This study joins an increasing body of research indentifying CRP and SAA as indicators of reduced survival from cancer. Previous studies have shown an association between elevated levels of CRP and poor survival outcomes in metastatic prostate cancer, as well as gastroesophageal, colorectal, inoperable non-small-cell lung, and pancreatic cancers. In other studies, a similar association was shown for SAA and gastric cancer and renal cell carcinoma. Although research has indicated that inflammation may play a role in the progression of cancer, the exact mechanism by which this happens has been unclear.

This is one of many papers to come out of NCI's HEAL study, an initiative designed to investigate the effects that physical activity, eating habits, weight patterns, diet, hormones, and other factors have on breast cancer prognosis. For this study, 1,183 women with early-stage breast cancer were recruited from three cancer centers, including the Fred Hutchinson Cancer Research Center in Seattle, the University of New Mexico, Albuquerque, and the University of Southern California, Los Angeles. Participants completed a lifestyle questionnaire when they joined the study and the researchers collected blood samples (which were analyzed for CRP and SAA levels) and height and weight measurements at a subsequent visit two years later (approximately 2.5 years after their initial diagnosis). The women will be followed for a total of 10 years.


This is the first large, population-based study to look at the relationship between breast cancer survivorship and biomarkers of inflammation that were measured after treatment. Because the biomarkers were measured approximately 31 months after diagnosis, enough time had passed so that the researchers could accurately assess the effect of chronic inflammation, as opposed to acute inflammation that may have been a result of the breast cancer treatments each patient received.

The researchers examined the relationships between the inflammation biomarkers and both overall survival and disease-free survival. Overall survival was defined as the amount of time from the follow-up appointment until the patient died (from any cause) or the study period ended. Disease-free survival was defined as the amount of time from the follow-up appointment until the patient's breast cancer returned, another, new cancer was diagnosed, the patient died, or the study period ended. The researchers found that elevated levels of both SAA and CRP were associated (statistically significant) with reduced overall survival. Women with high levels of SAA were three times as likely to die sooner, and women with high levels of CRP were two times as likely to die sooner. They found similar, but weaker, associations with disease-free survival, in that women with high levels of SAA were two times as likely to die or have their cancer return, and women with high levels of CRP were more than 1.5 times as likely to die or have their cancer return. This suggests that SAA and CRP may be more closely related to overall survival than disease-free survival. More research is needed to get a better understanding of these associations and other potential mediating factors, in order to create more precise risk estimates.

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