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Diet, Physical Activity, Weight, Biomarkers, and Breast Cancer Outcomes: What Have We Learned?

The Health, Eating, Activity and Lifestyle (HEAL) study is a multicenter, multiethnic prospective cohort study of 1,183 breast cancer survivors diagnosed in 1997-1999. Its purpose is to assess how lifestyle factors such as weight and diet patterns, physical activity, and biomarker profiles affect breast cancer prognosis and survival. Women diagnosed with in situ, stage I, stage II, or stage IIIA breast cancer were enrolled into HEAL study sites corresponding to the Surveillance, Epidemiology and End Results (SEER) region from which they were recruited: Fred Hutchinson Cancer Research Center in Seattle, WA; University of New Mexico in Albuquerque, NM; and City of Hope National Medical Center in Duarte, CA. The HEAL Principal Investigators at each of those institutions are Dr. Anne McTiernan, Dr. Charles Wiggins, and Dr. Leslie Bernstein, respectively.

Early HEAL research questions focused primarily on the effects of lifestyle factors, including weight and diet patterns, physical activity, breast density, and sex hormones on breast cancer prognosis and survival. More recently, potential associations of other biologic markers (e.g., tumor markers and serum and germline DNA) with prognosis have been identified and reported in the scientific literature. Based on those data, current HEAL research questions focus on exploring the association of biologic markers in the areas of genetics, telomere length, inflammation, dietary fatty acids, body composition, and vitamin D with long-term mortality and quality of life outcomes. For example, a recent study (Villasenor et al., 2012) showed that sarcopenia (low skeletal muscle mass) was associated with an increased risk of overall mortality in breast cancer survivors and may be associated with breast cancer-specific mortality. Another paper (Alfano et al., 2012) showed that HEAL participants who had a higher intake of omega 3 and omega 6 fatty acids had decreased inflammation and physical aspects of fatigue. HEAL investigators found that telomere shortening was associated with increased risk of breast cancer-specific and all-cause mortality, concluding that a change in blood telomere length over time may be a prognostic biomarker (Duggan et al., 2014). Other innovative analyses that use this unique data resource focus on: 1) side effects, alternative therapy and survival; 2) diet, single nucleotide polymorphisms (SNPs) and biomarkers; 3) mammographic density; and 4) lymphedema.

Dr. Rachel Ballard-Barbash serves as Principal Investigator of HEAL at NCI. Ms. Anita Ambs serves as Research Coordinator of HEAL at NCI. According to Dr. Ballard-Barbash, "the HEAL study has provided a unique resource to understand the biologic pathways by which these health behaviors influence breast cancer prognosis for women from diverse racial and ethnic backgrounds, and it has engaged a new generation of investigators in cancer survivorship research."

To learn more about HEAL, and to view citations and abstracts for HEAL publications, please visit the HEAL Web site.

Last Modified: 27 Jun 2014