Monday, May 29, 2023
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This activity is intended for hematologists/oncologists, medicine/primary care clinicians, internists, obstetricians/gynecologists/women's health clinicians, public health and prevention officials, nurses, nurse practitioners, physician assistants, pharmacists, and other members of the health care team involved in counseling minority women regarding lifestyle changes to lower cancer risk.
The goal of this activity is for learners, members of the healthcare team to be better able to describe the association of adherence to American Cancer Society guidelines on nutrition and physical activity for cancer prevention with risk for obesity-related cancer incidence and mortality in Black and Latina participants in the Women's Health Initiative.
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CME / ABIM MOC / CE Released: 11/4/2022
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The American Cancer Society (ACS) and the World Cancer Research Fund/American Institute for Cancer Research have provided guidelines on diet and physical activity to lower cancer risk. For communities of color, neighborhood socioeconomic status (SES) can intensify the burden of obesity by reducing opportunities to choose and engage in healthful behaviors.
Smoking, which is associated with weight loss and risk for some cancers, has varying prevalence by race/ethnicity. These potential moderators of cancer risk have not been fully studied in minority populations.
Adhering to ACS guidelines on nutrition and physical activity can help lower the risk for obesity-related cancers in Black and Latina women, new research shows.
Women who followed the lifestyle guidelines had a 28% to 42% lower risk of developing an obesity-related cancer.
This analysis is important because "there is limited evidence on following ACS cancer prevention guidelines and cancer risk specifically among women of color," said Ying Wang, PhD, ACS senior principal scientist, who wasn't involved in the study. "This study helps to fill that gap."
The analysis was published online in Cancer.
Adherence to the ACS guideline on nutrition and physical activity for cancer prevention is associated with a lower risk for obesity-related cancer incidence and mortality, but evidence in Black and Latina women remains limited.
The study authors focused on women of color because of the paucity of data in this population.
The 13 obesity-related cancers and cancer sites examined in the study are breast, ovary, colorectal, uterine, pancreas, thyroid, gallbladder, liver, meningioma, esophageal adenocarcinoma, gastric cardia, renal cell carcinoma, and multiple myeloma.
Among 9297 Black and 4215 Latina postmenopausal women participating in the long-running Women's Health Initiative, only about 9% of Black women and 8% of Latina women met all 2012 ACS guidelines for nutrition and physical activity for cancer prevention. These recommendations include maintaining a healthy weight, eating a healthy diet emphasizing plant foods, and being physically active for 150 minutes of moderate or 75 minutes of vigorous activity each week.
During up to 24 years of follow-up, 840 Black women and 269 Latina women developed a first obesity-related cancer and 259 Black women and 82 Latina women died from their disease.
High adherence to the ACS guidelines was associated with a lower incidence of obesity-related cancers: about 29% lower for Black women and about 42% lower for Latina women. High adherence was also linked to increased protection from less common obesity-related cancers among Black (31%) and Latina women (63%).
In terms of mortality, high adherence was associated with a lower risk for death from all causes after an obesity-related cancer diagnosis, but this link was not significant (hazard ratio [HR] for Black women, 0.86; HR for Latina women, 0.81).
Overall, "our findings suggest that Black and Latina women could benefit substantially from even moderate adherence to healthy lifestyle guidelines," the researchers said.
But when providing nutrition and exercise advice, it is essential to consider patients' "socioeconomic backgrounds and cultural context so that adoption and maintenance of behaviors can be sustained long-term," said lead author Margaret Pichardo, MD, PhD, MPH, Hospital of the University of Pennsylvania, Philadelphia.
Oncologist Marleen Meyers, MD, director of the survivorship program at NYU Langone Perlmutter Cancer Center in New York City, also noted that although advice on good nutrition and exercise is important, enthusiasm for lifestyle change is often "short lived."
In terms of maintaining nutrition and exercise regimens, cost, location, and time can be obstacles. For instance, "eating fresh fruits and vegetables is much more expensive than packaged food. Having access to healthy food also may depend on the neighborhood that you live in," noted Dr Meyers, who was not involved in the study.
"To get people to maintain a healthy lifestyle long past the initial surge of excitement is enormously difficult and requires a lot more support than we have funding or personnel for," Dr Meyers said.
Funding for the study was provided in part by grants from the National Cancer Institute, National Institute on Minority Health and Health Disparities, the National Institute of Aging, the Centers for Disease Control and Prevention, and a Yale Clinical and Translational Science Award. Dr Pichardo, Dr Wang, and Dr Meyers have disclosed no relevant financial relationships.
Cancer. Published online August 23, 2022.[1]
