Jung Wonyoung, Han Kyungdo, Kim Bongseong, Yu Jonghan, An Ji Hyun, Jeon Hong Jin, Park Yong-Moon Mark, Shin Dong Wook
Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
J Cancer Surviv. 2025 Apr 7. doi: 10.1007/s11764-025-01794-5.
Protective lifestyle behaviors could potentially mitigate the risk of depression in breast cancer survivors. This study examined the association between changes in key health behaviors and depression risk after breast cancer diagnosis and treatment.
This nationwide cohort study assessed 30,523 breast cancer survivors without a prior history of depression, focusing on changes in weight, smoking habits, alcohol consumption, and physical activity from pre- to post-cancer diagnosis. The primary outcome was incident depression, with adjusted hazard ratios and confidence intervals calculated to consider potential confounders.
During an average follow-up of 5.3 years (160,755 person-years), lifestyle changes post-diagnosis included decreases in smoking (2.8% to 0.9%) and alcohol consumption (24.9% to 7.5%) and an increase in physical activity (18.9% to 32.1%). Substantial weight gain (> 10%) was associated with a 27% elevated risk of depression compared to those who maintained weight. Both continuation and cessation of smoking were associated with increased depression risk compared to sustained non-smokers. Changes in alcohol consumption, either initiation or cessation, were associated with increased depression risk compared to sustained non-drinkers. Conversely, breast cancer survivors who became inactive post-diagnosis had a reduced risk of depression compared to those who remained inactive. Our exploratory analysis showed that regular physical activity prior to diagnosis was associated with a 7% lower risk of depression compared to inactivity.
We observed that post-diagnosis weight gain exceeding 10%, sustaining or quitting smoking, starting or stopping alcohol consumption, and pre-diagnosis physical inactivity were all associated with an increased risk of depression in breast cancer survivors. Healthcare providers should support healthy behaviors to mitigate depression risk after breast cancer diagnosis and treatment.
保持健康的生活方式可能会降低乳腺癌幸存者患抑郁症的风险。本研究调查了乳腺癌诊断和治疗后关键健康行为的变化与抑郁症风险之间的关联。
这项全国性队列研究评估了30523名无抑郁症病史的乳腺癌幸存者，重点关注癌症诊断前后体重、吸烟习惯、饮酒量和身体活动的变化。主要结局是新发抑郁症，计算调整后的风险比和置信区间以考虑潜在的混杂因素。
在平均5.3年（160755人年）的随访期间，诊断后的生活方式变化包括吸烟率下降（从2.8%降至0.9%）、饮酒量下降（从24.9%降至7.5%）以及身体活动增加（从18.9%增至32.1%）。与体重保持不变的人相比，体重大幅增加（>10%）与抑郁症风险升高27%相关。与持续不吸烟者相比，继续吸烟和戒烟均与抑郁症风险增加相关。与持续不饮酒者相比，饮酒量的变化（开始或停止饮酒）均与抑郁症风险增加相关。相反，与保持不活动的乳腺癌幸存者相比，诊断后变得不活动的幸存者患抑郁症的风险降低。我们的探索性分析表明，与不活动相比，诊断前经常进行体育活动与抑郁症风险降低7%相关。
我们观察到，诊断后体重增加超过10%、持续吸烟或戒烟、开始或停止饮酒以及诊断前身体不活动均与乳腺癌幸存者患抑郁症的风险增加相关。医疗保健提供者应支持健康行为，以降低乳腺癌诊断和治疗后患抑郁症的风险。
