Adherence to Cancer Prevention Lifestyle Recommendations Before, During, and 2 Years After Treatment for High-risk Breast Cancer

The American Institute for Cancer Research and American Cancer Society regularly publish modifiable lifestyle recommendations for cancer prevention. Whether these recommendations have an impact on high-risk breast cancer survival remains unknown. To investigate whether adherence to cancer prevention...

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Published in:JAMA network open 2023-05, Vol.6 (5), p.e2311673-e2311673
Main Authors: Cannioto, Rikki A, Attwood, Kristopher M, Davis, Evan W, Mendicino, Lucas A, Hutson, Alan, Zirpoli, Gary R, Tang, Li, Nair, Nisha M, Barlow, William, Hershman, Dawn L, Unger, Joseph M, Moore, Halle C F, Isaacs, Claudine, Hobday, Timothy J, Hortobagyi, Gabriel N, Gralow, Julie R, Albain, Kathy S, Budd, G Thomas, Ambrosone, Christine B
Format: Article
Language:English
Subjects:
Breast cancer
Breast Neoplasms - epidemiology
Breast Neoplasms - prevention & control
Cancer research
Chemotherapy
Disease prevention
Female
Hormones
Humans
Life Style
Lifestyles
Medical prognosis
Middle Aged
Mortality
Neoplasm Recurrence, Local - epidemiology
Neoplasm Recurrence, Local - prevention & control
Nutrition, Obesity, and Exercise
Online Only
Original Investigation
Prospective Studies
United States
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Summary:The American Institute for Cancer Research and American Cancer Society regularly publish modifiable lifestyle recommendations for cancer prevention. Whether these recommendations have an impact on high-risk breast cancer survival remains unknown. To investigate whether adherence to cancer prevention recommendations before, during, and 1 and 2 years after breast cancer treatment was associated with disease recurrence or mortality. The Diet, Exercise, Lifestyles, and Cancer Prognosis Study (DELCaP) was a prospective, observational cohort study designed to assess lifestyles before diagnosis, during treatment, and at 1 and 2 years after treatment completion, implemented ancillary to the Southwest Oncology Group (SWOG) S0221 trial, a multicenter trial that compared chemotherapy regimens in breast cancer. Participants were chemotherapy-naive patients with pathologic stage I to III high-risk breast cancer, defined as node-positive disease with hormone receptor-negative tumors larger than 1 cm or any tumor larger than 2 cm. Patients with poor performance status and comorbidities were excluded from S0221. The study was conducted from January 1, 2005, to December 31, 2010; mean (SD) follow-up time for those not experiencing an event was 7.7 (2.1) years through December 31, 2018. The analyses reported herein were performed from March 2022 to January 2023. An aggregated lifestyle index score comprising data from 4 time points and 7 lifestyles, including (1) physical activity, (2) body mass index, (3) fruit and vegetable consumption, (4) red and processed meat intake, (5) sugar-sweetened beverage consumption, (6) alcohol consumption, and (7) smoking. Higher scores indicated healthier lifestyle. Disease recurrence and all-cause mortality. A total of 1340 women (mean [SD] age, 51.3 [9.9] years) completed the baseline questionnaire. Most patients were diagnosed with hormone-receptor positive breast cancer (873 [65.3%]) and completed some education beyond high school (954 [71.2%]). In time-dependent multivariable analyses, patients with highest vs lowest lifestyle index scores experienced a 37.0% reduction in disease recurrence (hazard ratio, 0.63; 95% CI, 0.48-0.82) and a 58.0% reduction in mortality (hazard ratio, 0.42; 95% CI, 0.30-0.59). In this observational study of patients with high-risk breast cancer, strongest collective adherence to cancer prevention lifestyle recommendations was associated with significant reductions in disease recurrence and mortality. Educati
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2023.11673