Background: Lifestyle behavior change is one risk-reduction strategy for women with elevated breast cancer (BC) risk. According to the Health Belief Model, perception of personal risk is critical for motivating behavior change. Therefore, we aimed to assess BC risk perception, belief that BC risk can be lowered, and lifestyle behaviors (ie, weight management, diet, physical activity, alcohol use, and smoking) among a community-based sample of U.S. women with elevated BC risk. Methods: Non-Hispanic Black and non-Hispanic white women, aged 18–74 years, with no history of cancer, and ≥20% lifetime BC risk according to ≥1 risk estimation models (i.e., IBIS, Gail, Claus) were recruited mainly from community-based settings (ie, online research volunteer databases, social media, and community-based organizations). Eligible women completed an online survey about personal risk, risk perception, and risk-management behavior. Descriptive statistics were used to calculate proportions for variables of interest. Logistic regression was used to estimate odds ratios and 95% confidence intervals (CI) for associations between perceived risk, belief about BC risk, and lifestyle behaviors. Results: Our sample included 717 women with a median age of 36 years, 35% Black; 59% had ≥1 first-degree relative with BC, and 20% reported a BRCA1/2 mutation. Seventy-nine percent perceived their personal BC risk to be ≥20%, but 33% did not believe BC risk can be lowered. Lifestyle behaviors were generally poor: 61% had overweight or obese body mass index (BMI), 97% reported low fruit/vegetable intake, 34% reported heavy/excessive alcohol use, 27% reported inactive/sedentary physical activity, and 8% reported currently smoking. BC risk perception was associated only with BMI: women who perceived themselves to be at high (≥20% lifetime) risk had higher odds of having a normal BMI compared to women who had low (<20% lifetime) perceived risk (OR=1.42 [95% CI: 0.96, 2.09]). The belief that BC risk can be lowered was not associated with lifestyle behaviors, yet post-hoc analyses observed a strong association between this belief and use of preventive mastectomy (OR= 7.40 [95% CI: 3.34, 16.40]). Conclusion: Perceived BC risk was high, and most women believed that BC risk can be lowered, yet uptake of healthy lifestyle behaviors for BC prevention was low. Future studies should investigate and address barriers to uptake of healthy lifestyle behavior change as a cancer prevention strategy.
Uptake of lifestyle behaviors among high-risk women
