Harnessing Nutrition and Physical Activity for Breast Cancer Prevention and Control to Reduce Racial/Ethnic Cancer Health Disparities

Abstract

There are well-known racial/ethnic disparities in the prevalence of obesity and physical inactivity, as well as breast cancer risk and survival. However, most of the current scientific evidence that serves as a foundation for nutrition and physical activity guidelines is based on studies conducted in predominantly non-Hispanic White populations. Similarly, exercise, diet, or lifestyle intervention trials for breast cancer prevention and survivorship are scarce in racial/ethnic minority populations. We review the current evidence for racial/ethnic disparities in obesity and breast cancer risk and survival (we are focusing on obesity, because this is considered an ASCO priority, and studies conducted in the United States), discuss the evolution of nutrition/physical activity guidelines for cancer prevention and control, and provide an overview of lifestyle interventions, including barriers and facilitators in implementation and dissemination science among minority populations underrepresented in research. There is a critical need to include racially/ethnically diverse populations in cancer prevention and control research or to specifically target minority populations in which disparities are known to exist to achieve much needed health equity.

Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors

“…These findings reinforce the importance of physical activity as a modifiable factor in weight management during cancer survivorship. 9 Residential neighborhoods might have stronger influences on breast cancer survivors because of time and energy constraints and lower workforce participation compared with cancer-free populations. Regular employment dropped from 66% prediagnosis to 49% at around 24 months postdiagnosis in our study.…”

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

“…Aerobic and resistance exercise are means to reduce sarcopenia in obese and non-obese can-cer patients [145,156]. Concepts of avoiding sarcopenia, reducing metabolic syndrome, and improving function and strength in obese cancer patients, as advocated by Dieli-Conwright and others, can improve the quality of life while on therapy and in cancer survivors [145,148,[156][157][158][159][160][161][162][163][164][165]. This involves education to neither lose too much weight nor gain a lot of weight, but to focus on staying active and strong.…”

“…This involves education to neither lose too much weight nor gain a lot of weight, but to focus on staying active and strong. Aerobic and resistance exercise can improve the problem of sarcopenia and possibly mitigate expectations of worse outcomes in obese cancer patients [145,[156][157][158][159][160][161][162][163][164].…”

Exercise Cardio-Oncology: Exercise as a Potential Therapeutic Modality in the Management of Anthracycline-Induced Cardiotoxicity

“…Vulnerable groups that should be further explored due to the already identified risk of developing anthracycline-induced cardiotoxicities include survivors who receive high doses of anthracyclines, elderly and pediatric cancer populations, and survivors with comorbid disease (e.g., hypertension and diabetes) or with pre-existing CVD. Finally, racial/ethnic minorities are also in need of further study as they are disproportionately underrepresented in exercise oncology, exercise-cardio-oncology, and anthracycline settings, and often have a higher risk of cardiac-related events due to preexisting conditions and poor lifestyles (127,128). To establish exercise as a standard of care strategy in reducing anthracyclineinduced cardiotoxicities, further clinical trials involving these rarely studied and vulnerable groups are needed to confirm the translation of the benefits of exercise interventions to populations with other cancer types and characteristics.…”