Abstract
Breast cancer survival rates are significantly lower for African-American women compared to white women. Additionally, African-American women with breast cancer are more likely than other women to die from comorbid conditions including diabetes and hypertension. Such disparities are not easily explained and likely involve complex issues related to social injustices. However, obesity and behavioral factors may be additional contributors. Seventy-eight percent of African-American women are overweight or obese, and data suggest that many do not engage in regular physical activity and tend to have diets high in fat and low in vegetables and whole grains. The combined effects of obesity, unhealthy diet, and inactivity may contribute to the disparity in breast cancer survival between African-American and white women and may be the easiest modifiable factors to address in the near term. Although several weight loss interventions have reported beneficial results for breast cancer survivors, the inclusion of AA women has been extremely limited. This chapter presents a review of health behaviors among African-American breast cancer survivors, followed by a discussion of qualitative work exploring the beliefs, attitudes, barriers, and facilitators related to health behaviors and weight loss. A summary of interventions to date is provided as well as an in-depth look at one particular community-based intervention, Moving Forward.
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References
American Cancer Society (2004) Cancer facts and figures 2004. American Cancer Society, Atlanta, GA
Joslyn SA, West MM (2000) Racial differences in breast carcinoma survival. Cancer 88:114–123
Newman LA, Griffith KA, Jatoi I et al (2006) Meta-analysis of survival in African American and White American patients with breast cancer: ethnicity compared with socioeconomic status. J Clin Oncol 24:1342–1349
Surveillance Epidemiology and End Results (SEER) Program
Tammemagi CM, Nerenz D, Neslund-Dudas C et al (2005) Comorbidity and survival disparities among Black and White patients with breast cancer. JAMA 294:1765–1772
Eley JW, Hill HA, Chen VW et al (1994) Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA 272:947–954
McCullough ML, Feigelson HS, Diver WR et al (2005) Risk factors for fatal breast cancer in African-American women and White women in a large US prospective cohort. Am J Epidemiol 162:734–742
McKenzie F, Jeffreys M (2009) Do lifestyle or social factors explain ethnic/racial inequalities in breast cancer survival? Epidemiol Rev 31:52–66
Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20:1128–1143
Dignam JJ, Wieand K, Johnson KA et al (2003) Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst 95:1467–1476
Stephenson GD, Rose DP (2003) Breast cancer and obesity: an update. Nutr Canc 45:1–16
Nichols HB, Trentham-Dietz A, Egan KM et al (2009) Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev 18:1403–1409
Reeves GK, Patterson J, Vessey MP et al (2000) Hormonal and other factors in relation to survival among breast cancer patients. Int J Cancer 89:293–299
Vatten LJ, Foss OP, Kvinnsland S (1991) Overall survival of breast cancer patients in relation to preclinically determined total serum cholesterol, body mass index, height and cigarette smoking: a population-based study. Eur J Cancer 27:641–646
Kyogoku S, Hirohata T, Takeshita S et al (1990) Survival of breast-cancer patients and body size indicators. Int J Cancer 46:824–831
Endogenous Hormones Breast Cancer Collaborative G (2003) Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Nat Canc Inst 95:1218–1226
McTiernan A, Rajan KB, Tworoger SS et al (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 21:1961–1966
Goodwin PJ, Ennis M, Pritchard KI et al (2002) Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 20:42–51
Blackburn GL, Wang KA (2007) Dietary fat reduction and breast cancer outcome: results from the Women’s Intervention Nutrition Study (WINS). Am J Clin Nutr 86:878S–881S
Pierce BL, Ballard-Barbash R, Bernstein L et al (2009) Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. J Clin Oncol 27:3437–3444
Flegal KM, Graubard BI, Williamson DF et al (2010) Sources of differences in estimates of obesity-associated deaths from first National Health and Nutrition Examination Survey (NHANES I) hazard ratios. Am J Clin Nutr 91:519–527
Chlebowski RT, Chen Z, Anderson GL et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97:439–448
Newman S, Miller A, Howe G (1986) A study of the effect of weight and dietary fat on breast cancer survival time. Am J Epidemiol 123:767–774
Senie RT, Rosen PP, Rhodes P et al (1992) Obesity at diagnosis of breast carcinoma influences duration of disease-free survival. Ann Intern Med 116:26–32
Boyd N, Campbell J, Germanson T et al (1981) Body weight and prognosis in breast cancer. J Natl Cancer Inst 67:785–789
Camoriano JK, Loprinzi CL, Ingle JN et al (1990) Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. J Clin Oncol 8:1327–1334
Goodwin PJ, Panzarella T, Boyd NF (1988) Weight gain in women with localized breast cancer – a descriptive study. Breast Cancer Res Treat 11:59–66
Heasman KZ, Sutherland HJ, Campbell JA et al (1985) Weight gain during adjuvant chemotherapy for breast cancer. Breast Canc Res Treat 5:195–200
Demark-Wahnefried W, Rimer BK, Winer EP (1997) Weight gain in women diagnosed with breast cancer. J Am Diet Assoc 97:519–526, 529; quiz 527–8
Rock CL, Flatt SW, Newman V et al (1999) Factors associated with weight gain in women after diagnosis of breast cancer. Women’s Healthy Eating and Living Study Group. J Am Diet Assoc 99:1212–1221
Flegal KM, Carroll MD, Ogden CL et al (2002) Prevalence and trends in obesity among US adults, 1999–2000 [comment]. JAMA 288:1723–1727
Demark-Wahnefried W, Morey MC, Clipp EC et al (2003) Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors. Control Clin Trials 24:206–223
Rock CL, Demark-Wahnefried W (2002) Can lifestyle modification increase survival in women diagnosed with breast cancer? J Nutr 132:3504S–3507S
Adams-Campbell LL, Rosenberg L, Rao RS et al (2001) Strenuous physical activity and breast cancer risk in African-American women. J Natl Med Assoc 93:267–275
Hoffman-Goetz L, Apter D, Demark-Wahnefried W et al (1998) Possible mechanisms mediating an association between physical activity and breast cancer. Cancer 83:621–628
American Cancer Society (2003) Cancer facts & figures for African Americans 2003–2004. American Cancer Society, Atlanta, GA
Mitchell BD, Stern MP, Haffner SM et al (1990) Risk factors for cardiovascular mortality in Mexican Americans and non-Hispanic whites. Am J Epidemiol 131:423–432
Tangney CC, Young JA, Murtaugh MA et al (2002) Self-reported dietary habits, overall dietary quality and symptomatology of breast cancer survivors: a cross-sectional examination. Breast Canc Res Treat 71:113–123
Bowen DJ, Kestin M, McTiernan A et al (1995) Effects of dietary fat intervention on mental health in women. Cancer Epidemiol Biomarkers Prev 4:555–559
Courneya KS, Keats MR, Turner AR (2000) Physical exercise and quality of life in cancer patients following high dose chemotherapy and autologous bone marrow transplantation. Psychooncology 9:127–136
Courneya KS, Friedenreich CM (1997) Relationship between exercise during cancer treatment and current quality of life in survivors of breast cancer. J Psychol Oncol 15:35–57
Spencer SM, Carver CS, Price AA (1998) Psychological and social factors in adaptation. In: Holland JC (ed) Psycho-oncology. Oxford University Press, New York, NY, pp 211–222
Reardon KK, Aydin CE (1993) Changes in lifestyle initiated by breast cancer patients: who does and who doesn’t? Health Commun 5:263–282
Taylor SE, Lichtman RR, Wood JV (1984) Attributions, beliefs about control, and adjustment to breast cancer. J Pers Soc Psychol 46:489–502
Patterson RE, Neuhouser ML, Hedderson MM et al (2003) Changes in diet, physical activity, and supplement use among adults diagnosed with cancer. J Am Diet Assoc 103:323–328
Maunsell E, Drolet M, Brisson J et al (2002) Dietary change after breast cancer: extent, predictors, and relation with psychological distress. J Clin Oncol 20:1017–1025
Goodwin P, Esplen MJ, Butler K et al (1998) Multidisciplinary weight management in locoregional breast cancer: results of a phase II study. Breast Cancer Res Treat 48:53–64
Chlebowski RT, Blackburn GL, Buzzard IM et al (1993) Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer. The Women’s Intervention Nutrition Study [see comments]. J Clin Oncol 11:2072–2080
Pierce JP, Faerber S, Wright FA et al (1997) Feasibility of a randomized trial of a high-vegetable diet to prevent breast cancer recurrence. Nutr Canc 28:282–288
Berglund G, Bolund C, Gustafsson UL et al (1994) One-year follow-up of the ‘Starting Again’ group rehabilitation programme for cancer patients. Eur J Cancer 30A:1744–1751
Mock V, Dow KH, Meares CJ et al (1997) Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum 24:991–1000
Segar ML, Katch VL, Roth RS et al (1998) The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncol Nurs Forum 25:107–113
McTiernan A, Ulrich C, Kumai C et al (1998) Anthropometric and hormone effects of an eight-week exercise-diet intervention in breast cancer patients: results of a pilot study. Cancer Epidemiol Biomarkers Prev 7:477–481
Djuric Z, DiLaura NM, Jenkins I et al (2002) Combining weight-loss counseling with the weight watchers plan for obese breast cancer survivors. Obes Res 10:657–665
Mefferd K, Nichols J, Pakiz B et al (2007) A cognitive behavioral therapy intervention to promote weight loss improves body composition and blood lipid profiles among overweight breast cancer survivors. Breast Cancer Res Treat 104:145–152
Saxton JM, Daley A, Woodroofe N et al (2006) Study protocol to investigate the effect of a lifestyle intervention on body weight, psychological health status and risk factors associated with disease recurrence in women recovering from breast cancer treatment. BMC Cancer 6:35
Stolley MR, Sharp LK, Oh A et al (2009) A weight loss intervention for African American breast cancer survivors, 2006. Prev Chronic Dis 6:A22
de Waard F, Ramlau R, Mulders Y et al (1993) A feasibility study on weight reduction in obese postmenopausal breast cancer patients. Eur J Cancer Prev 2:233–238
Paxton RJ, Phillips KL, Jones LA et al (2012) Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors. Cancer 118:4024–4031
Dennis Parker EA, Sheppard VB, Adams-Campbell L (2013) Compliance with national nutrition recommendations among breast cancer survivors in “Stepping Stone”. Integr Cancer Ther 12(2):114–120
Paxton RJ, Taylor WC, Chang S et al (2013) Lifestyle behaviors of African American breast cancer survivors: a Sisters Network, Inc. study. PLoS One 8:e61854
Paxton RJ, Jones LA, Chang S et al (2011) Was race a factor in the outcomes of the women’s health eating and living study? Cancer 117:3805–3813
Stolley MR, Sharp LK, Wells AM et al (2006) Health behaviors and breast cancer: experiences of urban African American women. Health Educ Behav 33:604–624
Weathers B, Frances K, Barg A et al (2006) Perceptions of changes in weight among African American breast cancer survivors. Psychooncology 15:174–179
Halbert CH, Weathers B, Esteve R et al (2008) Experiences with weight change in African-American breast cancer survivors. Breast J 14:182–187
Fitzgibbon ML, Stolley MR (2004) Environmental changes may be needed for prevention of overweight in minority children. Pediatr Ann 33:45–49
Burdette HL, Whitaker RC (2004) Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children. Prev Med 38:57–63
Ross CE, Mirowsky J (2001) Neighborhood disadvantage, disorder, and health. J Health Soc Behav 42:258–276
Lackey NR, Gates MF, Brown G (2001) African American women’s experiences with the initial discovery, diagnosis, and treatment of breast cancer. Oncol Nurs Forum 28:519–527
Potts RG (1996) Spirituality and the experience of cancer in an African-American community: implications for psychosocial oncology. J Psychosoc Oncol 14:1–19
Post-White J, Ceronsky C, Kreitzer MJ et al (1996) Hope, spirituality, sense of coherence, and quality of life in patients with cancer. Oncol Nurs Forum 23:1571–1586
Djuric Z, Mirasolo J, Kimbrough LV et al (2009) A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. J Natl Med Assoc 101:552
Wilson DB, Porter JS, Parker G et al (2005) Anthropometric changes using a walking intervention in African American breast cancer survivors: a pilot study. Prev Chronic Dis 2:A16
Greenlee HA, Crew KD, Mata JM et al (2013) A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors. Obesity (Silver Spring) 21:65–76
Spector D, Deal AM, Amos KD et al (2013) A pilot study of a home-based motivational exercise program for African American breast cancer survivors: clinical and quality-of-life outcomes. Integr Cancer Ther 13(2):121–132
Foster GD, Wadden TA, Swain RM et al (1999) Changes in resting energy expenditure after weight loss in obese African American and white women. Am J Clin Nutr 69:13–17
Kumanyika S (2002) Obesity treatment in minorities. In: Wadden T, Stunkard A (eds) Handbook of obesity treatment. Guilford Press, New York, NY, pp 416–446
Kumanyika SK, Whitt-Glover MC, Gary TL et al (2007) Expanding the obesity research paradigm to reach African American communities. Prev Chronic Dis 4:A112
Davis EM, Clark JM, Carrese JA et al (2005) Racial and socioeconomic differences in the weight-loss experiences of obese women. Am J Public Health 95:1539–1543
Bronner Y, Boyington JE (2002) Developing weight loss interventions for African-American women: elements of successful models. J Natl Med Assoc 94:224–235
Stolzenberg-Solomon RZ, Falk RT, Stanczyk F et al (2012) Sex hormone changes during weight loss and maintenance in overweight and obese postmenopausal African-American and non-African-American women. Breast Cancer Res 14:R141
Gerber BS, Stolley MR, Thompson AL et al (2009) Mobile phone text messaging to promote healthy behaviors and weight loss maintenance: a feasibility study. Health Informatics J 15:17–25
Stolley MR, Fitzgibbon ML, Schiffer L et al (2009) Obesity Reduction Black Intervention Trial (ORBIT): six-month results. Obesity 17:100–106
NIH/NHLBI (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – the evidence report. Obes Res 6:51S–209S
Bandura A (1986) Social foundations of thought and action. Prentice-Hall, Englewood Cliffs, NJ
Stokols D (1996) Translating social ecological theory into guidelines for community health promotion. Am J Health Promot 10:282–298
Richard L, Potvin L, Kishchuk N et al (1996) Assessment of the integration of the ecological approach in health promotion programs. Am J Health Promot 10:318–328
Martin PD, Dutton GR, Brantley PJ (2004) Self-Efficacy as a predictor of weight change in African-American Women. Obesity 12:646–651
Walcott-Mcquigg J (2000) Psychological factors influencing cardiovascular risk reduction behavior in low and middle income African-American women. Natl Black Nurs Assoc 11:27–35
Ainsworth BE, Wilcox S, Thompson WW et al (2003) Personal, social, and physical environmental correlates of physical activity in African-American women in South Carolina. Am J Prev Med 25:23–29
Thomas JL, Stewart DW, Lynam IM et al (2009) Support needs of overweight African American women for weight loss (Report). Am J Health Behav 33(4):339
Wolfe W (2004) A review: maximizing social support – a neglected strategy for improving weight management with African-American women. Ethn Dis 14:212–218
King AC, Jeffery RW, Fridinger F et al (1995) Environmental and policy approaches to cardiovascular disease prevention through physical activity: issues and opportunities. Health Educ Behav 22:499–511
Robinson T (2008) Applying the socio-ecological model to improving fruit and vegetable intake among low-income African Americans. J Community Health 33:395–406
Kumanyika S (2008) Ethnic minorities and weight control research priorities: where are we now and where do we need to be? Prev Med 47:583–586
Huang TT, Drewnowski A, Kumanyika SK et al (2009) A systems-oriented multilevel framework for addressing obesity in the 21st century. Prev Chronic Dis 6:A97
Fallon EA, Wilcox S, Ainsworth BE (2005) Correlates of self-efficacy for physical activity in African American women. Women Health 41:47–62
Linn BS, Linn MW, Gurel L (1968) Cumulative illness rating scale. J Am Geriatr Soc 16:622–626
Miller MD, Paradis CF, Houck PR et al (1992) Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale. Psychiatry Res 41:237–248
Sallis JF, Pinski RB, Grossman RM et al (1988) The development of self-efficacy scales for health - related diet and exercise behaviors. Health Educ Res 3:283–292
Sallis JF, Grossman RM, Pinski RB et al (1987) The development of scales to measure social support for diet and exercise behaviors. Prev Med 16:825–836
Echeverria SE, Diez-Roux AV, Link BG (2004) Reliability of self-reported neighborhood characteristics. J Urban Health 81:682–701
Casey AA, Elliott M, Glanz K et al (2008) Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities. Prev Med 47:600–604
Buzzard IM (1994) Rationale for an international conference on dietary assessment methods. Am J Clin Nutr 59:143S–145S
Beaton GH (1994) Approaches to analysis of dietary data: relationship between planned analyses and choice of methodology. Am J Clin Nutr 59:253S–262S
Block G, Hartman AM, Dresser CM et al (1986) A data-based approach to diet questionnaire design and testing. Am J Epidemiol 124:453–469
Liu K (1994) Statistical issues related to semiquantitative food-frequency questionnaires. Am J Clin Nutr 59:262S–265S
Block G, Hartman AM, Naughton D (1990) A reduced dietary questionnaire: development and validation. Epidemiology 1:58–64
Norris J, Harnack L, Carmichael S et al (1997) U.S. trends in nutrient intake: the 1987 and 1992 National Health Interview Surveys. Am J Public Health 87:740–746
Hartman AM, Block G, Chan W et al (1996) Reproducibility of a self-administered diet history questionnaire administered three times over three different seasons. Nutr Cancer 25:305–315
Kriska AM, Caspersen CJ (1997) Introduction to a collection of physical activity questionnaires. Med Sci Sports Exerc 29:5
Irwin ML, Crumley D, McTiernan A et al (2003) Physical activity levels before and after a diagnosis of breast carcinoma. Cancer 97:1746–1757
Ainsworth BE, Sternfeld B, Slattery ML et al (1998) Physical activity and breast cancer: evaluation of physical activity assessment methods. Cancer 83:611–620
Troiano RP, Berrigan D, Dodd KW et al (2008) Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 40:181–188
Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7:333–340
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483
McHorney CA, Ware JE, Lu JFR et al (1994) The MOS 36-Item Short Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions and reliability across diverse patient groups. Med Care 32:40–66
Bowen D, Alfano C, McGregor B et al (2007) Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Res Treat 106:85–95
Bower JE, Ganz PA, Desmond KA et al (2006) Fatigue in long-term breast carcinoma survivors. Cancer 106:751–758
Fallowfield LJ, Leaity SK, Howell A et al (1999) Assessment of quality of life in women undergoing hormonal therapy for breast cancer: validation of an endocrine symptom subscale for the FACT-B. Breast Cancer Res Treat 55:189–199
Cella D, Eton DT, Lai J-S et al (2002) Combining anchor and distribution-based methods to derive minimal clinically important differences on the functional assessment of cancer therapy (FACT) anemia and fatigue scales. J Pain Symptom Manage 24:547–561
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Stolley, M. (2014). Community-Based Strategies to Alter Energy Balance in Underserved Breast Cancer Survivors. In: Bowen, D., Denis, G., Berger, N. (eds) Impact of Energy Balance on Cancer Disparities. Energy Balance and Cancer, vol 9. Springer, Cham. https://doi.org/10.1007/978-3-319-06103-0_10
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