Healthy lifestyle linked to reduced risk for breast cancer recurrence, mortality

Cannioto reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Key takeaways:

  • Women with the lowest lifestyle index scores had a higher risk for breast cancer recurrence and mortality.
  • Lifestyle interventions could help delay and prevent disease recurrence and death.

Adherence to American Institute for Cancer Research and American Cancer Society’s lifestyle recommendations appeared associated with a decreased risk for breast cancer recurrence and mortality among women with high-risk disease.

The findings, published in JAMA Network Open, suggest education and implementation strategies could help patients with breast cancer adhere to prevention recommendations throughout the cancer care continuum.

Healthy Foods in Container
Women with high-risk breast cancer who adhered to cancer prevention lifestyle recommendations, including consumption of fruits and vegetables, had a lower risk for disease recurrence and mortality. Image: Adobe Stock

Rationale and methodology

“The American Institute for Cancer Research and American Cancer Society regularly publish lifestyle recommendations for cancer prevention. Despite recommendations to adhere to these guidelines after a cancer diagnosis, which lifestyle factors impact cancer survival and whether they work together to do so remains unknown,” Rikki A. Cannioto, PhD, EdD, researcher in the department of cancer prevention and control at Roswell Park Comprehensive Cancer Center, told Healio. “As my research program focuses on modifiable lifestyle factors and cancer survival, we sought to investigate whether adhering to cancer prevention recommendations was also associated with improved survival in patients with high-risk breast cancer.”

Rikki A. Cannioto, PhD, EdD

Rikki A. Cannioto

The prospective, observational cohort Diet, Exercise, Lifestyles, and Cancer Prognosis (DELCaP) Study assessed lifestyles before diagnosis, during treatment, and at 1 and 2 years after completion of treatment among 1,340 women (mean age, 51.3 years) diagnosed with chemotherapy-naive stage I to stage III high-risk breast cancer between 2005 and 2010.

Overall, 65.3% of women had hormone receptor-positive breast cancer and 71.2% completed some education beyond high school.Researchers used an aggregated lifestyle index score that included data from four time points and seven lifestyle factors, including physical activity; BMI; consumption of fruit and vegetables, red and processed meat, sugar-sweetened beverages and alcohol; and smoking status. Higher scores indicated healthier lifestyle.

Disease recurrence and all-cause mortality served as main outcomes.

Mean follow-up was 7.7 years.


Results of time-dependent multivariable analyses showed women with highest vs. lowest lifestyle index scores had a 37% decrease in disease recurrence (HR = 0.63; 95% CI, 0.48-0.82) and a 58% decrease in mortality (HR = 0.42; 95% CI, 0.3-0.59).

“Significant reductions in recurrence and mortality were consistently observed, even among patients diagnosed with the more aggressive tumor types, including triple-negative and HER2-positive tumors,” Cannioto said.


The findings suggest that lifestyle interventions could be a safe, inexpensive and feasible ancillary strategy for delaying and preventing recurrence and death from the most common cancer in the world, Cannioto told Healio.

“This may be true for patients diagnosed with more aggressive tumors who do not respond well to current treatments,” she said. “We have additional studies underway aimed at examining these associations in more diverse patient populations and at understanding the molecular mechanisms that underly these associations.”

For more information:

Rikki A. Cannioto, PhD, EdD, can be reached at [email protected].