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Postdiagnosis body fatness, recreational physical activity, dietary factors and breast cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading.

Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. Department of Nutrition, Bjørknes University College, Oslo, Norway. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway. Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France. Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, UK. National Institute of Health Research Cancer and Nutrition Collaboration, Southampton, UK. Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands. World Cancer Research Fund International, London, UK. American Institute for Cancer Research, Arlington, Virginia, USA. Division of Medical Oncology, The Department of Internal Medicine, College of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.

International journal of cancer. 2023;(4):635-644
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Abstract

Based on the Global Cancer Update Programme, formally known as the World Cancer Research Fund/American Institute for Cancer Research Continuous Update Project, we performed systematic reviews and meta-analyses to investigate the association of postdiagnosis body fatness, physical activity and dietary factors with breast cancer prognosis. We searched PubMed and Embase for randomised controlled trials and longitudinal observational studies from inception to 31 October 2021. We calculated summary relative risks (RRs) and 95% confidence intervals (CIs) using random-effects meta-analyses. An independent Expert Panel graded the quality of evidence according to predefined criteria. The evidence on postdiagnosis body fatness and higher all-cause mortality (RR per 5 kg/m2 in body mass index: 1.07, 95% CI: 1.05-1.10), breast cancer-specific mortality (RR: 1.10, 95% CI: 1.06-1.14) and second primary breast cancer (RR: 1.14, 95% CI: 1.04-1.26) was graded as strong (likelihood of causality: probable). The evidence for body fatness and breast cancer recurrence and other nonbreast cancer-related mortality was graded as limited (likelihood of causality: limited-suggestive). The evidence on recreational physical activity and lower risk of all-cause (RR per 10 metabolic equivalent of task-hour/week: 0.85, 95% CI: 0.78-0.92) and breast cancer-specific mortality (RR: 0.86, 95% CI: 0.77-0.96) was judged as limited-suggestive. Data on dietary factors was limited, and no conclusions could be reached except for healthy dietary patterns, isoflavone and dietary fibre intake and serum 25(OH)D concentrations that were graded with limited-suggestive evidence for lower risk of the examined outcomes. Our results encourage the development of lifestyle recommendations for breast cancer patients to avoid obesity and be physically active.