The overall goal of this research project study is to conduct an observational study of post-treatment behavioral risk factors for recurrence of secondary breast tumors or new primaries. Specifically, we examine the effects of diet, physical activity, and weight gain in a cohort of 2400 women followed for an average of three and a half years after diagnosis with early stage breast cancer The study will also examine the interrelationships of the primary independent variables, specifically examining the effects of diet and activity on weight gain and activity on quality of life. The study will complement the Women's Healthy Eating Lifestyle Trial (WHEL), a high fruit and vegetable-low fat dietary intervention trial aimed at reducing breast cancer recurrence, by establishing an observational cohort of women who were screened for WHEL but not randomized, either because they were ineligible or not interested after further investigation. The primary hypotheses to be examined are whether women who have diets rich in plant sources , stable weights and high levels of physical activity have lower rates of recurrence compared to women who have diets low in plant sources, substantial weight gains and low levels of physical activity. Each of these behavioral factors will be examined individually and in combination with each other. Data will be collected on all of the above mentioned behavioral characteristics by mailed questionnaire on an annual basis. Recurrence data will be collected by mail on a semi-annual basis. Kaiser Permanente, one of the seven clinical sites in the WHEL trial will coordinate the study and recruit patients from all existing WHEL.tes. This study will allow us to examine normative time trends in breast cancer survivors with regard to recurrence rates, weight gain, dietary and physical activity habits and quality of life which will aid in the interpretation of the clinical trial. It will also establish a resource for future studies where predictors of long term survival can be examined
