title: Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity.
abstract: OBJECTIVE
  Single-variable analyses have associated physical activity, diet, and obesity with survival after breast cancer. This report investigates interactions among these variables.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cancer Prevention and Control Program, Moores University of California, San Diego Cancer Center, La Jolla, CA 92093-0901, USA. jppierce@ucsd.edu
authors.forename: John P
authors.initials: JP
authors.lastname: Pierce
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.forename: Shirley W
authors.initials: SW
authors.lastname: Flatt
authors.forename: Loki
authors.initials: L
authors.lastname: Natarajan
authors.forename: Barbara
authors.initials: B
authors.lastname: Sternfeld
authors.forename: Lisa
authors.initials: L
authors.lastname: Madlensky
authors.forename: Wael K
authors.initials: WK
authors.lastname: Al-Delaimy
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Thomson
authors.forename: Sheila
authors.initials: S
authors.lastname: Kealey
authors.forename: Richard
authors.initials: R
authors.lastname: Hajek
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Parker
authors.forename: Vicky A
authors.initials: VA
authors.lastname: Newman
authors.forename: Bette
authors.initials: B
authors.lastname: Caan
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Rock
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D001943:Breast Neoplasms / Q000401:mortality*; D004032:Diet; D015444:Exercise; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D053208:Kaplan-Meier Estimate; D008019:Life Style; D008875:Middle Aged; D009765:Obesity; D011446:Prospective Studies; D014675:Vegetables