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Lifestyle Interventions for Breast Cancer Prevention

  • Risk and Prevention (ME Wood, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

One in eight women in the USA will develop breast cancer in her lifetime. Despite established efficacy, the use of pharmacotherapy for breast cancer prevention is limited by concerns over toxicities that may negatively influence quality of life. Additional interventions for breast cancer prevention are needed.

Recent Findings

There is emerging evidence from observational studies that obesity, physical inactivity, sedentary behavior, and dietary patterns are associated with breast cancer risk. Randomized trials are necessary to provide unbiased efficacy estimates of lifestyle changes on breast cancer risk, but such trials require a large sample size, long-term follow-up, and substantial financial investment. One approach to manage these barriers is to leverage recent advances in precision prevention to identify high-risk study participants to reduce sample size or shorten length of follow-up.

Summary

Precision prevention approaches may accelerate the translation of epidemiologic discoveries into proven population-based breast cancer prevention interventions.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.

    Article  PubMed  Google Scholar 

  2. Freedman AN, Graubard BI, Rao SR, McCaskill-Stevens W, Ballard-Barbash R, Gail MH. Estimates of the number of US women who could benefit from tamoxifen for breast cancer chemoprevention. J Natl Cancer Inst. 2003;95(7):526–32.

    Article  PubMed  CAS  Google Scholar 

  3. Ropka ME, Keim J, Philbrick JT. Patient decisions about breast cancer chemoprevention: a systematic review and meta-analysis. J Clin Oncol. 2010;28(18):3090–5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Smith SG, Sestak I, Forster A, Partridge A, Side L, Wolf MS, et al. Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis. Ann Oncol. 2016;27(4):575–90.

    Article  PubMed  CAS  Google Scholar 

  5. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–91.

    Article  PubMed  CAS  Google Scholar 

  6. Tucker JM, Welk GJ, Beyler NK. Physical activity in US adults: compliance with the physical activity guidelines for Americans. Am J Prev Med. 2011;40(4):454–61.

    Article  PubMed  Google Scholar 

  7. Rehm CD, Peñalvo JL, Afshin A, Mozaffarian D. Dietary intake among US adults, 1999-2012. JAMA. 2016;315(23):2542–53.

    Article  PubMed  CAS  Google Scholar 

  8. Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol. 2017;18(8):e457–e71.

    Article  PubMed  Google Scholar 

  9. Engmann NJ, Golmakani MK, Miglioretti DL, Sprague BL, Kerlikowske K, Breast Cancer Surveillance C. Population-attributable risk proportion of clinical risk factors for breast cancer. JAMA Oncol. 2017;3(9):1228–36.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Islami F, Goding Sauer A, Miller KD, Siegel RL, Fedewa SA, Jacobs EJ, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68(1):31–54.

    Article  PubMed  Google Scholar 

  11. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med. 2003;348:1625–38.

    Article  PubMed  Google Scholar 

  12. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. Body fatness and cancer—viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794–8.

    Article  PubMed  Google Scholar 

  13. World Cancer Research Fund Internation/American Institute for Cancer Resarch. Continuous update project: diet, nutrition, physical activity and the preveniton of cancer summary of strong evidence. Available at: wcrf.org/cupmatrix. Accessed on 30 Mar 2018.esearch.

  14. World Cancer Resarch Fund/American Intitute for Cancer Research. Food, nutiriton, physical activity, and the prevention of cancer: a global perspective. Washington, DC: AICR; 2007.

    Google Scholar 

  15. Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816–25.

    Article  PubMed  PubMed Central  Google Scholar 

  16. McTiernan A. Mechanisms linking physical activity with cancer. Nat Rev Cancer. 2008;8(3):205–11.

    Article  PubMed  CAS  Google Scholar 

  17. Shen D, Mao W, Liu T, Lin Q, Lu X, Wang Q, et al. Sedentary behavior and incident cancer: a meta-analysis of prospective studies. PLoS One. 2014;9(8):e105709.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysissedentary time and disease incidence, mortality, and hospitalization. Ann Intern Med. 2015;162(2):123–32.

    Article  PubMed  Google Scholar 

  19. Brennan SF, Cantwell MM, Cardwell CR, Velentzis LS, Woodside JV. Dietary patterns and breast cancer risk: a systematic review and meta-analysis. Am J Clin Nutr. 2010;91(5):1294–302.

    Article  PubMed  CAS  Google Scholar 

  20. King M-C, Marks JH, Mandell JB. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science. 2003;302(5645):643–6.

    Article  PubMed  CAS  Google Scholar 

  21. Manders P, Pijpe A, Hooning MJ, Kluijt I, Vasen HF, Hoogerbrugge N, et al. Body weight and risk of breast cancer in BRCA1/2 mutation carriers. Breast Cancer Res Treat. 2011;126(1):193–202.

    Article  PubMed  CAS  Google Scholar 

  22. Nkondjock A, Robidoux A, Paredes Y, Narod S, Ghadirian P. Diet, lifestyle and BRCA-related breast cancer risk among French-Canadians. Breast Cancer Res Treat. 2006;98(3):285–94.

    Article  PubMed  CAS  Google Scholar 

  23. Kotsopoulos J, Olopado OI, Ghadirian P, Lubinski J, Lynch HT, Isaacs C, et al. Changes in body weight and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res. 2005;7(5):R833–43.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Brown JC, Kontos D, Schnall M, Wu S, Schmitz KH. The dose-response effects of aerobic exercise on body composition and breast tissue among women at high risk for breast cancer: a randomized trial. Cancer Prev Res. 2016;9(7):581–8.

    Article  Google Scholar 

  25. Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(11):815–40.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Siemes C, Visser LE, Coebergh JW, Splinter TA, Witteman JC, Uitterlinden AG, et al. C-reactive protein levels, variation in the C-reactive protein gene, and cancer risk: the Rotterdam study. J Clin Oncol. 2006;24(33):5216–22.

    Article  PubMed  CAS  Google Scholar 

  27. Morris PG, Hudis CA, Giri D, Morrow M, Falcone DJ, Zhou XK, et al. Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer. Cancer Prev Res (Phila). 2011;4(7):1021–9.

    Article  CAS  Google Scholar 

  28. Iyengar NM, Gucalp A, Dannenberg AJ, Hudis CA. Obesity and cancer mechanisms: tumor microenvironment and inflammation. J Clin Oncol. 2016;34(35):4270–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Boyle P, Boniol M, Koechlin A, Robertson C, Valentini F, Coppens K, et al. Diabetes and breast cancer risk: a meta-analysis. Br J Cancer. 2012;107(9):1608–17.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Foster-Schubert KE, Alfano CM, Duggan CR, Xiao L, Campbell KL, Kong A, et al. Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Obesity (Silver Spring). 2012;20(8):1628–38.

    Article  CAS  Google Scholar 

  31. Mason C, Foster-Schubert KE, Imayama I, Kong A, Xiao L, Bain C, et al. Dietary weight loss and exercise effects on insulin resistance in postmenopausal women. Am J Prev Med. 2011;41(4):366–75.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Imayama I, Ulrich CM, Alfano CM, Wang C, Xiao L, Wener MH, et al. Effects of a caloric restriction weight loss diet and exercise on inflammatory biomarkers in overweight/obese postmenopausal women: a randomized controlled trial. Cancer Res. 2012;72(9):2314–26.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Campbell KL, Foster-Schubert KE, Alfano CM, Wang CC, Wang CY, Duggan CR, et al. Reduced-calorie dietary weight loss, exercise, and sex hormones in postmenopausal women: randomized controlled trial. J Clin Oncol. 2012;30(19):2314–26.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Campbell KL, Foster-Schubert KE, Makar KW, Kratz M, Hagman D, Schur EA, et al. Gene expression changes in adipose tissue with diet- and/or exercise-induced weight loss. Cancer Prev Res (Phila). 2013;6(3):217–31.

    Article  CAS  Google Scholar 

  35. Prentice RL, Caan B, Chlebowski RT, Patterson R, Kuller LH, Ockene JK, et al. Low-fat dietary pattern and risk of invasive breast cancer: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):629–42.

    Article  PubMed  CAS  Google Scholar 

  36. Howard BV, Van Horn L, Hsia J, Manson JE, Stefanick ML, Wassertheil-Smoller S, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):655–66.

    Article  PubMed  CAS  Google Scholar 

  37. Tinker LF, Bonds DE, Margolis KL, Manson JE, Howard BV, Larson J, et al. Low-fat dietary pattern and risk of treated diabetes mellitus in postmenopausal women: the Women’s Health Initiative randomized controlled dietary modification trial. Arch Intern Med. 2008;168(14):1500–11.

    Article  PubMed  Google Scholar 

  38. Howard BV, Manson JE, Stefanick ML, Beresford SA, Frank G, Jones B, et al. Low-fat dietary pattern and weight change over 7 years: the Women’s Health Initiative Dietary Modification Trial. JAMA. 2006;295(1):39–49.

    Article  PubMed  CAS  Google Scholar 

  39. Toledo E, Salas-Salvadó J, Donat-Vargas C, Buil-Cosiales P, Estruch R, Ros E, et al. Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED trial: a randomized clinical trial. JAMA Intern Med. 2015;175(11):1752–60.

    Article  PubMed  Google Scholar 

  40. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90.

    Article  PubMed  CAS  Google Scholar 

  41. Salas-Salvado J, Bullo M, Babio N, Martinez-Gonzalez MA, Ibarrola-Jurado N, Basora J, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34(1):14–9.

    Article  PubMed  Google Scholar 

  42. Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Fito M, Chiva-Blanch G, et al. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4(8):666–76.

    Article  PubMed  CAS  Google Scholar 

  43. Prentice RL, Willett WC, Greenwald P, Alberts D, Bernstein L, Boyd NF, et al. Nutrition and physical activity and chronic disease prevention: research strategies and recommendations. J Natl Cancer Inst. 2004;96(17):1276–87.

    Article  PubMed  Google Scholar 

  44. Ballard-Barbash R, Hunsberger S, Alciati MH, Blair SN, Goodwin PJ, McTiernan A, et al. Physical activity, weight control, and breast cancer risk and survival: clinical trial rationale and design considerations. J Natl Cancer Inst. 2009;101(9):630–43.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Rebbeck TR. Precision prevention of cancer. Cancer Epidemiol Biomark Prev. 2014;23(12):2713–5.

    Article  Google Scholar 

  46. U.S. Department of Health and Human Services: Food and Drug Administration. Enrichment strategies for clinical trials to support approval of human drugs and biological products. Draft Guidance, December 2012.

  47. Maas P, Barrdahl M, Joshi AD, Auer PL, Gaudet MM, Milne RL, et al. Breast cancer risk from modifiable and nonmodifiable risk factors among white women in the United States. JAMA Oncology. 2016;2(10):1295–302.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Khera AV, Emdin CA, Drake I, Natarajan P, Bick AG, Cook NR, et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med. 2016;375(24):2349–58.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Funding

Research reported in this publication was supported by the National Cancer Institute (K99-CA218603; R25-CA203650).

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Correspondence to Jennifer A. Ligibel.

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The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Risk and Prevention

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Brown, J.C., Ligibel, J.A. Lifestyle Interventions for Breast Cancer Prevention. Curr Breast Cancer Rep 10, 202–208 (2018). https://doi.org/10.1007/s12609-018-0281-z

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  • DOI: https://doi.org/10.1007/s12609-018-0281-z

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