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CME / ABIM MOC / CE

Do Nutrition and Physical Activity Affect Cancer Risk for Minority Women?

  • Authors: News Author: Megan Brooks; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 11/4/2022
  • Valid for credit through: 11/4/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

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.

Upon completion of this activity, participants will:

 

  • Assess 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, based on an analysis of Black and Latina women participants in the Women's Health Initiative
  • Determine the clinical and public health implications of 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, based on an analysis of Black and Latina women participants in the Women's Health Initiative
  • Outline implications for the healthcare team


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All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


News Author

  • Megan Brooks

    Freelance writer, Medscape

    Disclosures

    Megan Brooks has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie Inc.

Editor/Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

Nurse Planner

  • Lisa Simani, APRN, MS, ACNP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Lisa Simani, APRN, MS, ACNP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


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In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

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  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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    Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 11/4/2023. PAs should only claim credit commensurate with the extent of their participation.

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

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CME / ABIM MOC / CE

Do Nutrition and Physical Activity Affect Cancer Risk for Minority Women?

Authors: News Author: Megan Brooks; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 11/4/2022

Valid for credit through: 11/4/2023

processing....

Clinical Context

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.

Study Synopsis and Perspective

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]

Study Highlights

  • A semi-Markov multistate model examined the association between ACS guideline adherence and obesity-related cancer (breast, ovary, colorectal, uterine, pancreas, thyroid, gallbladder, liver, meningioma, esophageal adenocarcinoma, gastric cardia, renal cell carcinoma, and multiple myeloma) incidence and mortality in the presence of competing events, combined and separately, for 9301 Black and 4221 Latina postmenopausal women enrolled in the Women's Health Initiative.
  • ACS guideline adherence was also examined in a subset of less common obesity-related cancers and potential effect modification by neighborhood SES and smoking.
  • Only 8.7% of Black women and 8.3% of Latina women met all 2012 ACS guidelines for nutrition and physical activity for cancer prevention (maintaining healthy weight, healthy diet emphasizing plant foods, physical activity for 150 minutes moderate or 75 minutes vigorous activity weekly).
  • Median follow-up was 11.1 years for incidence, 12.5 for nonconditional mortality, and 3.7 years for conditional mortality.
  • Black/Latina women had 1191 obesity-related cancers (841/269), 1970 all-cause deaths (1576/394), and 341 obesity-related cancer-related deaths (259/82).
  • Higher ACS guideline adherence was associated with lower obesity-related cancer incidence for both Black and Latina women.
  • High vs low cause-specific hazard ratio (HR) was 0.72 (95% CI, 0.55-0.94) for Black women and 0.58 (95% CI, 0.36-0.93) for Latina women.
  • Higher ACS guideline adherence was not associated with conditional all-cause mortality (Black women: HR, 0.86 [95% CI, 0.53-1.39]; Latina women: HR, 0.81 [95% CI, 0.32-2.06], respectively) or obesity-related cancer-specific deaths.
  • Higher adherence was associated with lower incidence of less common obesity-related cancer (31% for Black and 63% for Latina women; P trend=.025), but conditional mortality events were limited.
  • There was no evidence of effect modification by neighborhood SES or smoking.
  • The investigators concluded that in Black and Latina women, ACS guidelines adherence was associated with lower risk for obesity-related cancers (by 28% to 42%) and less common obesity-related cancers, but not with conditional obesity-related cancer-related mortality.
  • The findings support public health interventions to reduce growing racial/ethnic disparities in obesity-related cancers and suggest that Black and Latina women could benefit markedly from even moderate adherence to healthy lifestyle guidelines.
  • Latina women may realize even greater benefits from guidelines adherence than Black women.
  • To sustain healthy lifestyle behaviors over the long term, patients' socioeconomic background and cultural context must be considered.
  • Cost, location, and time can be barriers to maintaining healthy nutrition and exercise regimens.
  • Future studies should examine correlations of obesity-related cancer with adherence to new 2020 ACS guidelines and newly released guidelines for lifestyle management during cancer treatment among all adults.
  • Although current literature supports a significant role of neighborhood SES in energy balance and cancer risk and survival, the present study showed no interaction between neighborhood SES and adherence score.
  • However, power was limited to detect small differences, and the study could not account for other dimensions of neighborhood that may more strongly affect cancer risk or exclude changes in neighborhood SES over time.
  • Future research is needed to clarify the potential role of various aspects of neighborhood on the link between guideline adherence and cancer risk and outcomes for populations of color.
  • Study limitations include exposure measured only at baseline and self-reported diet and physical activity data.
  • The analysis required excluding the first 2 years of follow-up, suggesting potential for reverse causation or misclassification of participants by exposure.
  • Although recent research suggests that some physical activity is better than none, this study only compares individuals who met or exceeded the guideline with those who did not.

Clinical Implications

  • In Black and Latina women, ACS guidelines adherence was associated with lower risk for obesity-related cancers and less common obesity-related cancers, but not with conditional obesity-related cancer-related mortality.
  • The findings support public health interventions to reduce growing racial/ethnic disparities in obesity-related cancers.
  • Implications for the Health Care Team: To sustain healthy lifestyle behaviors over the long term, the healthcare team should consider patients' socioeconomic background and cultural context.

 

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