Challenges Remain in Perception, Communication of Weight-Related Risk Among Breast Cancer Survivors

Though evidence points to poorer outcomes for overweight and obese survivors of breast cancer, gaps remain with regard to risk perception and communication between survivors and health care providers. Data from a small study were presented June 16 at the 8th Biennial Cancer Survivorship Research Conference, a meeting of researchers, clinicians, cancer survivors and advocates in Washington, D.C.

Results from this exploratory, qualitative interview study demonstrated that approximately half of overweight and obese breast cancer survivors reported no weight-related discussion with a member of their health care team. Further, among those who did have a conversation related to weight, one-third said it was self-initiated and dismissed by the health care team member.

Better communication about breast cancer risk — and the development of interventions to modify those risk factors — could improve both clinical outcomes and quality of life for breast cancer survivors, according to the study’s poster.

The study recruited 22 individuals who had stage 1 or 2 breast cancer, were overweight or obese and had finished treatment at least two years prior. In total, nine survivors (41 percent) were white and 13 (59 percent) were African American. The mean age of all participants was 61 years and all spoke English.

Allison Christian, the lead author on the study, said her goal was to gain insight as to the needs of overweight and obese survivors of breast cancer.

“Had they had any discussions with their primary care providers — or any providers — about their weight status?” was a primary question of the study, Christian said, as well as what survivors knew about the association of weight and risk of breast cancer development or recurrence.

Interviews were tape recorded and transcribed to assess body image, risk perception, weight management, physician-patient communication regarding weight and preference for health information.

In the study, no survivors cited obesity as a risk factor for breast cancer, though one half to two-thirds of all participants said conversations about weight management were “lacking” and wanted more guidance.

“[Many survivors] desired lifestyle-based information education from their providers,” Christian said. “Despite the fact that they weren't having these conversations, there was that desire.”

Christian also emphasized a possible need for further physician education in communicating with patients about risk factors. Though she did not interview health care providers, she hypothesized that there may be a lack of time, training and tools for cancer survivorship care.

“When they return to primary care, [survivors] feel that the weight [question] is asked in such a way that it's part of the history and physical [examination],” Christian said. “There's no in-depth conversation that then follows up to that.”

Christian and her colleagues also saw significant gaps between white and African American survivors. According to the study’s poster, all white individuals were concerned about their weight, compared with about half of African American individuals that felt their weight needed to be addressed.

“White women, overall, were very aware and interested in the fact that they were overweight and obese and felt they understood the risk that that imposed,” she said. “African American breast cancer survivors didn't, overall, feel that [this] was something they needed to have addressed with their primary care providers.”

An emphasis on tailored communication and care for African American women is crucial, according to the study’s abstract, because of higher rates of obesity and lower breast cancer survival rates overall. Future studies are needed to “describe risks and socio-cultural barriers surrounding obesity, along with education and support.”

Many individuals, Christian said, simply did not know their risk for breast cancer prior to diagnosis or thought it was based solely on genetics.

Though there is “so much education out there” regarding obesity and breast cancer risk, Christian said, her study proves “there’s definitely a lot of work that needs to be done to raise awareness of the association.”