Highlights
- •It is unknown whether associations between lifestyle factors and ovarian cancer survival differ by BRCA variant status.
- •The adverse effects of smoking on ovarian cancer survival may be stronger for women with a BRCA variant than those without.
- •There was no differential association in survival by BRCA variant status for physical activity, BMI or alcohol intake.
Abstract
Objective
Women with ovarian cancer who have a pathogenic germline variant in BRCA1 or BRCA2 (BRCA) have been shown to have better 5-year survival after diagnosis than women who are
BRCA-wildtype (non-carriers). Modifiable lifestyle factors, including smoking, physical
activity and body mass index (BMI) have previously been associated with ovarian cancer
survival; however, it is unknown whether these associations differ by germline BRCA status.
Methods
We investigated measures of lifestyle prior to diagnosis in two cohorts of Australian
women with invasive epithelial ovarian cancer, using Cox proportional hazards regression
to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
In the combined studies (n = 1923), there was little association between physical activity, BMI or alcohol intake
and survival, and no difference by BRCA status. However, the association between current smoking status before diagnosis
and poorer survival was stronger for BRCA variant carriers (HR 1.98; 95% CI 1.20–3.27) than non-carriers (HR 1.18; 95% CI 0.96–1.46;
p-interaction 0.02). We saw a similar differential association with smoking when we
pooled results from two additional cohorts from the USA and UK (n = 2120). Combining the results from all four studies gave a pooled-HR of 1.94 (95%
CI 1.28–2.94) for current smoking among BRCA variant carriers compared to 1.08 (0.90–1.29) for non-carriers.
Conclusions
Our results suggest that the adverse effect of smoking on survival may be stronger
for women with a BRCA variant than those without. Thus, while smoking cessation may improve outcomes for
all women with ovarian cancer, it might provide a greater benefit for BRCA variant carriers.
Keywords
Abbreviations:
AOCS (Australian Ovarian Cancer Study), BMI (body mass index), CI (confidence interval), FIGO (International Federation of Obstetricians and Gynecologists), MAYO (Mayo Clinic Case-Only Ovarian Cancer Study/Mayo Clinic Ovarian Cancer Case Control Study), METhrs (metabolic equivalent hours), OCAC (Ovarian Cancer Association Consortium), OPAL (Ovarian cancer Prognosis and Lifestyle), PA (physical activity), pHR (pooled hazard ratio), SEARCH (Study of Epidemiology and Risk Factors in Cancer Heredity study)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 07, 2022
Accepted:
March 25,
2022
Received in revised form:
March 23,
2022
Received:
January 30,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
