Breast Cancer Research and Treatment

, Volume 114, Issue 1, pp 13–22 | Cite as

Lifestyle changes and breast cancer prognosis: a review

  • Eliane Kellen
  • Greet Vansant
  • Marie-Rose Christiaens
  • Patrick Neven
  • Erik Van Limbergen


Objective Because of its high incidence and improving survival, breast cancer is currently the most prevalent cancer in the world. We reviewed the published literature in our search for modifiable factors valuable as an adjuvant health measure to surgery, radio and systemic therapy for breast cancer. Methods We included material which was identified from computerised searches of PubMed (1966 to May, 2007). Published material was restricted to prospective cohort studies and randomised clinical trials. We reviewed the literature concerning the association between physical activity, smoking, weight gain after the diagnosis, diet and prognosis. Results and conclusion We conclude that life style changes following standard breast cancer therapy are highly recommended (although scientific evidence is still lacking for some of inconsistency regarding available data). They include physical activity, weight control, high consumption of fruit and vegetables, and a reduction of dietary fat intake.


Breast cancer Life style Prognosis 


  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedGoogle Scholar
  2. 2.
    Key TJ, Verkasalo PK, Banks E (2001) Epidemiology of breast cancer. Lancet Oncol 2:133–140PubMedCrossRefGoogle Scholar
  3. 3.
    World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, WashingtonGoogle Scholar
  4. 4.
    Duffy C, Perez K, Partridge A (2007) Implications of phytoestrogen intake for breast cancer. CA Cancer J Clin 57:260–277PubMedCrossRefGoogle Scholar
  5. 5.
    Michels KB, Mohllajee AP, Roset-Bahmanyar E, Beehler GP, Moysich KB (2007) Diet and breast cancer: a review of the prospective observational studies. Cancer 109:2712–2749PubMedCrossRefGoogle Scholar
  6. 6.
    Ha M, Mabuchi K, Sigurdson AJ et al (2007) Smoking cigarettes before first childbirth and risk of breast cancer. Am J Epidemiol 166:55–61PubMedCrossRefGoogle Scholar
  7. 7.
    Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML (2005) Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 16:545–556PubMedCrossRefGoogle Scholar
  8. 8.
    Irwin ML, Crumley D, McTiernan A et al (2003) Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer 97:1746–1757PubMedCrossRefGoogle Scholar
  9. 9.
    Lu W, Cui Y, Zheng Y et al (2007) Impact of newly diagnosed breast cancer on quality of life among Chinese women. Breast Cancer Res Treat 102:201–210PubMedCrossRefGoogle Scholar
  10. 10.
    Pierce JP, Faerber S, Wright FA et al (2002) A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) Study. Control Clin Trials 23:728–756PubMedCrossRefGoogle Scholar
  11. 11.
    Chlebowski RT, Blackburn GL, Buzzard IM et al (1993) Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer. The Women’s Intervention Nutrition Study. J Clin Oncol 11:2072–2080PubMedGoogle Scholar
  12. 12.
    Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293:2479–2486PubMedCrossRefGoogle Scholar
  13. 13.
    Holick CN, Newcomb PA, Trentham-Dietz A et al (2008) Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev 17:379–386PubMedCrossRefGoogle Scholar
  14. 14.
    Abrahamson PE, Gammon MD, Lund MJ et al (2006) Recreational physical activity and survival among young women with breast cancer. Cancer 107:1777–1785PubMedCrossRefGoogle Scholar
  15. 15.
    Enger SM, Bernstein L (2004) Exercise activity, body size and premenopausal breast cancer survival. Br J Cancer 90:2138–2141PubMedGoogle Scholar
  16. 16.
    Pierce JP, Stefanick ML, Flatt SW et al (2007) Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 25:2345–2351PubMedCrossRefGoogle Scholar
  17. 17.
    Borugian MJ, Sheps SB, Kim-Sing C et al (2004) Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? Cancer Epidemiol Biomarkers Prev 13:1163–1172PubMedGoogle Scholar
  18. 18.
    Ligibel JA, Campbell N, Partridge A et al (2008) Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. J Clin Oncol 26:907–912PubMedCrossRefGoogle Scholar
  19. 19.
    Campbell KL, McTiernan A (2007) Exercise and biomarkers for cancer prevention studies. J Nutr 137:161S–169SPubMedGoogle Scholar
  20. 20.
    McTiernan A, Tworoger SS, Rajan KB et al (2004) Effect of exercise on serum androgens in postmenopausal women: a 12-month randomized clinical trial. Cancer Epidemiol Biomarkers Prev 13:1099–1105PubMedGoogle Scholar
  21. 21.
    Campbell KL, Westerlind KC, Harber VJ, Bell GJ, Mackey JR, Courneya KS (2007) Effects of aerobic exercise training on estrogen metabolism in premenopausal women: a randomized controlled trial. Cancer Epidemiol Biomarkers Prev 16:731–739PubMedCrossRefGoogle Scholar
  22. 22.
    Adesanya OO, Zhou J, Samathanam C, Powell-Braxton L, Bondy CA (1999) Insulin-like growth factor 1 is required for G2 progression in the estradiol-induced mitotic cycle. Proc Natl Acad Sci USA 96:3287–3291PubMedCrossRefGoogle Scholar
  23. 23.
    Holmes MD, Murin S, Chen WY, Kroenke CH, Spiegelman D, Colditz GA (2007) Smoking and survival after breast cancer diagnosis. Int J Cancer 120:2672–2677PubMedCrossRefGoogle Scholar
  24. 24.
    Fentiman IS, Allen DS, Hamed H (2005) Smoking and prognosis in women with breast cancer. Int J Clin Pract 59:1051–1054PubMedCrossRefGoogle Scholar
  25. 25.
    Sagiv SK, Gaudet MM, Eng SM et al (2007) Active and passive cigarette smoke and breast cancer survival. Ann Epidemiol 17:385–393PubMedCrossRefGoogle Scholar
  26. 26.
    Manjer J, Andersson I, Berglund G et al (2000) Survival of women with breast cancer in relation to smoking. Eur J Surg 166:852–858PubMedCrossRefGoogle Scholar
  27. 27.
    Sopori M (2002) Effects of cigarette smoke on the immune system. Nat Rev Immunol 2:372–377PubMedCrossRefGoogle Scholar
  28. 28.
    Kendall A, Folkerd EJ, Dowsett M (2007) Influences on circulating oestrogens in postmenopausal women: relationship with breast cancer. J Steroid Biochem Mol Biol 103:99–109PubMedCrossRefGoogle Scholar
  29. 29.
    Terry PD, Rohan TE, Franceschi S, Weiderpass E (2002) Cigarette smoking and the risk of endometrial cancer. Lancet Oncol 3:470–480PubMedCrossRefGoogle Scholar
  30. 30.
    Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7:333–340PubMedCrossRefGoogle Scholar
  31. 31.
    Chlebowski RT (1994) Dietary fat intake reduction for patients with resected breast cancer. Adv Exp Med Biol 364:11–23PubMedGoogle Scholar
  32. 32.
    Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20:1128–1143PubMedCrossRefGoogle Scholar
  33. 33.
    Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23:1370–1378PubMedCrossRefGoogle Scholar
  34. 34.
    Caan BJ, Emond JA, Natarajan L et al (2006) Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer. Breast Cancer Res Treat 99:47–57PubMedCrossRefGoogle Scholar
  35. 35.
    Byers T, Sedjo RL (2006) A weight loss trial for breast cancer recurrence: pre-menopausal, post-menopausal, both, or neither? Cancer Causes Control 17:1–3PubMedCrossRefGoogle Scholar
  36. 36.
    McTiernan A, Rajan KB, Tworoger SS et al (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 21:1961–1966PubMedCrossRefGoogle Scholar
  37. 37.
    Griggs JJ, Sorbero ME, Lyman GH (2005) Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med 165:1267–1273PubMedCrossRefGoogle Scholar
  38. 38.
    Carmichael AR, Bates T (2004) Obesity and breast cancer: a review of the literature. Breast 13:85–92PubMedCrossRefGoogle Scholar
  39. 39.
    Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP (2003) Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst 95:1467–1476PubMedGoogle Scholar
  40. 40.
    Messina M, Caskill-Stevens W, Lampe JW (2006) Addressing the soy and breast cancer relationship: review, commentary, and workshop proceedings. J Natl Cancer Inst 98:1275–1284PubMedGoogle Scholar
  41. 41.
    Boyapati SM, Shu XO, Ruan ZX et al (2005) Soyfood intake and breast cancer survival: a followup of the Shanghai Breast Cancer Study. Breast Cancer Res Treat 92:11–17PubMedCrossRefGoogle Scholar
  42. 42.
    Limer JL, Speirs V (2004) Phyto-oestrogens and breast cancer chemoprevention. Breast Cancer Res 6:119–127PubMedCrossRefGoogle Scholar
  43. 43.
    Wu AH, Pike MC, Williams LD et al (2007) Tamoxifen, soy, and lifestyle factors in Asian American women with breast cancer. J Clin Oncol 25:3024–3030PubMedCrossRefGoogle Scholar
  44. 44.
    von SE, Rutqvist LE (2005) Menopausal hormone therapy after breast cancer: the Stockholm randomized trial. J Natl Cancer Inst 97:533–535Google Scholar
  45. 45.
    Holmberg L, Anderson H (2004) HABITS (hormonal replacement therapy after breast cancer–is it safe?), a randomised comparison: trial stopped. Lancet 363:453–455PubMedCrossRefGoogle Scholar
  46. 46.
    Holm LE, Nordevang E, Hjalmar ML, Lidbrink E, Callmer E, Nilsson B (1993) Treatment failure and dietary habits in women with breast cancer. J Natl Cancer Inst 85:32–36PubMedCrossRefGoogle Scholar
  47. 47.
    Zhang S, Folsom AR, Sellers TA, Kushi LH, Potter JD (1995) Better breast cancer survival for postmenopausal women who are less overweight and eat less fat. The Iowa Women’s Health Study. Cancer 76:275–283PubMedCrossRefGoogle Scholar
  48. 48.
    McEligot AJ, Largent J, Ziogas A, Peel D, Anton-Culver H (2006) Dietary fat, fiber, vegetable, and micronutrients are associated with overall survival in postmenopausal women diagnosed with breast cancer. Nutr Cancer 55:132–140PubMedCrossRefGoogle Scholar
  49. 49.
    Hebert JR, Hurley TG, Ma Y (1998) The effect of dietary exposures on recurrence and mortality in early stage breast cancer. Breast Cancer Res Treat 51:17–28PubMedCrossRefGoogle Scholar
  50. 50.
    Saxe GA, Rock CL, Wicha MS, Schottenfeld D (1999) Diet and risk for breast cancer recurrence and survival. Breast Cancer Res Treat 53:241–253PubMedCrossRefGoogle Scholar
  51. 51.
    Rohan TE, Hiller JE, McMichael AJ (1993) Dietary factors and survival from breast cancer. Nutr Cancer 20:167–177PubMedGoogle Scholar
  52. 52.
    Chlebowski RT, Blackburn GL, Thomson CA et al (2006) Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst 98:1767–1776PubMedCrossRefGoogle Scholar
  53. 53.
    Holmes MD, Stampfer MJ, Colditz GA, Rosner B, Hunter DJ, Willett WC (1999) Dietary factors and the survival of women with breast carcinoma. Cancer 86:826–835PubMedCrossRefGoogle Scholar
  54. 54.
    Kyogoku S, Hirohata T, Nomura Y, Shigematsu T, Takeshita S, Hirohata I (1992) Diet and prognosis of breast cancer. Nutr Cancer 17:271–277PubMedCrossRefGoogle Scholar
  55. 55.
    Wynder EL, Taioli E, Rose DP (1992) Breast cancer—the optimal diet. Adv Exp Med Biol 322:143–153PubMedGoogle Scholar
  56. 56.
    Rock CL, Flatt SW, Thomson CA et al (2004) Effects of a high-fiber, low-fat diet intervention on serum concentrations of reproductive steroid hormones in women with a history of breast cancer. J Clin Oncol 22:2379–2387PubMedCrossRefGoogle Scholar
  57. 57.
    Kroenke CH, Fung TT, Hu FB, Holmes MD (2005) Dietary patterns and survival after breast cancer diagnosis. J Clin Oncol 23:9295–9303PubMedCrossRefGoogle Scholar
  58. 58.
    Pierce JP, Natarajan L, Caan BJ et al (2007) Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA 298:289–298PubMedCrossRefGoogle Scholar
  59. 59.
    Ingram D (1994) Diet and subsequent survival in women with breast cancer. Br J Cancer 69:592–595PubMedGoogle Scholar
  60. 60.
    Fleischauer AT, Simonsen N, Arab L (2003) Antioxidant supplements and risk of breast cancer recurrence and breast cancer-related mortality among postmenopausal women. Nutr Cancer 46:15–22PubMedCrossRefGoogle Scholar
  61. 61.
    Rock CL, Flatt SW, Natarajan L et al (2005) Plasma carotenoids and recurrence-free survival in women with a history of breast cancer. J Clin Oncol 23:6631–6638PubMedCrossRefGoogle Scholar
  62. 62.
    Goodwin PJ, Ennis M, Pritchard KI, Koo J, Trudeau ME, Hood N (2003) Diet and breast cancer: evidence that extremes in diet are associated with poor survival. J Clin Oncol 21:2500–2507PubMedCrossRefGoogle Scholar
  63. 63.
    Veronesi U, Mariani L, Decensi A et al (2006) Fifteen-year results of a randomized phase III trial of fenretinide to prevent second breast cancer. Ann Oncol 17:1065–1071PubMedCrossRefGoogle Scholar
  64. 64.
    Ladas EJ, Jacobson JS, Kennedy DD, Teel K, Fleischauer A, Kelly KM (2004) Antioxidants and cancer therapy: a systematic review. J Clin Oncol 22:517–528PubMedCrossRefGoogle Scholar
  65. 65.
    D′Andrea GM (2005) Use of antioxidants during chemotherapy and radiotherapy should be avoided. CA Cancer J Clin 55:319–321PubMedCrossRefGoogle Scholar
  66. 66.
    McDonald PA, Williams R, Dawkins F, Adams-Campbell LL (2002) Breast cancer survival in African American women: is alcohol consumption a prognostic indicator? Cancer Causes Control 13:543–549PubMedCrossRefGoogle Scholar
  67. 67.
    Tapiero H, Townsend DM, Tew KD (2004) The role of carotenoids in the prevention of human pathologies. Biomed Pharmacother 58:100–110PubMedCrossRefGoogle Scholar
  68. 68.
    Rock CL, Kusluski RA, Galvez MM, Ethier SP (1995) Carotenoids induce morphological changes in human mammary epithelial cell cultures. Nutr Cancer 23:319–333PubMedGoogle Scholar
  69. 69.
    Boffetta P, Hashibe M (2006) Alcohol and cancer. Lancet Oncol 7:149–156PubMedCrossRefGoogle Scholar
  70. 70.
    Ballard-Barbash R, McTiernan A (2007) Is the whole larger than the sum of the parts? The promise of combining physical activity and diet to improve cancer outcomes. J Clin Oncol 25:2335–2337PubMedCrossRefGoogle Scholar
  71. 71.
    Jones LW, Demark-Wahnefried W (2006) Diet, exercise, and complementary therapies after primary treatment for cancer. Lancet Oncol 7:1017–1026PubMedCrossRefGoogle Scholar
  72. 72.
    Doyle C, Kushi LH, Byers T et al (2006) Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 56:323–353PubMedGoogle Scholar
  73. 73.
    Demark-Wahnefried W, Clipp EC, Lipkus IM et al (2007) Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. J Clin Oncol 25:2709–2718PubMedCrossRefGoogle Scholar
  74. 74.
    Sabatino SA, Coates RJ, Uhler RJ, Pollack LA, Alley LG, Zauderer LJ (2007) Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol 25:2100–2106PubMedCrossRefGoogle Scholar
  75. 75.
    Wold KS, Byers T, Crane LA, Ahnen D (2005) What do cancer survivors believe causes cancer? (United States). Cancer Causes Control 16:115–V23PubMedCrossRefGoogle Scholar
  76. 76.
    Irwin ML (2006) Randomized controlled trials of physical activity and breast cancer prevention. Exerc Sport Sci Rev 34:182–193PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Eliane Kellen
    • 1
  • Greet Vansant
    • 2
    • 3
  • Marie-Rose Christiaens
    • 4
  • Patrick Neven
    • 4
  • Erik Van Limbergen
    • 1
    • 4
  1. 1.Universitaire Ziekenhuizen Leuven-LUCKLeuvenBelgium
  2. 2.Department of Nutrition, Preventive MedicineCatholic University LeuvenLeuvenBelgium
  3. 3.Department of Nutrition, Preventive MedicineUniversity Hospital GasthuisbergLeuvenBelgium
  4. 4.Multidisciplinary Breast CentreUniversity Hospitals LeuvenLeuvenBelgium

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