MARIEplus and MARIEplus2

Follow-up studies of breast cancer patients in the MARIE Study

MARIEplus and MARIEplus2 are follow-up studies of the MARIE Study with breast cancer patients in the MARIE Study at staggered intervals of approximately 5 years.
As the mortality rate from breast cancer declines, women survive longer after being diagnosed with breast cancer, increasing the number of long term survivors.
But little is known about the diagnostic, therapeutic, clinical and genetic factors that influence recurrence or death of the disease. Furthermore, there is little known about how the use of hormones for the relief of menopausal symptoms or how lifestyle factors, e.g. diet and physical activity, or changes in them after diagnosis, affect the prognosis of the disease. There is also little known about how these factors modify the course of the disease after certain cancer therapies.


The aim of the MARIEplus and the MARIEplus2 Studies was to identify factors influencing the course of the disease in breast cancer patients and thus to find approaches to improve survival after the disease. It was investigated whether the following factors could modify the course of the disease and the prognosis after certain cancer therapies:


  • Taking hormones to relieve menopausal symptoms before diagnosis
  • Pre-diagnosis lifestyle factors such as diet and physical activity
  • Changes in lifestyle factors after diagnosis

To answer these questions, a long-term observation of breast cancer patients in the MARIE study was started in the study regions Rhein-Neckar-Karlsruhe and Hamburg. Therapeutic data were collected and a telephone interview was carried out with the participants in summer 2009 (MARIEplus) and winter 2014/2015 (MARIEplus2) in order to capture lifestyle changes, medication use, occurrence of comorbidities, and the recurrence of breast cancer. In cooperation with the cancer registries and the local authorities, all-cause and breast cancer specific mortality were determined.

In addition, the women were asked to provide a blood sample in order to investigate the following questions:


  • What is the relationship between the phytoestrogen level ("enterolactone") measured in the blood and the long-term prognosis for breast cancer? What role do lifestyle factors such as physical activity, overweight / underweight play?
  • Is there a connection between characteristics measured in the blood that may indicate an inflammatory reaction and the long-term course of breast cancer?


  • A healthy diet with plenty of fruit and vegetables favored a positive prognosis. In contrast, too much red meat, sausage, and fried foods are not recommended.
  • Physical activity such as walking or cycling had a positive effect on the course of the disease.
  • A high level of enterolactone in the blood (the most common and important phytoestrogen in our western diet) was also associated with a better prognosis.
  • Smoking and alcohol consumption were associated with an increased breast cancer mortality.
  • A stable weight was beneficial for survival.
  • Women who took hormones for menopausal symptoms were less likely to have a relapse.
  • Breast cancer recurrence was more common in patients who were diagnosed with low vitamin D levels.

A more detailed description of the results can be found in the study report, and further details are available in the scientific publications.

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