A combined breast health/weight loss intervention for Black women

Abstract

Background. Overall incidence of breast cancer is slightly lower, but mortality rates are higher, for Black women compared to White women. Higher body mass index (BMI), sedentary lifestyles, and lower compliance with recommended breast health behaviors may contribute to higher risk and mortality.

Methods. A randomized pilot intervention trial was conducted to assess feasibility and efficacy of a combined breast health/weight loss intervention for 64 overweight or obese Black women, ages 35–65. The primary objectives were to determine whether a 20-week (twice weekly) intervention could decrease weight and dietary fat intake and increase physical activity and breast self-exam (BSE) proficiency.

Results. The project was implemented in two cohorts and retention was high for both (96% and 89%, respectively). Both cohorts showed increased proficiency in BSE in the intervention versus the control group (2.4 vs. −0.4, P < 0.05; 3.3 vs. −0.2, P < 0.001, respectively), but only cohort 2 showed decreased percent body weight (4.0% decrease vs. 0.9% increase, P < 0.01), increased physical activity frequency (2.4 vs. 0.1 times/week, P < 0.05), and a trend for decreased dietary fat (−2.6% kcal vs. 0.0% kcal, P = 0.07) in the intervention compared to the control group.

Conclusion. Few studies have documented weight loss among Black women, and no combined breast health/weight loss intervention has been conducted. This study documents the feasibility of recruiting, randomizing, and retaining women in a combined intervention and demonstrated weight loss and associated lifestyle changes.

Introduction

Overall incidence of breast cancer is slightly lower in Black women than in White women. However, mortality rates are higher for Black women [1]. Studies of ethnic differences reveal that Black women with breast cancer are often younger and are diagnosed at later stages [2], [3]. Risk factors such as higher body mass index (BMI), increases in BMI, sedentary lifestyles, and lower compliance with recommended breast health behaviors (e.g., mammography, clinical breast exam, breast self-exam) may contribute to higher risk and mortality [4], [5], [6], [7], [8], [9], [10], [11], [12]. Most studies conducted with primarily White samples indicate that obesity is associated with a lower risk of premenopausal and a higher risk of postmenopausal breast cancer [13], [14], [15]. Furthermore, weight gain in adulthood contributes to increased risk of breast cancer [16], [17], [18], [19], [20] while weight loss may decrease breast cancer risk [8], [10], [11], [13]. Obesity and adult weight gain place Black women at increased risk since approximately 50% of Black female adults are obese [5]. Also, data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study showed that over a 10-year period, Black women gained approximately 11 kg, whereas White women gained 7 kg [21]. Furthermore, although data suggest that weight loss or weight gain prevention may decrease breast cancer risk [13], [14], [15], these are often elusive goals, particularly for Black women. Studies indicate that Black women are less likely to participate in traditional weight loss programs [22], are more apt to drop out of such programs [23], and lose less weight than White women due to biological and cultural factors [24], [25], [26].

Modifiable risk factors that promote obesity, as well as perhaps the development of breast cancer, include high-risk dietary and physical activity patterns. Studies suggest that a high intake of foods rich in heterocyclic amines (Has) (fried fish, fried chicken, bacon, and processed meats) may increase breast cancer risk [27], [28], [29], and that vitamins A and C, as well as physical activity, may protect against breast cancer [30], [31], [32], [33]. Numerous epidemiological studies have examined the relationship between physical activity and breast cancer risk in predominantly White populations. Although results are inconsistent, in general, high levels of physical activity are associated with a lower risk [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45]. Like obesity and dietary/physical activity patterns, early detection behaviors (clinical breast exam and mammography) are modifiable breast cancer risk factors. Historically, rates for mammography and clinical breast exam (CBE) have been lower for Black women compared to White women [12], [46]. Recent figures (2000–2001) show improvement; 66.7% of Black women ages 40 and older received a mammogram in the last year, 69.9% received CBE, and 54.8% received both [47]. In addition to regular CBE and mammography, breast self-exam (BSE) is also recommended as an integral part of comprehensive breast health behavior [48].

To date, health risk reduction interventions have not targeted multiple behaviors. For example, they have targeted early detection behaviors or diet [49], [50], but not physical activity or weight loss. Other interventions for Black women have targeted nutrition and physical activity but not breast health [51], [52]. Weight management and the practice of good breast health behavior may reduce risk and decrease health disparities [53]. There is a strong rationale for conducting combined interventions to reduce breast cancer risk in Black women since a disproportionate number of Black women are obese, and despite years of work to enhance breast health behaviors in underserved populations, there are still significant disparities [54]. The delivery of a combined (breast health/weight loss) intervention has not been conducted in this high-risk and underserved population. Moreover, one of the challenges in designing effective interventions for ethnic minorities is that there have been a limited number of health interventions that incorporate cultural values and traditions in a systematic manner. Thus, we conducted a pilot intervention to test the feasibility and efficacy of conducting a combined (breast health/weight loss) intervention in this population.