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Greater Survival After Breast Cancer in Physically Active Women With High Vegetable-Fruit Intake Regardless of Obesity

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, Cheryl L. Rock

From the Moores University of California, San Diego Cancer Center, La Jolla; Stanford Prevention Research Center, Stanford University, Palo Alto; Division of Research, Kaiser Permanente Medical Group Inc, Oakland, CA; Arizona Cancer Center, Tucson, AZ; and The University of Texas M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to John P. Pierce, PhD, Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0901; e-mail: jppierce{at}ucsd.edu

Purpose 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.

Results 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.

Conclusion 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.

Supported by the Walton Family Foundation, and support continued with funding from National Cancer Institute Grant No. CA 69375 for The Women's Healthy Eating and Living (WHEL) Study. Some of the data were collected from General Clinical Research Centers, National Institutes of Health Grants No. M01-RR00070, M01-RR00079, and M01-RR00827.

The National Cancer Institute played no role in the design and conduct of this study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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