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@ARTICLE{Gali:285363,
      author       = {K. Gali and E. Orban and A.-K. Ozga and A. Möhl and S.
                      Behrens$^*$ and B. Holleczek and H. Becher and N. Obi and J.
                      Chang-Claude$^*$},
      title        = {{D}oes breast cancer modify the long-term relationship
                      between lifestyle behaviors and mortality? {A} prospective
                      analysis of breast cancer survivors and population-based
                      controls.},
      journal      = {Cancer},
      volume       = {130},
      number       = {5},
      issn         = {0008-543X},
      address      = {New York, NY},
      publisher    = {Wiley-Liss},
      reportid     = {DKFZ-2023-02332},
      pages        = {781-791},
      year         = {2024},
      note         = {#LA:C020# / 2024 Mar 1;130(5):781-791},
      abstract     = {Modifiable lifestyle factors are known to impact survival.
                      It is less clear whether this differs between postmenopausal
                      women ever diagnosed with breast cancer and unaffected
                      women.Women diagnosed with breast cancer and unaffected
                      women of comparable age were recruited from 2002 to 2005 and
                      followed up until 2020. Using baseline information, a
                      lifestyle adherence score (range 0-8; categorized as low
                      [0-3.74], moderate [3.75-4.74], and high [≥4.75]) was
                      created based on the 2018 World Cancer Research
                      Fund/American Institute for Cancer Research (WCRF/AICR)
                      cancer prevention recommendations. Cox regression and
                      competing risks analysis were used to analyze the
                      association of adherence to WCRF/AICR lifestyle
                      recommendations with overall mortality and with death due to
                      cardiovascular diseases and cancer, respectively.A total of
                      8584 women were included (2785 with breast cancer and 5799
                      without). With a median follow-up of 16.1 years there were
                      2006 total deaths. Among the deaths of known causes
                      $(98.6\%),$ 445 were cardiovascular-related and 1004 were
                      cancer-related. The average lifestyle score was 4.2. There
                      was no differential effect of lifestyle score by
                      case-control status on mortality. After adjusting for
                      covariates, moderate (hazard ratio [HR], 0.66; $95\%$
                      confidence interval [CI], 0.57-0.76) and high (HR, 0.54;
                      $95\%$ CI, 0.47-0.63) adherence to WCRF/AICR lifestyle
                      recommendations were significantly associated with a
                      decrease in overall mortality. Similarly, in competing risks
                      analysis, moderate and high adherence were associated with
                      decreased mortality from cardiovascular diseases and from
                      cancer.A healthy lifestyle can substantially reduce
                      mortality risk in women. With low adherence to all WCRF/AICR
                      guidelines in about a third of study participants, health
                      interventions are warranted.},
      keywords     = {breast cancer (Other) / competing risks (Other) / dietary
                      habits (Other) / health behaviors (Other) / physical
                      activity (Other) / survival (Other) / tobacco use (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37950787},
      doi          = {10.1002/cncr.35104},
      url          = {https://inrepo02.dkfz.de/record/285363},
}