Breast cancer survival among young women: a review of the role of modifiable lifestyle factors

Abstract Almost 7 % of breast cancers are diagnosed among women age 40 years and younger in Western populations. Clinical outcomes among young women are worse. Early age-of-onset increases the risk of contralateral breast cancer, local and distant recurrence, and subsequent mortality. Breast cancers in young women (BCYW) are more likely to present with triple-negative (TNBC), TP53-positive, and HER-2 over-expressing tumors than among older women. However, despite these known differences in breast cancer outcomes and tumor subtypes, there is limited understanding of the basic biology, epidemiology, and optimal therapeutic strategies for BCYW. Several modifiable lifestyle factors associated with reduced risk of developing breast cancer have also been implicated in improved prognosis among breast cancer survivors of all ages. Given the treatment-related toxicities and the extended window for late effects, long-term lifestyle modifications potentially offer significant benefits to BCYW. In this review, we propose a model identifying three main areas of lifestyle factors (energy imbalance, inflammation, and dietary nutrient adequacy) that may influence survival in BCYW. In addition, we provide a summary of mechanisms of action and a synthesis of previous research on each of these topics.

[1]  Sameer M. Siddiqi,et al.  Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. , 2012, Journal of the National Cancer Institute.

[2]  B. Rasmussen,et al.  Mortality rates among early-stage hormone receptor-positive breast cancer patients: a population-based cohort study in Denmark. , 2011, Journal of the National Cancer Institute.

[3]  Young-In Kim Does a high folate intake increase the risk of breast cancer? , 2006, Nutrition reviews.

[4]  C. Rock,et al.  Dietary Intake, Supplement Use, and Survival Among Women Diagnosed With Early-Stage Breast Cancer , 2011, Nutrition and cancer.

[5]  C. Friedenreich,et al.  Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. , 2014, Medicine and science in sports and exercise.

[6]  S. Dickerson,et al.  Diurnal cortisol rhythm and fatigue in breast cancer survivors , 2005, Psychoneuroendocrinology.

[7]  R Peto,et al.  Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials , 2011, The Lancet.

[8]  A. Ray,et al.  Obesity and breast cancer: status of leptin and adiponectin in pathological processes , 2010, Cancer and Metastasis Reviews.

[9]  R. Schreiber,et al.  Cancer immunoediting: from immunosurveillance to tumor escape , 2002, Nature Immunology.

[10]  J. Manivel,et al.  A potential role for interleukin-8 in the metastatic phenotype of breast carcinoma cells. , 2001, The American journal of pathology.

[11]  A. Folsom,et al.  NSAID use and survival after breast cancer diagnosis in post-menopausal women , 2006, Breast Cancer Research and Treatment.

[12]  H Putter,et al.  Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: long-term results of European Organisation for Research and Treatment of Cancer studies. , 2006, European journal of cancer.

[13]  C. McCowan,et al.  Aspirin use and survival after the diagnosis of breast cancer: a population-based cohort study , 2014, British Journal of Cancer.

[14]  J. Chang-Claude,et al.  Serum enterolactone and prognosis of postmenopausal breast cancer. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  Kathleen A Cronin,et al.  US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. , 2014, Journal of the National Cancer Institute.

[16]  A. Wolk,et al.  Folate intake and breast cancer mortality in a cohort of Swedish women , 2012, Breast Cancer Research and Treatment.

[17]  J. Isola,et al.  Prognostic significance of elevated cyclooxygenase-2 expression in breast cancer. , 2002, Cancer research.

[18]  A. Ziogas,et al.  Diet and predictors of dietary intakes in women with family history of breast and/or ovarian cancer. , 2009, Cancer epidemiology.

[19]  T Nakamura,et al.  Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. , 1999, Biochemical and biophysical research communications.

[20]  J. Palmer,et al.  Use of multivitamins, folic acid and herbal supplements among breast cancer survivors: the black women's health study , 2011, BMC complementary and alternative medicine.

[21]  S. Edge,et al.  Pretreatment Serum Concentrations of 25-Hydroxyvitamin D and Breast Cancer Prognostic Characteristics: A Case-Control and a Case-Series Study , 2011, PloS one.

[22]  C. Shriver,et al.  Impact of lifestyle factors on prognosis among breast cancer survivors in the USA , 2012, Expert review of pharmacoeconomics & outcomes research.

[23]  M. Somerfield,et al.  Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. , 2017, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  B. Sternfeld,et al.  Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project , 2011, Breast Cancer Research and Treatment.

[25]  Umberto Veronesi,et al.  Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. , 2002, The New England journal of medicine.

[26]  D. Grabrick,et al.  High-Folate Diets and Breast Cancer Survival in a Prospective Cohort Study , 2002, Nutrition and cancer.

[27]  S. Barni,et al.  Lower survival in metastatic cancer patients with reduced interleukin-2 blood concentrations. Preliminary report. , 1991, Oncology.

[28]  I. Henderson,et al.  Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials: Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (Clinical Trial Service Unit (CTSU), Oxford, UK) Lancet 379:432-444, 2012§ , 2013 .

[29]  K. Gelmon,et al.  Should women younger than 40 years of age with invasive breast cancer have a mastectomy? 15-year outcomes in a population-based cohort. , 2014, International journal of radiation oncology, biology, physics.

[30]  J. Hoek,et al.  Mechanisms of alcohol-induced tissue injury. , 2003, Alcoholism, clinical and experimental research.

[31]  D. Gaffney,et al.  In the Modern Treatment Era, Is Breast Conservation Equivalent to Mastectomy in Women Younger Than 40 Years of Age? A Multi-Institution Study. , 2015, International journal of radiation oncology, biology, physics.

[32]  C. Rock,et al.  Soy Food Consumption and Breast Cancer Prognosis , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[33]  A. Cheung,et al.  Perimenopausal and Postmenopausal Health , 2004, BMC women's health.

[34]  V. Shavers,et al.  Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35 , 2003, Cancer.

[35]  P. Watson,et al.  Tumor-infiltrating lymphocytes predict response to anthracycline-based chemotherapy in estrogen receptor-negative breast cancer , 2011, Breast Cancer Research.

[36]  I. Tentes,et al.  Evaluation of predictive and prognostic significance of serum TGF-beta1 levels in breast cancer according to HER-2 codon 655 polymorphism. , 2008, Neoplasma.

[37]  I. Olivotto,et al.  Declining Use of Mastectomy for Invasive Breast Cancer in Canada, 1981–2000 , 2004, Canadian journal of public health = Revue canadienne de sante publique.

[38]  S. Seal,et al.  Prevalence of BRCA1 and BRCA2 gene mutations in patients with early-onset breast cancer. , 1999, Journal of the National Cancer Institute.

[39]  M. Cotterchio,et al.  Phytoestrogen Content of Foods Consumed in Canada, Including Isoflavones, Lignans, and Coumestan , 2006, Nutrition and cancer.

[40]  Duane D. Miller,et al.  The role of vitamin D in cancer prevention. , 2015, Chinese journal of natural medicines.

[41]  D F Dinges,et al.  Soluble TNF-alpha receptor 1 and IL-6 plasma levels in humans subjected to the sleep deprivation model of spaceflight. , 2001, The Journal of allergy and clinical immunology.

[42]  Heike Knüpfer,et al.  Significance of interleukin-6 (IL-6) in breast cancer (review) , 2007, Breast Cancer Research and Treatment.

[43]  T. Funahashi,et al.  The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A. Copyright © 2001 by The Endocrine Society Hypoadiponectinemia in Obesity and Type 2 Diabetes: Close Association with Insulin Resistance , 2022 .

[44]  R. Peto,et al.  Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. , 2012, Lancet.

[45]  P. Vertino,et al.  Age/race differences in HER2 testing and in incidence rates for breast cancer triple subtypes , 2010, Cancer.

[46]  Young-In Kim Role of folate in colon cancer development and progression. , 2003, The Journal of nutrition.

[47]  R. Coates,et al.  Recreational physical activity and survival among young women with breast cancer , 2006, Cancer.

[48]  F. Hu,et al.  Are Diet Quality Scores After Breast Cancer Diagnosis Associated with Improved Breast Cancer Survival? , 2013, Nutrition and cancer.

[49]  D. Wheeler,et al.  Synthesis of 1,25-dihydroxyvitamin D(3) by human endothelial cells is regulated by inflammatory cytokines: a novel autocrine determinant of vascular cell adhesion. , 2002, Journal of the American Society of Nephrology : JASN.

[50]  L. Bernstein,et al.  Exercise activity, body size and premenopausal breast cancer survival , 2004, British Journal of Cancer.

[51]  J. Levy,et al.  Use and abuse of HOMA modeling. , 2004, Diabetes care.

[52]  J. Beilby,et al.  Folate levels and cancer morbidity and mortality: prospective cohort study from Busselton, Western Australia. , 2006, Annals of epidemiology.

[53]  E. Giovannucci,et al.  Role of vitamin and mineral supplementation and aspirin use in cancer survivors. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[54]  F. Queiroga,et al.  A Role for T-Lymphocytes in Human Breast Cancer and in Canine Mammary Tumors , 2014, BioMed research international.

[55]  R. Aft,et al.  Patient and tumor characteristics associated with increased mortality in young women (≤40 years) with breast cancer , 2009, Journal of surgical oncology.

[56]  Ian O Ellis,et al.  Tumor-infiltrating CD8+ lymphocytes predict clinical outcome in breast cancer. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[57]  J. Mullington,et al.  Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. , 2007, Sleep.

[58]  M. Pike,et al.  Epidemiology of soy exposures and breast cancer risk , 2008, British Journal of Cancer.

[59]  G. Neuner,et al.  Similar survival with breast conservation therapy or mastectomy in the management of young women with early-stage breast cancer. , 2011, International journal of radiation oncology, biology, physics.

[60]  A. Miller,et al.  Tumor characteristics and survival of breast cancer patients in relation to premorbid diet and body size , 2004, Breast Cancer Research and Treatment.

[61]  F. Cardoso,et al.  First international consensus guidelines for breast cancer in young women (BCY1). , 2014, Breast.

[62]  R. Collins,et al.  Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials , 2005, The Lancet.

[63]  N. Parekh,et al.  Dietary fat in breast cancer survival. , 2013, Annual review of nutrition.

[64]  A. Ray,et al.  Effects of adiponectin on breast cancer cell growth and signaling , 2008, British Journal of Cancer.

[65]  W. Willett,et al.  Plasma adiponectin concentrations and risk of incident breast cancer. , 2006, The Journal of clinical endocrinology and metabolism.

[66]  C. Mantzoros,et al.  Relationship of Plasma Adiponectin With Sex Hormone and Insulin‐like Growth Factor Levels , 2007, Obesity.

[67]  C. Denny,et al.  Alcohol use among pregnant and nonpregnant women of childbearing age - United States, 1991-2005. , 2009, MMWR. Morbidity and mortality weekly report.

[68]  C. Quesenberry,et al.  Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study , 2009, Breast Cancer Research and Treatment.

[69]  Carsten Denkert,et al.  Tumor-associated lymphocytes as an independent predictor of response to neoadjuvant chemotherapy in breast cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[70]  S. Narod BRCA mutations in the management of breast cancer: the state of the art , 2010, Nature Reviews Clinical Oncology.

[71]  M. Cotterchio,et al.  Dietary Phytoestrogens, Including Isoflavones, Lignans, and Coumestrol, in Nonvitamin, Nonmineral Supplements Commonly Consumed by Women in Canada , 2007, Nutrition and cancer.

[72]  C. Ulrich,et al.  Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[73]  Lori Minasian,et al.  The Role of Obesity in Cancer Survival and Recurrence , 2012, Cancer Epidemiology, Biomarkers & Prevention.

[74]  N. Gebruers,et al.  Late effects of cancer treatment in breast cancer survivors , 2015, South Asian Journal of Cancer.

[75]  Jan Born,et al.  Sleep and immune function , 2011, Pflügers Archiv - European Journal of Physiology.

[76]  P. Hall,et al.  Risk of ischemic heart disease in women after radiotherapy for breast cancer. , 2013, The New England journal of medicine.

[77]  Alberto Mantovani,et al.  Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. , 2009, Carcinogenesis.

[78]  C. Anders,et al.  Breast cancer in adolescents and young adults: a review with a focus on biology. , 2013, Journal of the National Comprehensive Cancer Network : JNCCN.

[79]  Y.-I. Kim,et al.  Folate: a magic bullet or a double edged sword for colorectal cancer prevention? , 2006, Gut.

[80]  B. Trock,et al.  Meta-analysis of soy intake and breast cancer risk. , 2006, Journal of the National Cancer Institute.

[81]  C. Rubino,et al.  Increased risk of second cancers following breast cancer: Role of the initial treatment , 2000, Breast Cancer Research and Treatment.

[82]  J. Mullington,et al.  Sleep loss and inflammation. , 2010, Best practice & research. Clinical endocrinology & metabolism.

[83]  A. Bleyer,et al.  Breast cancer before age 40 years. , 2009, Seminars in oncology.

[84]  A. Green,et al.  Expression of cytokine messenger RNA in normal and neoplastic human breast tissue: Identification of interleukin‐8 as a potential regulatory factor in breast tumours , 1997, International journal of cancer.

[85]  J. Chang-Claude,et al.  Serum enterolactone and postmenopausal breast cancer risk by estrogen, progesterone and herceptin 2 receptor status , 2012, International journal of cancer.

[86]  S. Edge,et al.  Use of Nonsteroidal Anti-inflammatory Drugs and Survival Following Breast Cancer Diagnosis , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[87]  A. Neugut,et al.  B-Vitamin Intake, One-Carbon Metabolism, and Survival in a Population-Based Study of Women with Breast Cancer , 2008, Cancer Epidemiology Biomarkers & Prevention.

[88]  S. Hankinson,et al.  Plasma Vitamin D Levels, Menopause, and Risk of Breast Cancer , 2013, Medicine.

[89]  R. Wu,et al.  Post-diagnosis soy food intake and breast cancer survival: a meta-analysis of cohort studies. , 2013, Asian Pacific Journal of Cancer Prevention.

[90]  D. Cutter,et al.  Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials , 2012, The Lancet.

[91]  P. Watson,et al.  Intratumoral Immune Responses Can Distinguish New Primary and True Recurrence Types of Ipsilateral Breast Tumor Recurrences (IBTR) , 2011, Breast cancer : basic and clinical research.

[92]  Hong-Bin Kang,et al.  Positive effects of soy isoflavone food on survival of breast cancer patients in China. , 2012, Asian Pacific journal of cancer prevention : APJCP.

[93]  L. Qin,et al.  Soy isoflavones consumption and risk of breast cancer incidence or recurrence: a meta-analysis of prospective studies , 2010, Breast Cancer Research and Treatment.

[94]  J. Peterse,et al.  Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[95]  M. Irwin Depression and Insomnia in Cancer: Prevalence, Risk Factors, and Effects on Cancer Outcomes , 2013, Current Psychiatry Reports.

[96]  J. Chang-Claude,et al.  Alcohol Consumption and Survival after a Breast Cancer Diagnosis: A Literature-Based Meta-analysis and Collaborative Analysis of Data for 29,239 Cases , 2014, Cancer Epidemiology, Biomarkers & Prevention.

[97]  R. Tibshirani,et al.  Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications , 2001, Proceedings of the National Academy of Sciences of the United States of America.

[98]  J. Blay,et al.  Prognostic value of serum levels of interleukin 6 and of serum and plasma levels of vascular endothelial growth factor in hormone-refractory metastatic breast cancer patients , 2003, British Journal of Cancer.

[99]  E. Bar-Meir,et al.  Second international consensus guidelines for breast cancer in young women (BCY2). , 2014, Breast.

[100]  D. Dimitrov,et al.  Folate receptor‐β constitutes a marker for human proinflammatory monocytes , 2014, Journal of leukocyte biology.

[101]  J. Palmer,et al.  Use of nonsteroidal antiinflammatory drugs and risk of breast cancer: the Case-Control Surveillance Study revisited. , 2005, American journal of epidemiology.

[102]  EBCTCG (Early Breast Cancer Trialists' Collaborati Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials , 2014, The Lancet.

[103]  K. Skinner,et al.  The Association Between Breast Cancer Prognostic Indicators and Serum 25-OH Vitamin D Levels , 2012, Annals of Surgical Oncology.

[104]  M. Keyes,et al.  Is mastectomy superior to breast-conserving treatment for young women? , 2007, International journal of radiation oncology, biology, physics.

[105]  D. Jeffe,et al.  Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. , 2009, Journal of the American College of Surgeons.

[106]  I. Soerjomataram,et al.  Risks of second primary breast and urogenital cancer following female breast cancer in the south of The Netherlands, 1972-2001. , 2005, European journal of cancer.

[107]  D. Rose,et al.  Adipokines as endocrine, paracrine, and autocrine factors in breast cancer risk and progression. , 2007, Endocrine-related cancer.

[108]  C. Ulrich,et al.  Associations of serum 25-hydroxyvitamin D with overall and breast cancer–specific mortality in a multiethnic cohort of breast cancer survivors , 2013, Cancer Causes & Control.

[109]  N. Lunet,et al.  Impact of breast cancer treatments on sleep disturbances - A systematic review. , 2014, Breast.

[110]  Irmtraud M. Meyer,et al.  The clonal and mutational evolution spectrum of primary triple-negative breast cancers , 2012, Nature.

[111]  J. Chang-Claude,et al.  Meta-analyses of lignans and enterolignans in relation to breast cancer risk. , 2010, The American journal of clinical nutrition.

[112]  A. McTiernan,et al.  Body mass index and survival in women with breast cancer—systematic literature review and meta-analysis of 82 follow-up studies , 2014, Annals of oncology : official journal of the European Society for Medical Oncology.

[113]  Young-In Kim Folic acid fortification and supplementation--good for some but not so good for others. , 2007, Nutrition reviews.

[114]  A. Bleyer,et al.  Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975-2000. , 2006 .

[115]  Young-In Kim Folate and DNA methylation: a mechanistic link between folate deficiency and colorectal cancer? , 2004, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[116]  M. Ramos-Nino The Role of Chronic Inflammation in Obesity-Associated Cancers , 2013, ISRN oncology.

[117]  I. Tentes,et al.  Significance of Serum Tumor Necrosis Factor-Alpha and its Combination with Her-2 Codon 655 Polymorphism in the Diagnosis and Prognosis of Breast Cancer , 2010, The International journal of biological markers.

[118]  L. Dogliotti,et al.  Prognostic role of vitamin d status and efficacy of vitamin D supplementation in cancer patients: a systematic review. , 2011, The oncologist.

[119]  M. Coory,et al.  Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis , 2010, Breast Cancer Research and Treatment.

[120]  H. Abdul-Jabar,et al.  Alcohol and Breast Cancer: The Mechanisms Explained , 2009, Journal of clinical medicine research.

[121]  G. Colditz,et al.  COX-2 expression predicts worse breast cancer prognosis and does not modify the association with aspirin , 2011, Breast Cancer Research and Treatment.

[122]  J. Marks,et al.  Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[123]  J. Pierce Diet and breast cancer prognosis: making sense of the Women's Healthy Eating and Living and Women's Intervention Nutrition Study trials , 2009, Current opinion in obstetrics & gynecology.

[124]  V. Kosma,et al.  Lymphocyte infiltrates as a prognostic variable in female breast cancer. , 1992, European journal of cancer.

[125]  Yan Zhu,et al.  Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. , 2004, The American journal of clinical nutrition.

[126]  A. Leathem,et al.  Lignans and breast cancer risk in pre- and post-menopausal women: meta-analyses of observational studies , 2009, British Journal of Cancer.

[127]  H. Honoré,et al.  Breast cancer in young women. , 1979, British medical journal.

[128]  V. Livolsi Anti-metastatic effect of aspirin. , 1973, Lancet.

[129]  A. Luini,et al.  Breast-conserving surgery in 201 very young patients (<35 years). , 2010, Breast.

[130]  C. Geyer,et al.  Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[131]  L. Holmberg,et al.  Breast Cancer in Young Women: Poor Survival Despite Intensive Treatment , 2009, PloS one.

[132]  Haifa Dbouk,et al.  Epidemiology and prognosis of breast cancer in young women. , 2013, Journal of thoracic disease.

[133]  J. Carroll,et al.  Bone health issues in breast cancer survivors: a Medicare Current Beneficiary Survey (MCBS) study , 2013, Supportive Care in Cancer.

[134]  C. Sotiriou,et al.  Elucidating Prognosis and Biology of Breast Cancer Arising in Young Women Using Gene Expression Profiling , 2012, Clinical Cancer Research.

[135]  S. Swain,et al.  Cardiac Toxicity in Breast Cancer Survivors: Review of Potential Cardiac Problems , 2008, Clinical Cancer Research.

[136]  X. Shu,et al.  Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. , 2012, The American journal of clinical nutrition.

[137]  P. Rothwell,et al.  Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials , 2012, The Lancet.

[138]  J. Stagg,et al.  Immunotherapeutic approaches in triple-negative breast cancer: latest research and clinical prospects , 2013, Therapeutic advances in medical oncology.

[139]  P. Goodwin,et al.  Prognostic effects of 25-hydroxyvitamin D levels in early breast cancer. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[140]  B. Shane Folate fortification: enough already? , 2003, The American journal of clinical nutrition.

[141]  G. Nagaraju,et al.  Pleiotropic effects of genistein in metabolic, inflammatory, and malignant diseases. , 2013, Nutrition reviews.

[142]  J. Overgaard,et al.  Second primary cancers after adjuvant radiotherapy in early breast cancer patients: a national population based study under the Danish Breast Cancer Cooperative Group (DBCG). , 2013, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[143]  S. Narod,et al.  Folate and breast cancer: what about high-risk women? , 2012, Cancer Causes & Control.

[144]  Marilie D. Gammon,et al.  Breast cancers among very young premenopausal women (United States) , 2003, Cancer Causes & Control.

[145]  R. Hayes,et al.  Cancer Causes & Control , 2004, Cancer Causes & Control.

[146]  Qingyuan Zhang,et al.  Effect of soy isoflavones on breast cancer recurrence and death for patients receiving adjuvant endocrine therapy , 2010, Canadian Medical Association Journal.

[147]  S. Gomez,et al.  Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011. , 2014, JAMA.

[148]  C. Ulrich,et al.  Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[149]  C. Mathers,et al.  Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 , 2010, International journal of cancer.

[150]  W. Willett,et al.  Diet Quality Indices and Postmenopausal Breast Cancer Survival , 2011, Nutrition and cancer.

[151]  E. van Limbergen,et al.  Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. , 2015, The Lancet. Oncology.

[152]  W. Willett,et al.  Dietary factors and the survival of women with breast carcinoma , 1999, Cancer.

[153]  David W. Dunstan,et al.  Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003–2006) , 2010, Cancer Causes & Control.

[154]  A. Ray,et al.  Balance of adiponectin and leptin modulates breast cancer cell growth , 2008, Cell Research.

[155]  C. Friedenreich The role of physical activity in breast cancer etiology. , 2010, Seminars in oncology.

[156]  M. Lucock,et al.  Folic acid: nutritional biochemistry, molecular biology, and role in disease processes. , 2000, Molecular genetics and metabolism.

[157]  David M. Thomas,et al.  The distinctive biology of cancer in adolescents and young adults , 2008, Nature Reviews Cancer.

[158]  Benjamin E. Gross,et al.  The cBio cancer genomics portal: an open platform for exploring multidimensional cancer genomics data. , 2012, Cancer discovery.

[159]  I. Ellis,et al.  An immune response gene expression module identifies a good prognosis subtype in estrogen receptor negative breast cancer , 2007, Genome Biology.

[160]  S. Sheps,et al.  Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? , 2004, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[161]  A. Kurian,et al.  Occurrence of breast cancer subtypes in adolescent and young adult women , 2012, Breast Cancer Research.

[162]  J. Manson,et al.  Biomarkers of one-carbon metabolism are associated with biomarkers of inflammation in women. , 2014, The Journal of nutrition.

[163]  I. M. Neiman,et al.  [Inflammation and cancer]. , 1974, Patologicheskaia fiziologiia i eksperimental'naia terapiia.

[164]  D. de Freitas,et al.  [Alcohol and cancer]. , 1997, Acta medica portuguesa.

[165]  Shailesh Agarwal,et al.  Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. , 2014, JAMA surgery.

[166]  X. Shu,et al.  Soy food intake and breast cancer survival. , 2009, JAMA.

[167]  A. Cooke,et al.  Immunity, Transferrin, and Survival in Kwashiorkor , 1970, British medical journal.

[168]  C. Rock,et al.  Diet and risk for breast cancer recurrence and survival , 1999, Breast Cancer Research and Treatment.

[169]  A. Neugut,et al.  Effect of breast cancer radiotherapy and cigarette smoking on risk of second primary lung cancer. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[170]  J. Ray Folic acid food fortification in Canada. , 2004, Nutrition reviews.

[171]  M. Irwin,et al.  Sleep disturbance, inflammation and depression risk in cancer survivors , 2013, Brain, Behavior, and Immunity.

[172]  N. Parekh,et al.  Obesity, insulin resistance, and cancer prognosis: implications for practice for providing care among cancer survivors. , 2009, Journal of the American Dietetic Association.

[173]  E. Lee,et al.  Adipokines, insulin resistance, metabolic syndrome, and breast cancer recurrence: a cohort study , 2011, Breast Cancer Research.

[174]  Chaoming Mao,et al.  Circulating adiponectin levels and the risk of breast cancer: a meta-analysis , 2014, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[175]  R. Baumgartner,et al.  Associations of insulin resistance and adiponectin with mortality in women with breast cancer. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[176]  C. Stewart,et al.  Antimetastatic effects associated with platelet reduction. , 1968, Proceedings of the National Academy of Sciences of the United States of America.

[177]  J. Vilcoq,et al.  Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. , 1989, International journal of radiation oncology, biology, physics.

[178]  E. Ostrander,et al.  Frequency of BRCA1/BRCA2 mutations in a population‐based sample of young breast carcinoma cases , 2000, Cancer.

[179]  C. Ulrich,et al.  Postdiagnosis Diet Quality Is Inversely Related to a Biomarker of Inflammation among Breast Cancer Survivors , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[180]  Early Breast Cancer Trialists' Collaborative Group Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials , 2011, The Lancet.

[181]  Young-In Kim Folate and colorectal cancer: an evidence-based critical review. , 2007, Molecular nutrition & food research.

[182]  Daniel Birnbaum,et al.  Gene expression profiling shows medullary breast cancer is a subgroup of basal breast cancers. , 2006, Cancer research.

[183]  W. Woodward,et al.  Age and survival estimates in patients who have node-negative T1ab breast cancer by breast cancer subtype. , 2011, Clinical breast cancer.

[184]  C. Friedenreich Physical activity and breast cancer: review of the epidemiologic evidence and biologic mechanisms. , 2011, Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer.

[185]  Garret A. FitzGerald,et al.  Prostaglandins and Inflammation , 2011, Arteriosclerosis, thrombosis, and vascular biology.

[186]  D. Hicks,et al.  Folate receptor α associated with triple-negative breast cancer and poor prognosis. , 2014, Archives of pathology & laboratory medicine.

[187]  H. Putter,et al.  COX2 expression in prognosis and in prediction to endocrine therapy in early breast cancer patients , 2011, Breast Cancer Research and Treatment.

[188]  D. Rose,et al.  Adiposity, type 2 diabetes and the metabolic syndrome in breast cancer , 2007, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[189]  L. Habel,et al.  NSAIDs and breast cancer recurrence in a prospective cohort study , 2007, Cancer Causes & Control.

[190]  X. Chen,et al.  Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. , 2011, The Journal of clinical investigation.

[191]  A. Bertolotti,et al.  Host Resistance in Relation to Survival in Breast Cancer , 1974, British medical journal.

[192]  B. E. F. Isher,et al.  Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. , 2002 .

[193]  Ya-li Liu,et al.  Alcohol Consumption and Breast Cancer Survival: A Meta- analysis of Cohort Studies. , 2013, Asian Pacific journal of cancer prevention : APJCP.

[194]  R Peto,et al.  Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials , 2011, The Lancet.

[195]  R. Demicheli,et al.  Reduction of Breast Cancer Relapses with Perioperative Non-Steroidal Anti-Inflammatory Drugs: New Findings and a Review , 2013, Current medicinal chemistry.

[196]  D. Noh,et al.  Prognosis of breast cancer is associated with one-carbon metabolism related nutrients among Korean women , 2012, Nutrition Journal.