Impact of Lifestyle Behaviors and Social Determinants of Health on Breast Cancer Prevention and Survivorship: A Comprehensive Primary Analysis of Patient-Reported Data

Lifestyle behaviors and social determinants of health (SDOH) are critical in breast cancer prevention, survivorship, and recurrence risk, yet adherence to evidence-based recommendations identified by American Society of Clinical Oncology (ASCO) remains variable. This primary cross-sectional study evaluated patient-reported SDOH and lifestyle factors among 700 breast cancer patients receiving care at a large academic oncology clinic between June and August 2023. Data collected through the patient portal included body mass index (BMI), fruit and vegetable intake, physical activity, alcohol consumption, financial insecurity, cancer stage, and hormonal profile as identified by World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) guidelines. The majority of patients exhibited behaviors inconsistent with WCRF/AICR recommendations. Two-thirds of patients exhibited elevated BMI, 95% reported fewer than 5 daily servings of produce, and mean weekly physical activity was 128 minutes, below recommendation. Only 34% of patients reported no alcohol consumption. In a subgroup analysis of estrogen receptor-positive patients, 47% consumed 4 servings of fruits and vegetables daily, below the recommended ≥5 servings daily. Despite minimal reported financial barriers, adherence to lifestyle recommendations was low, highlighting opportunities for integrating lifestyle medicine and SDOH-informed care into oncology practice to improve cancer outcomes, survivorship, and long-term quality of life.