Breast cancer risk status influences uptake, retention and efficacy of a weight loss programme amongst breast cancer screening attendees: two randomised controlled feasibility trials

Michelle Harvie,Philip Foden,Sarah Mcdiarmid,Louise Donnelly,Grace Cooper,Helen Ruane,Mary Pegington,D Gareth Evans,Anthony Howell,David French,Katharine Sellers

doi:10.1186/s12885-019-6279-8

Abstract

BackgroundExcess body weight and sub-optimal lifestyle are modifiable causes of breast cancer and other diseases. There is little evidence that behaviour change is possible within screening programmes and whether this is influenced by prior knowledge of disease risk. We determined whether breast cancer risk influences uptake, retention and efficacy of a weight control programme in the UK National Health Service Breast Screening Programme, and whether additional cardiovascular disease and type 2 diabetes risk information improves uptake and retention further.MethodOverweight/obese women in the UK National Health Service Breast Screening Programme identified at high, moderately increased, average and low-risk of breast cancer were randomised to receive individualised breast cancer risk information (breast cancer prevention programme), or individualised breast cancer, cardiovascular disease (QRISK2) and type 2 diabetes (QDiabetes, HbA1c) information (multiple disease prevention programme). Personalised breast cancer risk feedback was given before randomisation in Study-1, and after randomisation in Study-2.ResultsRecruitment was 9% (126/1356) in Study-1 and 7% (52/738) in Study-2. With respect to breast cancer risk, odds ratio of uptake for high/moderately increased vs low risk women was 1.99 (95% CI 1.24–3.17, P = 0.004) in Study-1 and 3.58 (95% CI 1.59–8.07, P = 0.002) in Study-2. Odds ratio of retention for high/moderately increased -risk vs. low risk women was 2.98 (95% CI 1.05–8.47, P = 0.041) in Study-1 and 3.88 (95% CI 1.07–14.04, P = 0.039) in Study-2. Weight loss of ≥5% at 12 months was achieved by 63% high/moderate vs. 43% low-risk women in Study-1 (P = 0.083) and 39% vs. 8% in Study-2 (P = 0.008). Uptake, retention and weight loss were equivalent in both the breast cancer prevention programme and the multiple disease prevention programme in both studies.ConclusionsWomen who are informed that they are at increased breast cancer risk were significantly more likely to join and remain in the programmes and consequently lose more weight across both studies. High risk women are more likely engage in a lifetyle prevention programme and also have the greatest potential benefit fom risk reduction strategies.Trial registrationISRCTN91372184 Registered 28 September 2014.

Highlights

Excess body weight and sub-optimal lifestyle are modifiable causes of breast cancer and other diseases
With respect to breast cancer risk, odds ratio of uptake for high/moderately increased vs low risk women was 1.99 in Study-1 and 3.58 in Study-2
Women who are informed that they are at increased breast cancer risk were significantly more likely to join and remain in the programmes and lose more weight across both studies

Summary

Introduction

Excess body weight and sub-optimal lifestyle are modifiable causes of breast cancer and other diseases. Maintaining a healthy weight, limiting alcohol, and meeting physical activity (PA) recommendations could prevent 19–26% of breast cancer (BC) in Western populations in the UK [1], Europe [2] and USA [3]. These healthy behaviours could potentially reduce risk of 12 other cancers, type 2 diabetes (T2D) and cardiovascular disease (CVD) [4]. The PROCAS Study has been described previously [6] It assessed the feasibility of collecting breast cancer risk information and providing personalised BC risk assessment amongst 53,000 women in the Manchester NHSBSP between 2009 and 2013. Breast cancer risk assessment was used to triage higher risk patients for chemoprevention, and risk-adapted screening [7]

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