Evidence-Based Interventions for Reducing Breast Cancer Disparities: What Works and Where the Gaps Are?

Simple Summary Breast cancer is the most common cancer in women in the United States and most countries around the world. There are many breast cancer risk factors that are amenable to intervention. This includes long-established risk factors (physical activity, obesity, alcohol consumption, breastfeeding), as well as emerging risk factors (tobacco smoke in early life, environmental chemicals). To inform future prevention, we inventoried existing evidence-based cancer control programs (EBCCP) in the National Cancer Institute's online repository. We found that there are no existing EBCCPs for alcohol, breastfeeding, or environmental chemicals. While there are EBCCPs for physical activity, obesity, and early life tobacco control, only three programs were identified as high-quality, multilevel programs that were developed for populations that face breast cancer disparities. There thus remains a need for evidence-based interventions that can reduce breast cancer disparities. The National Cancer Institute (NCI) has established an online repository of evidence-based cancer control programs (EBCCP) and increasingly calls for the usage of these EBCCPs to reduce the cancer burden. To inventory existing EBCCPs and identify remaining gaps, we summarized NCI's EBCCPs relevant to reducing breast cancer risk with an eye towards interventions that address multiple levels of influence in populations facing breast cancer disparities. For each program, the NCI EBCCP repository provides the following expert panel determined summary metrics: (a) program ratings (1-5 scale, 5 best) of research integrity, intervention impact, and dissemination capability, and (b) RE-AIM framework assessment (0-100%) of program reach, effectiveness, adoption, and implementation. We quantified the number of EBCCPs that met the quality criteria of receiving a score of >= 3 for research integrity, intervention impact, and dissemination capability, and receiving a score of >= 50% for available RE-AIM reach, effectiveness, adoption, and implementation. For breast cancer risk reduction, we assessed the presence and quality of EBCCPs related to physical activity (PA), obesity, alcohol, tobacco control in early life, breastfeeding, and environmental chemical exposures. Our review revealed several major gaps in EBCCPs for reducing the breast cancer burden: (1) there are no EBCCPs for key breast cancer risk factors including alcohol, breastfeeding, and environmental chemical exposures; (2) among the EBCPPs that exist for PA, obesity, and tobacco control in early life, only a small fraction (24%, 17% and 31%, respectively) met all the quality criteria (>= 3 EBCCP scores and >= 50% RE-AIM scores) and; (3) of those that met the quality criteria, only two PA interventions, one obesity, and no tobacco control interventions addressed multiple levels of influence and were developed in populations facing breast cancer disparities. Thus, developing, evaluating, and disseminating interventions to address important risk factors and reduce breast cancer disparities are needed.