On the 30th September the American Institute for Cancer Research (AICR) experts shared 3 evidence based strategies for reducing risk of breast cancer. Recent research shows that women can reduce their risk of developing breast cancer by staying a healthy weight, getting enough physical activity and eating a healthy diet. The AICR believes that 1 in every 3 breast cancer cases (in the US) could be prevented with diet, exercise habits and weight management. “While there are no guarantees when it comes to developing cancer, what we do know is that women can take steps everyday to reduce the odds of developing breast cancer, along with many other cancers and chronic disease,” said Alice Bender, MS, RDN, AICR’s Head of Nutrition Programs. “This is such an empowering and important message.”
The 3 strategies are
1 Get to and stay at a healthy weight. The AICR say that roughly 1 in 5 of post menopausal cases of breast cancer are due to excess body fat. Excess fat can promote chronic inflammation, increase blood levels of insulin and related hormones that can encourage the growth of cancer cells.
2 Fit activity into your day. Getting at least 30 minutes of moderate activity reduces the risk of breast cancer both before and after menopause. Activity can help manage weight and boost immune function along with a healthy gastrointestinal tract.
The 3rd strategy is avoidance of alcohol, or if you do drink, drink moderately. The evidence is clear that even small amounts of alcohol on a regular basis will increase risk of breast cancers. As alcohol intake increases so does the risk of breast cancer. Alcohol is a carcinogen which could damage DNA and increase levels of hormones that fuel cancer. The AICR recommendation is for women to limit alcohol intake to 1 glass per day.
“When it comes to breast cancer, you can take control to lower risk through lifestyle changes that offer powerful protection,” said Bender.
SOURCE: American Institute for Cancer Research, news release, Sept. 30, 2016
This paper was written assess the prospective epidemiological evidence on night shift work and breast cancer incidence. Evidence mainly from animal studies has suggested that night shift work can increase the incidence of breast cancer by circadian disruption which is probably carcinogenic to humans. The researchers looked at data from the Million Woman Study, EPIC Oxford and UK Biobank participant data. These participants answered questions on shift work are were followed for breast cancer incidence. The meta analysis combined the relative risks found from the previous data with the relative risk data from seven previously published prospective studies. A total of 1.4 million women were included in the results. The meta analysis included 4660 breast cancers in women who reported night shift work. When compared with other women the relative risk for any night shift work was 0.99, 1.01 for 20 or more years and 1.0 for 30 or more years. From the totality of prospective data the researchers were able to conclude that night shift work, including long-term shift work, has little or no effect on breast cancer incidence.
Ruth C Travis, Angela Balkwill, Georgina K Fensom et al JNCI J Natl Cancer Inst (2016) 108 (12): djw169 doi: 10.1093/jnci/djw169
This study compared relapse free survival and breast cancer specific mortality according to PIK3CA mutation status and NSAIDs use after diagnosis. PI3K is a pathway that mediates key cellular functions included growth and proliferation A subunit of PI3K called PIK3CA is found in more than 30% of breast cancer. The use of aspirin and other non steroidal anti-inflammatory drugs (NSAIDs) is known to decrease PI3K activity. A total of 257 breast cancers were tested for PIK3CA. Medical records were reviewed and patients contacted with regards to their NSAID use. After an average follow-up of 5.5 years, there were 22 relapses (29%) and 9 breast-cancer related deaths (12%) among 77 subjects who regularly used an NSAID after breast cancer diagnosis, compared to 73 relapses (41%) and 53 deaths (29%) among 180 nonusers. Of the participants 66 (26%) had the PIK3CA mutation. The researchers were able to conclude that NSAID use was associated with a lower risk of relapse and cancer specific death in breast cancer pateints and that this was regardless of PIK3CA status.
Nataliya Sostin MD, Shiquan He MS, Oleg Sostin MD, Megan Troxell MD, PhD.
DOI: http://dx.doi.org/10.1093/ajcp/aqw159.086 315 First published online: 11 September 2016
Breast cancer patients often use complementary and alternative medicine. Specifically, for postmenopausal breast cancer patients there is very little prospectively collected data on the topic. The EvAluate-TM study is a prospective study evaluating the use of letrozole. As part of the data collection process 5045 participants (3411 responded) were asked about their interest in and information needs regarding integrative medicine. This research was conducted in order to identify the characteristics of those interested in integrative medicine. Of these participants 1583 expressed an interest in integrative medicine. Predictors of interest in integrative medicine were age, body mass index, tumor size, previous chemotherapy, and use of concomitant medications for other medical conditions. Interest declined significantly with age (65 years, 38.0%). Those who favored integrative medicine were less satisfied with the information they had received regarding their individual treatment and antihormonal therapy. They were often interested in rehabilitation and fitness, nutrition and support from self-help organisations. These women were mostly interested in receiving information about their disease and integrative medicine from a physician, rather than from other sources. The study concluded that a considerable proportion of post menopausal breast cancer patients are interested in integrative medicine. They recommend that information about this should be provided as part of the standard of care for this group and that most patients were interested in receiving this from their doctor.
Hack CC, Fasching PA, Fehm T et al Published online before print September 14, 2016, doi: 10.1177/1534735416668575 Integr Cancer Ther September 14, 2016 1534735416668575
Insulin-like growth factors (IGF´s) are known to play a crucial role in controlling cancer cell growth and spread. It has been suggested that exercise is an effective non pharmacological intervention promoting wellbeing during and after cancer treatment and improving cancer-related outcomes and survival. Some researchers have proposed that exercise can be used as a mechanism to decrease IGF levels and aid in cancer prevention. Its effects on IGF´s are not well understood. This paper is the first meta-analysis that has summarized the effectiveness of exercise training in modulating the IGF system in breast cancer survivors. The cell growth effects of IGF-1 are related to a poorer prognosis in breast cancer and increased all-cause mortality. The type of exercise did not appear to affect any direct association.
However it is suggested that different forms of exercise cause different responses in IGF-1. In conclusion this the authors report that their findings “provide novel insight regarding the role of exercise as a non-pharmacological and non-cytotoxic effective intervention in modulating the tumoral microenvironment as well as in the management of cancer treatment-related side effects (i.e., fatigue, depression and impairments of quality of life). Furthermore, our findings have crucial implications on cancer recurrence and disease free survival rates”.
The insulin-like growth factor system is modulated by exercise in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer201616:682. DOI: 10.1186/s12885-016-2733-z
The relationship between non-steroidal anti-inflammatory drug (NSAID) consumption and breast cancer has been repeatedly studied, although the results remain controversial. The most recent meta-analysis reported a 20 % protective effect of NSAID especially aspirin and COX-2 inhibitors against breast cancer, which seems to be restricted to estrogen receptors + (ER+) or progesterone receptors + (PR+) tumors. This large case-control study looked at the NSAID relationship and breast cancer differentiating between women’s characteristics (i.e.: menopausal status or body mass index category) and by tumor characteristics. The study found that NSAID use was associated with a 24 % reduction in breast cancer risk. “There is a trend towards a stronger protective effect of NSAID in postmenopausal women, ductal cancer, and hormone receptor or HER2 receptor positive tumors. This protective effect was less
pronounced in premenopausal women, non-ductal cancer, or triple negative cancer, although the small number of cases with triple negative cancer makes it difficult to reach definitive conclusions”.
Use of non-steroidal anti-inflammatory drugs and risk of breast cancer: The Spanish Multi-Case-control (MCC). BMC Cancer201616:660. DOI: 10.1186/s12885-016-2692-4
Fear of cancer recurrence (FOR) is one of the most common and distressing concerns of breast cancer survivors. This fear is associated with the fear that a recurrence could lead to their death. The primary aim of this study was to test the effects of a brief, low-cost gratitude intervention on overall FOR and death-related FOR. The theory being that creating and following meaningful goals would
decrease FOR. Sixty-seven women with early stage breast cancer were randomly assigned to either a 6-week online gratitude intervention or a 6-week online control condition. Results revealed that patients in the gratitude intervention experienced a significant decrease in death-related FOR compared to the control condition. Moreover, this effect was significantly mediated by meaningful goal pursuit. Overall, findings support the notion that a brief gratitude intervention can promote well-being and psychological adaptation to cancer by stimulating the pursuit of meaningful goals and subsequently reducing death-related FOR.
Effects of a Randomized Gratitude Intervention on Death-Related Fear of Recurrence in Breast Cancer Survivors. 2016. Otto AK, Szczesny EC, Soriano EC, Laurenceau JP, Siegel SD. Health Psychology. 2016 Aug 11. [Epub ahead of print] PMID: 27513475 DOI: 10.1037/hea0000400
This research was an evaluation of individual grain-containing foods and whole and refined grain intake during adolescence, early adulthood, and premenopausal years in relation to breast cancer risk in the Nurses’ Health Study II. Grain-containing food intakes were reported on a baseline dietary questionnaire (1991) and every four years thereafter. After adjusting for known breast cancer risk factors, adult intake of whole grain foods was associated with lower premenopausal breast cancer risk but not postmenopausal breast cancer. This association was no longer significant after further adjustment for fiber intake. The average of adolescent and early adulthood whole grain food intake was suggestively associated with lower premenopausal breast cancer risk. Total refined grain food intake was not associated with risk of breast cancer. Most individual grain-containing foods were not associated with breast cancer risk. The exceptions were adult brown rice which was associated with lower risk of overall and premenopausal breast cancer (for each two servings/week as well as breast cancer before and after menopause. The results suggest that high whole grain food intake may be associated with lower breast cancer risk before menopause. Fiber in whole grain foods may mediate the association with whole grains.
Lifetime grain consumption and breast cancer risk. 2016. Farvid, M.S., Cho, E., Eliassen, A.H. et al. Breast Cancer Research and Treatment (2016) 159: 335. DOI:10.1007/s10549-016-3910-0
The BMJ recently published the results of this systemic review and meta analysis of the association between the amount of total physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events. WHO recommends at least 600 metabolic equivalent (MET) minutes of total activity (irrespective of domains) per week for health benefits; this would be, for example, about 150 minutes/week of brisk walking or 75 minutes/week of running. Although higher levels of total physical activity were significantly associated with lower risk for all outcomes, major gains occurred at lower levels of activity (up to 3000-4000 metabolic equivalent (MET) minutes/week). A person can achieve 3000 MET minutes/week by incorporating different types of physical activity into the daily routine—for example, climbing stairs 10 minutes, vacuuming 15 minutes, gardening 20 minutes, running 20 minutes, and walking or cycling for transportation 25 minutes on a daily basis would together achieve about 3000 MET minutes a week. Individuals with a total activity level of 600 MET minutes/week (the minimum recommended level) had a 2% lower risk of diabetes compared with those reporting no physical activity. An increase from 600 to 3600 MET minutes/week reduced the risk by an additional 19%. The researchers concluded that people who achieve total physical activity levels several times higher than the current recommended minimum level have a significant reduction in the risk of the five diseases studied. They suggest that total physical activity needs to be several times higher than the current recommended minimum level of 600 MET minutes/week to achieve larger reductions in risks of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke.
Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. Kyu H. Bachman V. Alexander L et alBMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i3857 (Published 09 August 2016) BMJ 2016;354:i3857
A randomised controlled trial, undertaken by Italian researchers, investigated the effectiveness of acupuncture for the management of hot flashes in women with breast cancer. The researchers concluded that acupuncture in association with enhanced self-care is an effective integrative intervention for managing hot flashes and improving quality of life in women with breast cancer. The study included 190 women with breast cancer and compared acupuncture and enhanced self-care
with enhanced self-care alone. Both groups received information about managing hot flashes (climacteric syndrome) and were instructed to follow the management guidelines for 12 weeks. In addition the acupuncture group received 10 traditional acupuncture treatment sessions. Health outcomes were measured for six months after treatment. The results demonstrated that acupuncture plus enhanced self-care was associated with a significantly lower hot flash score than enhanced self-care at the end of treatment. Acupuncture was also associated with fewer climacteric symptoms and higher quality of life in the vasomotor, physical, and psychosocial dimensions.
Source: Lesi G, et al: Journal of Clinical Oncology, 2016 Mar 28; pii:JCO632893.
Night work has previously been linked with an increased risk of breast cancer. This study, undertaken among women in France,explored the links between tumour status (positive or negative) for oestrogen (ER), progesterone (PR) and human epidermal growth factor receptor 2 (HER2), and night shift work. Data from a casecontrol study was used and included 975 cases and 1317 controls. The results of the study provide evidence that working at night increases the risk of ER+, PR+ and HER2+ breast cancer by 100% or more among pre-menopausal women. The risk of ER+ and PR+ breast cancer among those who worked night shift was approximately twice that of those who didn’t work nights shift and for HER2+ the risk was 2.8 times greater. Noticeably there was no association with night shift work and breast cancer receptor status in post-menopausal women or in receptor negative breast cancers.
Source: Cordina-Duverger E, et al: Chronobiology International; 2016 Apr 14:1-5.
This meta-analysis by Italian researchers explored the association between apple intake and cancer risk. The results indicate that consumption of apples is associated with a reduced risk of cancer in different anatomical sites. The authors of this analysis describe conflicting results between fruit consumption and cancer risk and how little is known about the cancer preventive effects of different fruit types. Twenty casecontrol studies (including five on breast cancer) and twenty-one cohort studies (including three on breast cancer) were included in the data analysis. Comparing the highest versus lowest level of apple consumption, a significant effect of apples in reducing risk of breast cancer was found only in case-control studies while prospective studies indicated no effect. No evidence of publication bias could be detected for colorectal, oral cavity, oesophageal and breast cancer. However, some confounding effects may be present and related to the consumption of other fruit that were not considered as adjusting factors.
Source: Fabiani R, et al: Public Health Nutrition; 2016 Mar 22:1-15.
With recent controversies surrounding the validity of breast screening there have been widespread moves to develop risk stratified approaches to breast screening. The authors were aware that the public needs to be in favour of receiving breast cancer risk information and that this information should not have any detrimental effect. This study investigated risk perception, the proportion wishing to know their ten-year risk and whether subsequent screening attendance is affected in fifty thousand women attending the NHS Breast Screening Programme. These women completed a risk assessment questionnaire. Ten-year breast cancer risks were estimated and women at high risk (>8%) and low risk (<1%) were invited for faceto-face or telephone risk feedback and counselling. Of those invited to receive risk feedback, 74.3% of high-risk women opted to receive a consultation, compared with 54.9% of low-risk women. Women at high risk were significantly more likely to perceive their risk as high and to attend their subsequent mammogram (94.4%) compared with low-risk women (84.2%) and all attendees (84.3%).
Source: Evans DG, et al: British Journal of Cancer; 2016 Apr 26; 114(9): 1045-52.
According to this new study from Germany nearly one in four women (23 percent) newly diagnosed with breast cancer reported symptoms consistent with PTSD shortly after diagnosis, with increased risk among black and Asian women. This study investigated the prevalence and course of post-traumatic stress in patients with early breast cancer during their first year after diagnosis. The study also determined the effects of mastectomy and chemotherapy. Women under the age of 65 with stage 0-III breast cancer were evaluated using an accepted tool for PTSD before treatment, after chemotherapy and one year after diagnosis. The results of the study found that most newly diagnosed patients with breast cancer experience PTSD symptoms, although full diagnoses of DSM-IV stress disorder are rare. Symptoms diminish somewhat within one year furthered by university education but independently from mastectomy and chemotherapy. Throughout the year after diagnosis, having breast cancer entails a markedly increased burden of PTSD symptoms.
Source: Voigt V, et al: Psychooncology, 2016 Feb 22.