Increasing trial diversity and tailoring interventions for underrepresented groups may facilitate health equity in breast cancer prevention and control, according to experts.

A recent review cites studies suggesting that obesity, unhealthy diets, and physical inactivity may increase the risk of developing breast cancer and dying from it, but lifestyle interventions may lower those risks.1

The results of these studies may not be generalizable, however, as many were conducted predominantly in non-Hispanic White patients, according to review author Elisa V. Bandera, MD, PhD, of Rutgers Cancer Institute of New Jersey in New Brunswick, and colleagues.

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“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,” the authors wrote.

Existing Evidence

Data suggest that Hispanic women have a lower incidence of breast cancer than non-Hispanic White women.2 However, breast cancer incidence is on the rise in Hispanic women, and breast cancer is the leading cause of cancer death in this group.

Although breast cancer incidence rates are similar for non-Hispanic White women and Black women, death rates are higher for Black women.1 Asian/Pacific Islander women have the lowest incidence and death rates of all racial/ethnic groups.

These differences could be explained, in part, by “differences in health behaviors, such as physical activity or differences in overweight or obesity, which we know is associated with decreased survival and breast cancer survival specifically,” said Scherezade K. Mama, DrPH, an assistant professor in the Department of Health Disparities Research at the University of Texas MD Anderson Cancer Center in Houston.

One large meta-analysis showed that physical activity reduced breast cancer risk in both pre- and postmenopausal women.3 Both adult weight gain and greater body adiposity were associated with an increased risk of breast cancer in postmenopausal women, but the evidence was less consistent in premenopausal women.

Although the meta-analysis included more than 100 studies, the authors still concluded that more studies are needed of different racial and ethnic groups that may have different risk patterns.

In their review, Dr Bandera and colleagues noted that studies among Black women have found “mostly null associations between adult BMI and premenopausal breast cancer risk.”1 The authors also noted that “few studies have evaluated the impact of obesity on breast cancer risk among Hispanic women.”

Data do suggest the prevalence of obesity varies by racial or ethnic group, with non-Hispanic Black women having higher rates (56.9%) than Hispanic (43.7%), non-Hispanic White (39.8%), and Asian (17.2%) women.1