Cancer Prevention Lifestyle Reduces Risk of Recurrence, Death in High-Risk Breast Cancer
Women diagnosed with high-risk breast cancer who most closely followed cancer prevention lifestyle recommendations from the American Cancer Society and the American Institute for Cancer Research were the least likely to have the breast cancer come back (recurrence) or to die from breast cancer, according to a study.
The research was published online on May 4, 2023, by the journal JAMA Network Open. Read “Adherence to Cancer Prevention Lifestyle Recommendations Before, During, and 2 Years After Treatment for High-risk Breast Cancer.”
Cancer prevention lifestyle recommendations
Both the American Cancer Society and the American Institute for Cancer Research regularly publish recommendations for lifestyle choices to reduce the risk of developing cancer.
The most recent recommendations include:
maintaining a healthy weight
exercising regularly; meaning 150 to 300 minutes of moderate-intensity exercise (brisk walking) a week and two days of strength exercises a week
eating a colorful variety of vegetables, fruits, and whole grains
limiting red and processed meats, fast food, and other highly processed foods
avoiding or limiting sugar-sweetened beverages
avoiding or limiting alcohol to one drink or fewer a day
avoiding smoking
About the study
Although much research has shown that these lifestyle recommendations can reduce the risk of developing cancer, there are few studies looking at whether the recommendations can affect outcomes after a person has been diagnosed with cancer. So the researchers decided to investigate.
The study, called the Diet, Exercise, Lifestyles, and Cancer Prognosis (DELCaP) study, included 1,340 women who were diagnosed with high-risk breast cancer.
For this study, the researchers defined high-risk breast cancer as:
stage I to stage III
node-positive
hormone receptor-negative
larger than 1 centimeter
any breast cancer, regardless of stage, node status, or hormone receptor status, larger than 2 centimeters
The women in the study had an average age of 51.3 and:
83.7% were white
7% were Black
3.2% were Asian
3.4% were multiracial
4.9% were Hispanic
52.5% were post-menopausal
Of the breast cancers in the study:
26.1% were node-negative
37.5% were in one to three lymph nodes
36.4% were in four or more lymph nodes
79.1% were HER2-negative
20.9% were HER2-positive
34.7% were hormone receptor-negative
65.3% were hormone receptor-positive
26.3% were triple-negative
The women filled out a questionnaire that asked about lifestyle choices four times during the study:
when they joined the study, which asked about choices one month before they were diagnosed
when they completed treatment, which asked about choices during treatment
one year after joining the study, which asked about choices during the previous year
two years after joining the study, which asked about choices during the previous year
The questionnaire asked about the women’s ability to meet seven cancer prevention lifestyle recommendations:
exercising regularly
maintaining a healthy body mass index (BMI)
eating a colorful variety of fruits and vegetables
limiting red and processed meat
limiting sugar-sweetened drinks
avoiding alcohol
avoiding smoking
The researchers developed a lifestyle assessment score for each woman. For each recommendation, a woman received:
one point for strongly following the recommendation
a half point for partially following the recommendation
zero points for not following the recommendation
So each time the women filled out the questionnaire, they received a score ranging from zero to seven.
The average follow-up time was 7.7 years. During follow-up:
310 women had a breast cancer recurrence
222 women died
The researchers’ analysis found that lower recurrence risk was linked to:
strongly or partially following the exercise and smoking recommendations
strongly following the fruit and vegetable and sugar-sweetened drinks recommendations
A lower risk of dying from breast cancer was linked to:
strongly following the exercise, smoking, fruit and vegetable, and sweetened drinks recommendations
strongly or partially following the red and processed meat recommendations
These decreases in the risk of recurrence and mortality were statistically significant, which means they were likely due to following the recommendations, rather than just because of chance.
“Strongest collective adherence to cancer prevention recommendations before, during, and after treatment was associated with significant reductions in disease recurrence and mortality among patients with high-risk breast cancer in the DELCaP Study,” the researchers concluded. “Strongest adherence to recommendations for smoking, physical activity, fruit and vegetable intake, and sugar-sweetened beverage consumption was most consistently associated with improved outcomes. Importantly, significant survival advantages were consistently observed in patients diagnosed with more aggressive breast cancer subtypes.”
What this means for you
Sadly, this study was not very diverse; nearly 84% of the women were white. But the researchers did note that the links between lower recurrence and mortality risk weren’t affected by a woman’s race, ethnicity, or menopausal status.
If you’ve been diagnosed with any type of breast cancer, it’s likely you can benefit from following the seven cancer prevention lifestyle recommendations.
Strongly following all the recommendations may seem daunting. So it may make sense to follow the five that offered the most benefit:
Exercise every day. The American Cancer Society recommends that adults get 150 to 300 minutes of moderate intensity or 75 to 150 minutes of vigorous intensity exercise each week. Moderate intensity exercises are things like brisk walking or riding a bike. Vigorous intensity exercises include running and playing basketball or singles tennis. It’s also a good idea to do muscle-strengthening exercises using weights or resistance bands two days a week.
Eat a colorful variety of fruits and vegetables. Try to eat vegetables that make up all the colors of the rainbow, from dark green kale, to bright red peppers and tomatoes, to purple eggplants, to yellow squash. Whole fruits are better than juice or smoothies because they contain fiber.
Don’t smoke or quit if you do. Smoking causes a number of diseases and is linked to a higher risk of breast cancer in younger, pre-menopausal women. Research also has shown that there may be a link between very heavy secondhand smoke exposure and breast cancer risk in post-menopausal women.
Avoid sugar-sweetened drinks. Drinking sugar-sweetened beverages such as soda or pop, sports and energy drinks, and sweetened coffee and tea, is linked to weight gain, obesity, type 2 diabetes, heart disease, kidney diseases, non-alcoholic liver disease, tooth decay, and gout. Although eating sugar doesn’t cause cancer, weight gain, obesity, diabetes, and the inflammation caused by heart, kidney, and liver disease are linked to a risk of developing cancer. Instead of sweet drinks, have water, unsweetened tea, or seltzer.
Limiting the amount of red and processed meat you eat. Red meat refers to beef, veal, pork, lamb, mutton, horse, and goat. Processed meat is meat that has been salted, cured, smoked, fermented, or processed in another way to enhance its flavor or preserve it. Examples include hot dogs, ham, sausages, beef jerky, bacon, and corned beef. There are three chemicals in particular that are linked to cancer:
heme, a pigment that occurs naturally in red meat
nitrates and nitrites, which are added to processed meat to keep it fresher longer
heterocyclic amines and polycyclic amines, which are produced when meat is cooked at high temperatures
Processed meat also tends to be high in sodium, which is linked to high blood pressure, heart disease, and inflammation.
To cut down, try recipes that use fresh chicken or fish instead of processed or red meat. You also can try substituting beans or lentils for meat in your favorite dishes.
Learn more about diet and nutrition.
Learn more about exercise.
— Last updated on June 20, 2023 at 3:14 PM