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Healthy Living After A Breast Cancer Diagnosis

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Research increasingly shows that “energy balance” is important in breast cancer. Learn why exercise, weight, and diet are important for breast cancer patients.

Publié dans : Santé & Médecine
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Healthy Living After A Breast Cancer Diagnosis

  1. 1. Healthy Living After A Breast Cancer Diagnosis Jennifer Ligibel, MD Dana-Farber Cancer Institute Young Women’s Forum October 13, 2017
  2. 2. Research increasingly shows that “energy balance” is important in breast cancer Energy we take in Energy we “spend” What remains (Food) (Exercise + Metabolism) (Weight) _ = Each of these factors has been linked to breast cancer
  3. 3. But diet and exercise recommendations for preventing and treating cancer are everywhere– and they don’t always agree!
  4. 4. How can you sort out fact from fiction? Is there an optimal diet to prevent breast cancer recurrence? Is exercise important for breast cancer survivors?
  5. 5. Most studies looking at links between diet and cancer are “Observational” studies • In this kind of study, a large group of people is asked what kind of food they are eating • Participants are followed over time (“Observed”) to see who gets cancer or has a recurrence, and links are made between cancer and the kinds of diet people consumed Pro Studies many different diet factors and cancers at once Con Hard to separate out other factors (people who eat certain types of diets may be different in other ways, like exercise more or weigh less)
  6. 6. What kinds of foods have been linked to cancer risk? • Red meat has been linked to colon cancer risk – Try to consume < 18 ounces/week • Smoked and processed meats have been linked to stomach and other cancers – Even small amounts linked to slight increase in cancer risk • Alcohol has been linked to risk of head and neck, liver, esophageal and breast cancers – Women should consume no more than 1 drink day; men no more than 2
  7. 7. Do we have any evidence that changing diet could prevent breast cancer?
  8. 8. One study looked at whether eating a Mediterranean diet affected the risk of developing breast cancer Mediterranean diet: • Lots of veggies, fish, olive oil • Not much red meat or processed food • A little wine
  9. 9. Study basics • Primary goal: study the effect of a Mediterranean diet on heart disease • Study also looked at effect of the diet on risk of breast cancer in women taking part in the study • Study participants divided into 3 groups • Mediterranean diet + extra virgin olive oil • Mediterranean diet + nuts • Usual diet • About 4000 women who had never had breast cancer took part
  10. 10. Did the diets make a difference? • Not very many women developed breast cancer—only 35 during the course of the study • Women in the olive oil group had a 62% lower risk of breast cancer compared to usual diet group • Women in the nut group had a 38% lower risk of breast cancer compared to usual diet group
  11. 11. Is there any evidence that a specific diet or food has health benefits for women who have already had breast cancer?
  12. 12. “Observing” trials show links between some types of food and breast cancer recurrence • Diets high in fat linked to higher cancer recurrence • Weak links between higher intake of fiber and protein and lower cancer recurrence • No real link with carbohydrate intake
  13. 13. Most studies looking at the direct effect of a particular food on cancer were done using cells in test tubes or in animals, not people
  14. 14. Broccoli and Breast Cancer
  15. 15. What’s the Evidence? • Different kinds of breast cancer cells were grown in a lab • Breast cancer cells were exposed to different concentrations of nutrients isolated from broccoli • At high concentrations, the growth rate of breast cancer cells slowed and cells had a higher death rate
  16. 16. Broccoli in rats • Young female rats divided into groups; some given 5 days of nutrients isolated from broccoli, some given typical food and no broccoli • All rats exposed to chemical that causes breast cancer • Rats given high doses of broccoli nutrients about 50% less likely to develop breast cancer
  17. 17. What about in people? • No studies testing what happens in women with breast cancer who increase broccoli in their diet • Several studies asked women without breast cancer how much broccoli (and other fruits and vegetables they ate) • Results not very consistent • Some studies showed a slightly lower rate of breast cancer in women who ate more broccoli • Other studies showed no difference
  18. 18. But is there any evidence that diet after breast cancer is linked to risk of cancer recurrence?
  19. 19. Two studies looked at whether changing diet after diagnosis would lower risk of recurrence Women’s Interventional Nutrition Study (WINS) • Goal: test the effect of reducing dietary fat after breast cancer diagnosis on recurrence • Study enrolled ~2400 women with Stage I-III breast cancer • WINS Diet : reduce fat to 15% of total calories .
  20. 20. Second trial testing effect of changing diet on breast cancer recurrence • Goal: to test the effect of eating less fat, and more fruits, vegetables and fiber on the risk of breast cancer recurrence • Included 3088 women with stage I-III breast cancer Women’s Healthy Eating and Living (WHEL) Trial
  21. 21. Both trials successfully changed participants’ diets WINS Trial • Low fat diet group cut fat by 33% • Usual diet group cut fat by 9% WHEL Trial • Diet group – Cut fat by 25% – Increased fruits and vegetables by 5 servings per day • Usual diet group – Decreased fat by 4% – No change in fruits and vegetable servings
  22. 22. Results of trials were a bit different WINS Trial • Low fat diet group had a reduced risk of breast cancer recurrence • Benefit mostly in patients with estrogen negative cancers • Benefits seemed to be reduced over time WHEL Trial • No difference in recurrence risk in diet and usual care groups • No benefits of diet program seen in any patient group
  23. 23. No clear evidence that a specific diet can reduce or increase the risk of breast cancer recurrence, based on what we know now
  24. 24. What about exercise? • Women who exercise less likely to get breast cancer • A few studies have looked at links between exercise after breast cancer diagnosis and risk of recurrence • Exercise linked to 30-50% lower risk of cancer recurrence!
  25. 25. What kind of exercise were these women doing? • The most common exercise was walking at a moderate pace • Benefits seen with walking at a 3-mile-per-hour pace for half an hour per day • Not necessary to run a marathon! (of course you always can if you like)
  26. 26. Exercise also shown to have other benefits in breast cancer survivors • Better quality of life • More energy • Less arthritis and joint pain • Better self esteem and mood • Plus: decreased risk of diabetes and heart disease!
  27. 27. How could exercise effect breast cancer? • Enrolled breast cancer survivors who were not exercising • Assigned them to exercise or usual care group • Exercise program: – Strength training – Cardio at home • Study showed that exercise lowered levels of insulin, a hormone linked to breast cancer The Dana-Farber Exercise and Insulin Study
  28. 28. The Breast Cancer Weight Loss Trial
  29. 29. BWEL Study Basics • The BWEL study will test the ability of a weight loss program to reduce rates of breast cancer recurrence • BWEL is a randomized trial: half of the study participants will take part in the weight loss program and half will receive a breast cancer education program • The study will enroll 3136 women in the US and Canada • Study is designed to test whether weight loss reduces the risk of cancer recurrence by 20%
  30. 30. Who can take part in BWEL? • Women with breast cancer diagnosed within the past year • Must have a BMI of at least 27kg/m2 • Must have HER-2 negative breast cancer • Cancer must be stage II or III • Patients can’t have metastatic breast cancer • Patients can’t be taking certain types of diabetes medicines • Must be completed with surgery and with chemotherapy (if it was used)
  31. 31. BWEL Weight Loss Program • Goal: to help participants lose 10% of their body weight through diet and exercise • Participants are paired with a health coach • Receive 42 phone calls over 2 years • Record weight, food intake and exercise
  32. 32. Conclusions • Exercise, weight and diet are important in breast cancer patients • It’s never too late to make healthy changes in lifestyle! • More research is needed to understand how changes in diet and exercise could affect breast cancer recurrence rates