healthy way and exercised), but overweight women did not.

Survival based on estrogen receptor status:

Univariate analysis showed no survival advantage for healthy lifestyle in estrogen receptor–negative/progesterone receptor–negative (ER negative/ PR negative) group (P = .4), a borderline advantage for ER negative/ PR positive group (P = .09), and significant advantage for ER positive/PR negative (P = .04) and ER positive/PR positive groups (P = .01).

From the study conclusions:

"In these breast cancer survivors who were interested in lifestyle change and were predominantly nonsmokers, the 30% of women who were physically active and consumed at least 5 servings of vegetables and fruits each day had an estimated 10-year mortality rate of 7%, approximately half that of any other combination of PA and dietary pattern.

Of particular importance, this halving of risk was seen in women who were not obese as well as in those who were obese.

Indeed, it appeared that both being physically active and having a healthy dietary pattern attenuated the increase in risk observedamongthe obese.

It was noted, however, that obese women were approximately one half as likely as nonobese women to be both physically active and to have a healthy dietary pattern".

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