Ashley M Geczik1, Jennifer S Ferris1, Mary Beth Terry1,2, Irene L Andrulis3,4, Saundra S Buys5, Mary B Daly6, John L Hopper7, Esther M John8,9, Allison W Kurian8,9, Melissa C Southey7,10,11, Yuyan Liao1, Jeanine M Genkinger12,13. 1. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., New York, NY, 10019, USA. 2. Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA. 3. Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, M5G 1X5, Canada. 4. Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada. 5. Department of Medicine and Huntsman Cancer Institute, University of Utah Health, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA. 6. Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA. 7. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, VIC, 3010, Australia. 8. Department of Epidemiology & Population Health, Stanford University School of Medicine, 3145 Porter Drive, Suite E223, Palo Alto, CA, 94304, USA. 9. Department of Medicine (Oncology), Stanford University School of Medicine, 150 Governor's Lane Stanford, Stanford, CA, 94305, USA. 10. Precision Medicine Group, School of Clinical Sciences at Monash Health, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia. 11. Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia. 12. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., New York, NY, 10019, USA. jg3081@columbia.edu. 13. Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA. jg3081@columbia.edu.
Abstract
PURPOSE: The American Cancer Society (ACS) published an updated Guideline for Cancer Prevention (ACS Guideline) in 2020. Research suggests that adherence to the 2012 ACS Guideline might lower breast cancer risk, but there is limited evidence that this applies to women at increased familial and genetic risk of breast cancer. METHODS: Using the Breast Cancer Family Registry (BCFR), a cohort enriched for increased familial and genetic risk of breast cancer, we examined adherence to three 2020 ACS Guideline recommendations (weight management (body mass index), physical activity, and alcohol consumption) with breast cancer risk in 9615 women. We used Cox proportional hazard regression modeling to calculate hazard ratios (HRs) and 95% confidence intervals (CI) overall and stratified by BRCA1 and BRCA2 pathogenic variant status, family history of breast cancer, menopausal status, and estrogen receptor-positive (ER +) breast cancer. RESULTS: We observed 618 incident invasive or in situ breast cancers over a median 12.9 years. Compared with being adherent to none (n = 55 cancers), being adherent to any ACS recommendation (n = 563 cancers) was associated with a 27% lower breast cancer risk (HR = 0.73, 95% CI: 0.55-0.97). This was evident for women with a first-degree family history of breast cancer (HR = 0.68, 95% CI: 0.50-0.93), women without BRCA1 or BRCA2 pathogenic variants (HR = 0.71, 95% CI: 0.53-0.95), postmenopausal women (HR = 0.63, 95% CI: 0.44-0.89), and for risk of ER+ breast cancer (HR = 0.63, 95% CI: 0.40-0.98). DISCUSSION: Adherence to the 2020 ACS Guideline recommendations for BMI, physical activity, and alcohol consumption could reduce breast cancer risk for postmenopausal women and women at increased familial risk.
PURPOSE: The American Cancer Society (ACS) published an updated Guideline for Cancer Prevention (ACS Guideline) in 2020. Research suggests that adherence to the 2012 ACS Guideline might lower breast cancer risk, but there is limited evidence that this applies to women at increased familial and genetic risk of breast cancer. METHODS: Using the Breast Cancer Family Registry (BCFR), a cohort enriched for increased familial and genetic risk of breast cancer, we examined adherence to three 2020 ACS Guideline recommendations (weight management (body mass index), physical activity, and alcohol consumption) with breast cancer risk in 9615 women. We used Cox proportional hazard regression modeling to calculate hazard ratios (HRs) and 95% confidence intervals (CI) overall and stratified by BRCA1 and BRCA2 pathogenic variant status, family history of breast cancer, menopausal status, and estrogen receptor-positive (ER +) breast cancer. RESULTS: We observed 618 incident invasive or in situ breast cancers over a median 12.9 years. Compared with being adherent to none (n = 55 cancers), being adherent to any ACS recommendation (n = 563 cancers) was associated with a 27% lower breast cancer risk (HR = 0.73, 95% CI: 0.55-0.97). This was evident for women with a first-degree family history of breast cancer (HR = 0.68, 95% CI: 0.50-0.93), women without BRCA1 or BRCA2 pathogenic variants (HR = 0.71, 95% CI: 0.53-0.95), postmenopausal women (HR = 0.63, 95% CI: 0.44-0.89), and for risk of ER+ breast cancer (HR = 0.63, 95% CI: 0.40-0.98). DISCUSSION: Adherence to the 2020 ACS Guideline recommendations for BMI, physical activity, and alcohol consumption could reduce breast cancer risk for postmenopausal women and women at increased familial risk.
Authors: Cheryl L Rock; Cynthia Thomson; Ted Gansler; Susan M Gapstur; Marjorie L McCullough; Alpa V Patel; Kimberly S Andrews; Elisa V Bandera; Colleen K Spees; Kimberly Robien; Sheri Hartman; Kristen Sullivan; Barbara L Grant; Kathryn K Hamilton; Lawrence H Kushi; Bette J Caan; Debra Kibbe; Jessica Donze Black; Tracy L Wiedt; Catherine McMahon; Kirsten Sloan; Colleen Doyle Journal: CA Cancer J Clin Date: 2020-06-09 Impact factor: 508.702