Abstract 6224: Lifestyle patterns and mortality in a population-based cohort of Black breast cancer survivors

Abstract Background: African American/Black women have a nearly 40% higher breast cancer (BC) mortality rate compared to White women, reflecting a significant health disparity. Although lifestyle modifications may improve BC survival, robust, population-specific estimates quantifying the association between pre-diagnosis lifestyle patterns and mortality among Black women with BC are lacking. This study leverages data from a population-based cohort of Black BC survivors in New Jersey to examine the relationship between pre-diagnosis lifestyle patterns and mortality outcomes in this high-risk group. Methods: Lifestyle pattern scores for approximately one year before diagnosis were computed based on adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations, which align with the American Cancer Society guidelines. These scores were calculated using lifestyle factors measured or self-reported during baseline home interviews, including adiposity (BMI and waist circumference), physical activity, and dietary quality (consumption of fruits and vegetables, fiber, ultra-processed foods, red and processed meat, sugar-sweetened beverages, and alcohol). Scores ranged from 0 to 7, with higher scores indicating greater adherence to guidelines. Associations between lifestyle pattern scores and mortality outcomes (all-cause and BC-specific) were analyzed using Cox proportional hazards models and competing risk models to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Among 1, 710 women (mean age: 54.1 [SD: 10.7]), 391 deaths occurred over a median follow-up of 8.6 years, including 205 BC-related deaths. The average lifestyle score was 2.9 (SD: 1.1). In multivariate models adjusted for age, education, household income, health insurance, marital status, and smoking status, women with the highest scores (5-7) had a 39% lower risk of all-cause mortality (HR = 0.61, 95% CI: 0.39-0.95) and a 31% lower risk of BC-specific mortality (HR = 0.69, 95% CI: 0.37-1.29) compared to those with the lowest scores (0-2), though the latter CI includes the null. Women with the highest lifestyle pattern scores (5-7) also had significantly lower risks of all-cause mortality by 53% over 5 years and 45% over 10 years, respectively. Findings were consistent across subgroups defined by age at diagnosis, tumor subtype, and stage. Conclusion: High adherence to cancer-related lifestyle guidelines was associated with lower mortality rates among Black BC survivors compared to those with low adherence. These findings suggest that adherence to lifestyle guidelines encompassing multiple lifestyle factors may improve survival outcomes among Black women following a BC diagnosis. Citation Format: Bo Qin, Shromona Sarkar, Tengteng Wang, Nur Zeinomar, Marley M. Perlstein, Coral O. Omene, Karen S. Pawlish, Kitaw Demissie, Christine B. Ambrosone, Chi-Chen Hong, Elisa V. Bandera. Lifestyle patterns and mortality in a population-based cohort of Black breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 6224.