The impact of cancer prevention guideline adherence on overall mortality in a high-risk cohort of women from the New York site of the Breast Cancer Family Registry

Lifestyle Modifications and Breast Cancer Risk

Lifestyle modifications have been shown to be effective in reducing breast cancer [...].

Evidence-Based Interventions for Reducing Breast Cancer Disparities: What Works and Where the Gaps Are?

The National Cancer Institute (NCI) has established an online repository of evidence-based cancer control programs (EBCCP) and increasingly calls for the usage of these EBCCPs to reduce the cancer burden. To inventory existing EBCCPs and identify remaining gaps, we summarized NCI's EBCCPs relevant to reducing breast cancer risk with an eye towards interventions that address multiple levels of influence in populations facing breast cancer disparities. For each program, the NCI EBCCP repository provides the following expert panel determined summary metrics: (a) program ratings (1-5 scale, 5 best) of research integrity, intervention impact, and dissemination capability, and (b) RE-AIM framework assessment (0-100%) of program reach, effectiveness, adoption, and implementation. We quantified the number of EBCCPs that met the quality criteria of receiving a score of ≥3 for research integrity, intervention impact, and dissemination capability, and receiving a score of ≥50% for available RE-AIM reach, effectiveness, adoption, and implementation. For breast cancer risk reduction, we assessed the presence and quality of EBCCPs related to physical activity (PA), obesity, alcohol, tobacco control in early life, breastfeeding, and environmental chemical exposures. Our review revealed several major gaps in EBCCPs for reducing the breast cancer burden: (1) there are no EBCCPs for key breast cancer risk factors including alcohol, breastfeeding, and environmental chemical exposures; (2) among the EBCPPs that exist for PA, obesity, and tobacco control in early life, only a small fraction (24%, 17% and 31%, respectively) met all the quality criteria (≥3 EBCCP scores and ≥50% RE-AIM scores) and; (3) of those that met the quality criteria, only two PA interventions, one obesity, and no tobacco control interventions addressed multiple levels of influence and were developed in populations facing breast cancer disparities. Thus, developing, evaluating, and disseminating interventions to address important risk factors and reduce breast cancer disparities are needed.

Adherence to the 2020 American Cancer Society Guideline for Cancer Prevention and risk of breast cancer for women at increased familial and genetic risk in the Breast Cancer Family Registry: an evaluation of the weight, physical activity, and alcohol consumption recommendations

PURPOSE

The American Cancer Society (ACS) published an updated Guideline for Cancer Prevention (ACS Guideline) in 2020. Research suggests that adherence to the 2012 ACS Guideline might lower breast cancer risk, but there is limited evidence that this applies to women at increased familial and genetic risk of breast cancer.

METHODS

Using the Breast Cancer Family Registry (BCFR), a cohort enriched for increased familial and genetic risk of breast cancer, we examined adherence to three 2020 ACS Guideline recommendations (weight management (body mass index), physical activity, and alcohol consumption) with breast cancer risk in 9615 women. We used Cox proportional hazard regression modeling to calculate hazard ratios (HRs) and 95% confidence intervals (CI) overall and stratified by BRCA1 and BRCA2 pathogenic variant status, family history of breast cancer, menopausal status, and estrogen receptor-positive (ER +) breast cancer.

RESULTS

We observed 618 incident invasive or in situ breast cancers over a median 12.9 years. Compared with being adherent to none (n = 55 cancers), being adherent to any ACS recommendation (n = 563 cancers) was associated with a 27% lower breast cancer risk (HR = 0.73, 95% CI: 0.55-0.97). This was evident for women with a first-degree family history of breast cancer (HR = 0.68, 95% CI: 0.50-0.93), women without BRCA1 or BRCA2 pathogenic variants (HR = 0.71, 95% CI: 0.53-0.95), postmenopausal women (HR = 0.63, 95% CI: 0.44-0.89), and for risk of ER+ breast cancer (HR = 0.63, 95% CI: 0.40-0.98).

DISCUSSION

Adherence to the 2020 ACS Guideline recommendations for BMI, physical activity, and alcohol consumption could reduce breast cancer risk for postmenopausal women and women at increased familial risk.

The DAMA25 Study: Feasibility of a Lifestyle Intervention Programme for Cancer Risk Reduction in Young Italian Women with Breast Cancer Family History

BACKGROUND

Diet and physical activity (PA) can modulate sporadic and possibly familial breast cancer (BC) risk. The DAMA25 study is a single-arm 12-month intervention aimed to modify dietary and PA habits in healthy young Italian women with a positive BC family history, categorized as having intermediate or high genetic risk according to NICE (National Institute for Health and Cancer Excellence) guidelines.

METHODS

Participants, aged 25-49 years, were asked to adopt a diet mainly based on plant-based foods and to increase moderate daily activities combined with 1 h/week of more intense activity. Cooking lessons, collective walks, educational sessions, brochures, booklets and online materials were implemented. Dietary, PA habits and anthropometry were collected at baseline and at the end of the intervention. Changes on dietary, lifestyle habits and anthropometry were evaluated by GLM adjusted for weight reduction counselling aimed to participant with a BMI ≥ 25, age and baseline values of each variable.

RESULTS

Out of 237 eligible women 107 (45.2%) agreed to participate and among them 98 (91.6%) completed the intervention. The adherence rate of the intervention was 77.8%. We observed a reduction in red and processed meat (p < 0.0001) and cakes consumption (p < 0.0001). Consumption of whole grain bread (p < 0.001), leafy vegetables (p = 0.01) and olive oil (p = 0.04) increased. We observed an increase in moderate (p < 0.0001) and more intense (p < 0.0001) recreational activities, an average 1.4 kg weight loss (p = 0.005), a reduction of waist circumference (p < 0.001) and fat mass (p = 0.015).

CONCLUSIONS

The DAMA25 study shows that it is feasible an intervention to improve in the short-term dietary and PA habits and anthropometry in women with high BC familial risk.

Factors associated with meeting cancer prevention guidelines in adults

BACKGROUND

Because much worldwide cancer incidence and mortality is related to modifiable risk factors, many global health organizations provide evidence-based recommendations on healthy weight, diet, and physical activity levels for cancer prevention. Even though adherence to such guidelines is reported to reduce cancer incidence and mortality, this adherence is often suboptimal. Identifying factors related to adherence to the guidelines can suggest interventions to improve health promoting lifestyle behaviors for cancer prevention.

OBJECTIVES

Examine a comprehensive set of potentially predictive factors in meeting American Cancer Society's guidelines for healthy weight, fruits and vegetables intake, and physical activity.

METHODS

Data used in the analysis were from adults aged 18 years and older without a history of a cancer diagnosis who participated in the Health Information National Trends Survey in 2019 (n = 3407). Multivariate logistic regression analyses were used to determine the significant predictors for meeting each of the healthy weight, fruits and vegetables intake, and physical activity guidelines.

RESULTS

Overall adherence to each guideline was low: 39.0% met the physical activity guideline, 30.4% met the healthy weight guideline, and 17.6% met the fruits and vegetables intake guideline. Meeting the healthy body weight guideline was greater in current smokers, females, those who had at least some college education, those who did not have a chronic health condition, and those who had very good self-rated health. Meeting the fruits and vegetables intake guideline was greater in females, those who had very good self-rated health, and those who talked to friends or family members regarding their health. Meeting the physical activity guideline was greater in males, those who had household incomes of at least $50,000, those who did not have a chronic health condition, and those who had very good self-rated health.

CONCLUSIONS

The current analyses identified a unique set of predictors for meeting each guideline among US adults who reported never having been diagnosed with cancer. Based on these findings, interventions related to each guideline should be especially targeted to individuals having characteristics that were less likely to meet them.

CLINICAL RELEVANCE

Findings from the current study can assist health care providers who counsel about cancer prevention in the clinical setting.

Histórico familiar para câncer de mama em mulheres: estudo populacional em Uberaba (MG) utilizando o Family History Screen-7

RESUMO Objetiva-se determinar a prevalência de mulheres com risco de desenvolvimento de câncer de mama pelo histórico familiar em Uberaba (MG), e essa prevalência nas diferentes condições socioeconômicas e epidemiológicas. Pesquisa quantitativa, analítica, observacional e transversal de base populacional. Amostra com 1.520 mulheres a partir de 20 anos. Dados coletados por entrevistas domiciliares sobre informações socioeconômicas e epidemiológicas. A avaliação do risco hereditário de câncer de mama foi realizada pelo Family History Screen-7 (FHS-7). Como resultado, 28,6% da amostra apresentaram risco hereditário para câncer de mama. Houve associação significativa do risco de câncer quanto a: faixa etária, sendo nas mulheres com idade de 70 anos ou mais a maior proporção com risco (33,5%); etnia, sendo a maior proporção entre mulheres de etnia branca (31,2%); renda familiar, com maior ocorrência para renda per capita > 2,5 salários-mínimos (31,6%); prática de exames preventivos (30,6%); e alterações benignas na mama (46,7%). Conclui-se que, a partir do histórico familiar pelo FHS-7, o risco de as mulheres desenvolverem câncer mostrou-se significativamente associado com maior faixa etária, etnia branca e maior renda per capita, com a prática de exames preventivos em dia e alterações benignas na mama. Tais resultados possibilitam melhores direcionamentos de políticas públicas.

Lifestyle Patterns and Survival Following Breast Cancer in the Carolina Breast Cancer Study

BACKGROUND

Few studies have examined the impact of lifestyle patterns on survival following breast cancer. We aimed to identify distinct lifestyle patterns based on five behavior/dietary exposures among a population-based sample of women diagnosed with breast cancer and to examine their association with subsequent survival.

METHODS

In the Carolina Breast Cancer Study Phases I/II, we interviewed 1,808 women 20-74 years of age following diagnosis of invasive breast cancer. We determined vital status using the National Death Index (717 deaths, 427 from breast cancer; median follow-up 13.56 years). We assessed lifestyle patterns using a latent class analysis based on five behavioral and dietary exposures: current versus never/former smokers; low versus high vegetable and fruit intake; high and low/moderate, versus no alcohol consumption; and no and low/moderate, versus high regular physical activity. We used Cox regression to estimate covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality, and cause-specific and subdistribution HRs for breast cancer-specific mortality within 5 years and 13 years postdiagnosis conditional on 5-year survival.

RESULTS

We identified three distinct lifestyle patterns: healthy behavior and diet (n = 916); healthy behavior and unhealthy diet (n = 624); and unhealthy behavior and diet (n = 268). The unhealthy (vs. healthy) behavior and diet pattern was associated with a 13-year conditional all-cause mortality HR of 1.4 (95% CI = 1.1, 1.9) and with 13-year conditional breast cancer-specific and subdistribution HRs of 1.2 (95% CI = 0.79, 1.9) and 1.2 (95% CI = 0.77, 1.8), respectively.

CONCLUSIONS

Behavioral and dietary patterns can be used to identify lifestyle patterns that influence survival patterns following breast cancer diagnosis.

Preventative Health and Risk Behaviors Among Adolescent Girls With and Without Family Histories of Breast Cancer

PURPOSE

To compare health behaviors (smoking, alcohol use, fruit and vegetable intake, and exercise frequency) and breast self-exam (BSE) between girls with breast cancer family history (BCFH+) and without (BCFH-) and assess associates of behaviors across all girls.

METHODS

A total of 208 BCFH+ girls (11-19 years old), with first- or second-degree relatives with breast cancer or a mother with a BRCA1/2 mutation, and 112 BCFH- peers reported their health behaviors, beliefs, and psychosocial function.

RESULTS

Despite higher BCFH+ girls' greater perceived breast cancer risk, there were no differences between BCFH+ and BCFH- girls on diet, exercise, alcohol initiation, or BSE. BCFH+ girls were slightly more likely to report trying cigarettes (11% vs. 5%, p = .04). In multivariable models with all girls, categorical associations with behaviors included the following: developmental and demographic factors with smoking, alcohol, diet, and exercise; family breast cancer history and experience with smoking, alcohol, and diet; psychosocial factors with smoking; girls perceptions of cancer controllability and mother support for health behaviors with alcohol, diet, exercise, and BSE; and mother behaviors with diet.

CONCLUSIONS

Adolescent girls from BCFH+ families reported similar health behaviors to BCFH- peers, signaling that they are not translating their higher perceived risk into cancer control behaviors. Both uncontrollable (i.e., breast cancer experiences) and modifiable factors relate to health behaviors and warrant further investigation. Results indicate that interventions with teens and parents that target modifiable variables such as controllability perceptions, maternal modeling, and communication may relate to better health behaviors and reduced future breast cancer risk.

Adherence to Mediterranean Diet and Metabolic Syndrome in BRCA Mutation Carriers

Background. Insulin resistance is associated with higher breast cancer (BC) penetrance in BRCA mutation carriers. Metabolic syndrome (MetS), an insulin resistance syndrome, can be reversed by adhering to the Mediterranean diet (MedDiet). In a dietary intervention trial on BRCA mutation carriers, we evaluated adherence to the MedDiet, and the association with the MetS, by analyzing data from the Mediterranean Diet Adherence Screener (MEDAS). Methods. BRCA mutation carriers, with or without BC, aged 18 to 70 years, were eligible for the trial. After the baseline examinations, women were randomized to a dietary intervention or to a control group. Both groups completed the MEDAS at baseline and at the end of the dietary intervention. Results. A total of 163 women completed the 6 months of dietary intervention. Compared with controls, the women in the intervention group significantly reduced their consumption of red meat (P < .01) and commercial sweets (P < .01) and their MEDAS score rose significantly (+1.3 vs +0.55, P = .02). The number of MetS parameters decreased with increasing points of adherence to the MEDAS score (P = .01). In the intervention group, there was a significant association with the greater reduction of MetS. Conclusion. BRCA mutation carriers in the intervention group experienced greater improvement in their MedDiet and MetS parameters.

WCRF/AICR recommendation adherence and breast cancer incidence among postmenopausal women with and without non-modifiable risk factors

Taller height, family history of breast cancer, greater number of years of potential fertility and nulliparity are established non-modifiable risk factors for postmenopausal breast cancer. Greater adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) diet, physical activity and body weight recommendations has previously been shown to be associated with lower breast cancer risk. However, no prior studies have evaluated whether women with non-modifiable risk factors receive similar benefits from recommendation adherence compared to women without these risk factors. In the Iowa Women's Health Study prospective cohort, we investigated whether associations of WCRF/AICR recommendation adherence differed by the presence/absence of non-modifiable breast cancer risk factors. Baseline (1986) questionnaire data from 36,626 postmenopausal women were used to create adherence scores for the WCRF/AICR recommendations (maximum score = 8.0). Overall and single recommendation adherence in relation to breast cancer risk (n = 3,189 cases) across levels of non-modifiable risk factors were evaluated using proportional hazards regression. Mean adherence score was 5.0 points (range: 0.5-8.0). Higher adherence scores (score ≥ 6.0 vs. ≤ 3.5, HR = 0.76, 95% CI = 0.67-0.87), and adherence to the individual recommendations for body weight and alcohol intake were associated with a lower breast cancer incidence. While not statistically significant among women with more non-modifiable risk factors (score ≥ 6.0 vs. ≤ 3.5, HR = 0.76, 95% CI = 0.36-1.63), hazard ratios were comparable to women with the no non-modifiable risk factors (score ≥ 6.0 vs. ≤ 3.5, HR = 0.74, 95% CI = 0.49-0.93) (p-interaction = 0.57). WCRF/AICR recommendation adherence is associated with lower breast cancer risk, regardless of non-modifiable risk factor status.

Can diet and lifestyle prevent breast cancer: what is the evidence?

Breast cancer is the most common cancer among women in both developed and less-developed countries. Rates of breast cancer are increasing worldwide, with a particular increase in postmenopausal and estrogen receptor-positive cases. The World Cancer Research Fund (WCRF) and American Cancer Society (ACS) cancer prevention guidelines recommend maintaining a healthy weight, undertaking at least 150 minutes of moderate intensity exercise per week, limiting alcohol consumption, and eating a plant-based diet. Observational data link adherence to physical activity and alcohol guidelines throughout life to a reduced risk of developing pre- and postmenopausal breast cancer. Weight control throughout life appears to prevent cases after menopause. Adherence to a healthy dietary pattern does not have specific effects on breast cancer risk but remains important as it reduces the risk for other common diseases, such as cardiovascular disease (CVD), diabetes, and dementia. Emerging data suggest that smoking during adolescence or early adulthood increases later risk of breast cancer. Lifestyle factors appear to modify risk among high-risk women with a family history and those with typical risk of the general population, although their effects among carriers of BRCA mutations are not well defined. Recent expert reports estimate that successful lifestyle changes could prevent 25% to 30% of cases of breast cancer. These reductions will only be achieved if we can implement targeted prevention programs for high-risk women and women in population-based breast screening programs during childhood, adolescence, and early adulthood when the rapidly developing breast is particularly susceptible to carcinogenesis.

LIFESTYLE und erblicher Brustkrebs

Nicht für alle Trägerinnen einer Mutation in den Genen BRCA1 und BRCA2 liegt das lebenslange Erkrankungsrisiko für Brust- oder Eierstockkrebs gleich hoch. Bislang werden jedoch bei der Indikationsstellung zur Teilnahme am intensivierten Früherkennungs- und Nachsorgeprogramm oder zur Durchführung einer prophylaktischen Operation keine risikomodifizierenden Faktoren berücksichtigt. Für das sporadische Mammakarzinom sind zahlreiche direkt und indirekt veränderbare nicht-genetische Einflussfaktoren bekannt. Studien lassen vermuten, dass Lebensstilfaktoren auch das Risiko der BRCA-assoziierten Tumoren modulieren. Die Erforschung der genetischen und nicht-genetischen Faktoren und ihrer Interaktion untereinander führt zur Erstellung eines umfassenden Vorhersagemodells. Dieses hat zum einen die Vermeidung von Übertherapie im Hinblick auf präventive Maßnahmen zum Ziel. Zum anderen bereitet die Kenntnis der individuellen Trigger einer potenziellen Brust- oder Eierstockkrebserkrankung den Weg für eine gezieltere Prävention von der medikamentösen Therapie bis hin zur Lebensstilintervention.