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Adherence to the 2020 American Cancer Society Guideline for Cancer Prevention and risk of breast cancer for women at increased familial and genetic risk in the Breast Cancer Family Registry: an evaluation of the weight, physical activity, and alcohol consumption recommendations



The American Cancer Society (ACS) published an updated Guideline for Cancer Prevention (ACS Guideline) in 2020. Research suggests that adherence to the 2012 ACS Guideline might lower breast cancer risk, but there is limited evidence that this applies to women at increased familial and genetic risk of breast cancer.


Using the Breast Cancer Family Registry (BCFR), a cohort enriched for increased familial and genetic risk of breast cancer, we examined adherence to three 2020 ACS Guideline recommendations (weight management (body mass index), physical activity, and alcohol consumption) with breast cancer risk in 9615 women. We used Cox proportional hazard regression modeling to calculate hazard ratios (HRs) and 95% confidence intervals (CI) overall and stratified by BRCA1 and BRCA2 pathogenic variant status, family history of breast cancer, menopausal status, and estrogen receptor-positive (ER +) breast cancer.


We observed 618 incident invasive or in situ breast cancers over a median 12.9 years. Compared with being adherent to none (n = 55 cancers), being adherent to any ACS recommendation (n = 563 cancers) was associated with a 27% lower breast cancer risk (HR = 0.73, 95% CI: 0.55–0.97). This was evident for women with a first-degree family history of breast cancer (HR = 0.68, 95% CI: 0.50–0.93), women without BRCA1 or BRCA2 pathogenic variants (HR = 0.71, 95% CI: 0.53–0.95), postmenopausal women (HR = 0.63, 95% CI: 0.44–0.89), and for risk of ER+ breast cancer (HR = 0.63, 95% CI: 0.40–0.98).


Adherence to the 2020 ACS Guideline recommendations for BMI, physical activity, and alcohol consumption could reduce breast cancer risk for postmenopausal women and women at increased familial risk.

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We would like to thank all of the investigators, staff, and participants of the Breast Cancer Family Registry for making this research possible.


This work was supported by the CTSA grant TL1TR001875 and U01 CA164920 from the USA National Cancer Institute. The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the USA Government or the BCFR.

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Authors and Affiliations



All authors provided a critical review of the manuscript and approved the final manuscript. JS Ferris and AM Geczik performed the data analysis and wrote the manuscript. AM Geczik and JM Genkinger contributed to the study conception. MB Terry, IL Andrulis, SS Buys, MB Daly, JL Hopper, EM John, and MC Southey contributed to the funding acquisition and data collection. Y Liao performed data cleaning and management for the study.

Corresponding author

Correspondence to Jeanine M. Genkinger.

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Conflict of interests

The authors have no competing interests.

Ethical approval

This study was performed in accordance with the Declaration of Helsinki. All participants in the BCFR provided written informed consent before participation. Human research ethics committees at the participating institutions granted ethics approval for the six sites of the BCFR:Northern California—Cancer Prevention Institute of California, Institutional Review Board (2001–033) and Stanford University School of Medicine, Institutional Review Board (45842) New York—Columbia University Medical Center, Institutional Review Board (AAA7794) Philadelphia—Fox Chase Cancer Center, Institutional Review Board (95–009) Utah—Huntsman Cancer Institute, University of Utah, Institutional Review Board (00004965) Ontario—Mount Sinai Hospital Research Ethics Board (#02–0076-U) and University Health Network Research Ethics Board (#96-U107-CE) Australia—University of Melbourne, Human Ethics Sub-Committee (1441420.1).

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Geczik, A.M., Ferris, J.S., Terry, M.B. et al. Adherence to the 2020 American Cancer Society Guideline for Cancer Prevention and risk of breast cancer for women at increased familial and genetic risk in the Breast Cancer Family Registry: an evaluation of the weight, physical activity, and alcohol consumption recommendations. Breast Cancer Res Treat 194, 673–682 (2022).

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  • Breast Cancer
  • Cancer Prevention
  • Incidence
  • Lifestyle behaviors