gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

The impact of menopausal hormone therapy, life style and genetic factors on mortality and recurrence in postmenopausal breast cancer patients (The MARIEplus study)

Meeting Abstract

  • Nadia Obi
  • Alina Vrieling
  • Judith Heinz
  • Jenny Chang-Claude
  • Dieter Flesch-Janys

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds610

doi: 10.3205/11gmds610, urn:nbn:de:0183-11gmds6108

Published: September 20, 2011

© 2011 Obi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: The MARIEplus study is the prospective follow-up of 3,813 incident primary breast cancer (BC) cases, recruited within a large population based case-control study (2001-2005) that was aimed to identify risk factors for BC subtypes (MARIE study). The baseline study was conducted in two regions, Hamburg and Rhein-Neckar-Karlsruhe (RNK), and consisted of a comprehensive face-to-face interview, a self-administered food frequency questionnaire, collection of pathology reports and a blood sample. Objectives of the MARIEplus study are to evaluate the role of lifestyle and BC risk factors, such as menopausal hormone therapy, for prognosis, including mortality, recurrence and second cancers.

Methods: After ascertainment of vital status through the residents’ registration office, patients were interviewed by telephone during follow-up in 2009 regarding lifestyle, and the occurrence of relapse, metastasis, or an incident second cancer in the interim. Eligible patients were sent a questionnaire on BC related quality of life. Data on primary BC treatment were collected from hospitals, oncologists and radiologists, thereby verifying patients’ reports on recurrence. The Hamburg cancer registry provided information on BC recurrence, secondary cancers and causes of death. Baseline blood samples were analyzed for various genetic polymorphisms, such as related to oxidative stress and hormone metabolism. Serum concentrations of 25-hydroxyvitamin D and enterolactone were previously measured in samples from the RNK region. Tumour tissue blocks are being collected to prepare Tissue Micro Arrays for several tumour and proliferation markers to further classify certain subtypes, e.g. triple negative and Her2 positive BC.

Results: By December, 31st, 2009 (median follow-up 6 years) 507 deaths (13.3%) occurred, of which 71% were due to BC. The five years overall survival (OS) rate was 83%. Final numbers for recurrence, metastasis and second tumours are still being validated. Present analyses are focussed on the following subjects in relation to BC prognosis:

1. Postmenopausal hormone therapy: Prediagnostic HT use seems to be associated with lower mortality after adjustment for age, tumour and lifestyle characteristics.

2. Serum 25-hydroxyvitamin D: Lower 25(OH)D concentrations were associated with poorer OS and distant disease-free survival in the RNK region.

3. Dietary intake of lignans and fibre, and serum enterolactone: High estimated dietary intake of enterolactone, enterodiol, and fibre (as well as high serum enterolactone levels in the RNK region) were associated with significantly better OS.

Additionally, oxidative stress related genes polymorphisms, physical activity before and during treatment, and fatigue and Quality of Life are being evaluated in relation to BC survival.