| dc.description.abstract | Breast cancer (BC) survivors, a large and growing population resulting from early detection and effective treatments, have been reported to experience faster physical and cognitive decline due to cancer and/or cancer treatment, indicative of accelerated aging. However, the aging trajectory among BC survivors has not been clearly depicted, and evidence of its associations with cancer characteristics and cancer treatment was limited. Leveraging a clinical cohort of BC patients (N=2,000) and non-cancer controls (N=1,299) and the UK Biobank female participants (8,002 BC cases and 39,889 controls), we investigated the aging acceleration trajectory among BC survivors via 1) Phenotypic Age Acceleration (PAA), derived from chronological age and blood count/chemistry biomarkers, 2) self-reported frailty, 3) telomere length, and 4) cognitive functions; and evaluated the associations of cancer characteristics and treatment with aging acceleration. Statistical analysis was conducted using linear mixed models for repeated PAA measures, and linear and multinomial logistic regression models for other continuous and categorical outcomes, respectively, with the effects of cancer treatments assessed among cases only. In the clinical cohort, we identified a higher PAA among BC survivors than controls at year 1 (by 1.68 years) and 10 (by 1.16 years) post-diagnosis, especially among those with advanced stage, higher-grade BC, and receiving chemotherapy and hormone therapy. In a subset of this cohort who responded to a survey (N=557), BC survivors with advanced stage and high-grade BC showed a higher frailty prevalence. The adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS Guideline) was associated with 74% and 81% reduced prevalence for pre-frailty and frailty. In the UK Biobank, BC survivors had a higher PAA than propensity score-matched controls (by 0.34 years); no significant difference was observed for other aging-related outcomes. In summary, we found that BC survivors had accelerated aging which differed by cancer characteristic and treatment, and could be ameliorated by adherence to the ACS Guideline. As one of the first investigations in accelerated aging among BC survivors, our findings call for larger longitudinal studies to further our understanding and address the unique needs of cancer survivors. | |
