BACKGROUND: The American Cancer Society (ACS) established 2012 guidelines focusing on healthy lifestyle behaviors for the prevention of cancer and other chronic diseases. In our study, we compared adherence to the ACS guidelines for cancer prevention across a spectrum of breast cancer risk in a predominantly Hispanic population of women undergoing screening mammography.
METHODS: We conducted a cross-sectional study in Washington Heights, NY among non-smoking women with a body mass index (BMI) >18.5 kg/m2 undergoing routine screening mammography. Participants completed a self-administered questionnaire on demographics, breast cancer risk factors, and lifestyle factors, including adherence to ACS guidelines for physical activity (≥2.5 hours/week of moderate physical activity), consumption of fruits and vegetables (≥5 servings/day), alcohol intake (≤1 serving/day), and self-reported height and weight (BMI of 18.5-24.9 kg/m2 ). We calculated a composite ACS adherence score, where each of the four main components were scored 0 for non-adherence, 1 for partial adherence, and 2 for complete adherence (range, 0-8), with scores of 6 to 8 representing optimal adherence. High breast cancer risk status was based upon a ≥1.67% 5-year risk of invasive breast cancer according to the Gail model or meeting family history criteria for BRCA genetic testing. Logistic regression models were used to examine the association between demographics, breast cancer risk status, and health behaviors.
RESULTS: From Nov 2014-Dec 2015, 18,681 presented for screening, 2846 (15%) were approached for enrollment, 2345 consented, and 1977 were evaluable for this analysis. The mean age was 58.8 years (SD 10.9), over three-quarters identified as Hispanic, nearly 40% had not graduated high school, 24% met high-risk criteria for breast cancer, and only 8.3% had optimal adherence to ACS guidelines for lifestyle behaviors. In multivariable analysis, older women, racial/ethnic minorities, and those with lower educational levels were less likely to adhere to ACS guidelines. After controlling for known confounders, breast cancer risk status was not associated with adherence to lifestyle factors.
CONCLUSION: Our findings indicated that there is a significant difference in adherence to ACS guidelines for cancer prevention based upon age, race/ethnicity, and educational level. Our study has identified a population of women who may be targeted for lifestyle modification and screening mammography may provide a teachable moment to discuss strategies for preventing breast cancer and other chronic diseases.
