title: Health-related behaviors and mortality outcomes in women diagnosed with ductal carcinoma in situ.
abstract: OBJECTIVE
  Women diagnosed with ductal carcinoma in situ (DCIS) of the breast are at greater risk of dying from cardiovascular disease and other causes than from breast cancer, yet associations between health-related behaviors and mortality outcomes after DCIS have not been well studied.
  
  
  METHODS
  We examined the association of body mass index, physical activity, alcohol consumption, and smoking with mortality among 1925 women with DCIS in the Wisconsin In Situ Cohort study. Behaviors were self-reported through baseline interviews and up to three follow-up questionnaires. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality after DCIS, with adjustment for patient sociodemographic, comorbidity, and treatment factors.
  
  
  RESULTS
  Over a mean of 6.7 years of follow-up, 196 deaths occurred. All-cause mortality was elevated among women who were current smokers 1 year prior to diagnosis (HR = 2.17 [95% CI 1.48, 3.18] vs. never smokers) and reduced among women with greater physical activity levels prior to diagnosis (HR = 0.55 [95% CI: 0.35, 0.87] for ≥5 h per week vs. no activity). Moderate levels of post-diagnosis physical activity were associated with reduced all-cause mortality (HR = 0.31 [95% CI 0.14, 0.68] for 2-5 h per week vs. no activity). Cancer-specific mortality was elevated among smokers and cardiovascular disease mortality decreased with increasing physical activity levels.
  
  
  CONCLUSIONS
  There are numerous associations between health-related behaviors and mortality outcomes after a DCIS diagnosis.
  
  
  CONCLUSIONS
  Women diagnosed with DCIS should be aware that their health-related behaviors are associated with mortality outcomes.
authors.affiliation: Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA.|Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA.
authors.forename: Christopher Thomas
authors.initials: CT
authors.lastname: Veal
authors.affiliation: Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA.|Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Hart
authors.affiliation: Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA.|Department of Clinical Cancer Prevention & Cardiology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Lakoski
authors.affiliation: Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Hampton
authors.affiliation: Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.|Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Gangnon
authors.affiliation: Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.|Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
authors.forename: Polly A
authors.initials: PA
authors.lastname: Newcomb
authors.affiliation: Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA.|Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, USA.|University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Higgins
authors.affiliation: Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA.|Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Trentham-Dietz
authors.affiliation: Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA. bsprague@uvm.edu.|Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA. bsprague@uvm.edu.|University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA. bsprague@uvm.edu.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breast neoplasms; Cause of death; Follow-up studies; Health behavior; Non-infiltrating intra-ductal carcinoma