ContextPhysical activity has been shown to decrease the incidence of breast
cancer, but the effect on recurrence or survival after a breast cancer diagnosis
is not known.ObjectiveTo determine whether physical activity among women with breast cancer
decreases their risk of death from breast cancer compared with more sedentary
women.Design, Setting, and ParticipantsProspective observational study based on responses from 2987 female
registered nurses in the Nurses’ Health Study who were diagnosed with
stage I, II, or III breast cancer between 1984 and 1998 and who were followed
up until death or June 2002, whichever came first.Main Outcome MeasureBreast cancer mortality risk according to physical activity category
(<3, 3-8.9, 9-14.9, 15-23.9, or ≥24 metabolic equivalent task [MET]
hours per week).ResultsCompared with women who engaged in less than 3 MET-hours per week of
physical activity, the adjusted relative risk (RR) of death from breast cancer
was 0.80 (95% confidence interval [CI], 0.60-1.06) for 3 to 8.9 MET-hours
per week; 0.50 (95% CI, 0.31-0.82) for 9 to 14.9 MET-hours per week; 0.56
(95% CI, 0.38-0.84) for 15 to 23.9 MET-hours per week; and 0.60 (95% CI, 0.40-0.89)
for 24 or more MET-hours per week (P for trend =
.004). Three MET-hours is equivalent to walking at average pace of 2 to 2.9
mph for 1 hour. The benefit of physical activity was particularly apparent
among women with hormone-responsive tumors. The RR of breast cancer death
for women with hormone-responsive tumors who engaged in 9 or more MET-hours
per week of activity compared with women with hormone-responsive tumors who
engaged in less than 9 MET-hours per week was 0.50 (95% CI, 0.34-0.74). Compared
with women who engaged in less than 3 MET-hours per week of activity, the
absolute unadjusted mortality risk reduction was 6% at 10 years for women
who engaged in 9 or more MET-hours per week.ConclusionsPhysical activity after a breast cancer diagnosis may reduce the risk
of death from this disease. The greatest benefit occurred in women who performed
the equivalent of walking 3 to 5 hours per week at an average pace, with little
evidence of a correlation between increased benefit and greater energy expenditure.
Women with breast cancer who follow US physical activity recommendations may
improve their survival.

https://jamanetwork.com/journals/jama/articlepdf/200955/JOC50040.pdf

Physical activity and survival after breast cancer diagnosis

0.80 (95% confidence interval [CI], 0.60-1.06) for 3 to 8.9 MET-hours per week; 0.50 (95% CI, 0.31-0.82) for 9 to 14.9 MET-hours per week; 0.56 (95% CI, 0.38-0.84) for 15 to 23.9 MET-hours per week; and 0.60 (95% CI, 0.40-0.89) for 24 or more METhours per week (P for trend = .004). Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour. The benefit of physical activity was particularly apparent among women with hormone-responsive tumors. The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more METhours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 (95% CI, 0.34-0.74). Compared with women who engaged in less than 3 MET-hours per week of activity, the absolute unadjusted mortality risk reduction was 6% at 10 years for women who engaged in 9 or more MET-hours per week.

http://www.breastcancerpartner.com/Michelle%20Holmes%20Physical.activity.%26.brca.survival%5B1%5D.pdf

Women with primary invasive breast cancer receive both local and systemic treatment. Surgery and radiation therapy are local treatments given to reduce the risk of recurrent cancer in the breast, chest wall, and regional lymph nodes. In some cases, these local treatments may prevent the dissemination of cancer and may reduce mortality from breast cancer. Cytotoxic chemotherapy and hormonal therapy are systemic treatments given after local treatment to reduce systemic recurrences and overall mortality from breast cancer. Recent guidelines from the National Institutes of Health Consensus Conference, the National Comprehensive Cancer Center Network, and other groups recommend adjuvant chemotherapy, tamoxifen, . . .

Side Effects of Adjuvant Treatment of Breast Cancer

Purpose To determine whether weight prior to diagnosis and weight gain after diagnosis are predictive of breast cancer survival. Methods Patients included 5,204 Nurses' Health Study participants diagnosed with incident, invasive, nonmetastatic breast cancer between 1976 and 2000; 860 total deaths, 533 breast cancer deaths, and 681 recurrences (defined as secondary lung, brain, bone, or liver cancer, and death from breast cancer) accrued to 2002. We computed the change in body mass index (BMI) from before to the first BMI reported ≥ 12 months after the date of diagnosis. Cox proportional hazards models were used to evaluate associations of categories of BMI before diagnosis and of BMI change with time to event. We stratified by smoking, menopausal status, and breast cancer–related variables. Results In multivariate-adjusted analyses, weight before diagnosis was positively associated with breast cancer recurrence and death, but this was apparent only in never smokers. Similarly, among never-smoking women, t...

Weight, Weight Gain, and Survival After Breast Cancer Diagnosis

PURPOSE: To systematically review and summarize evidence relevant to obesity and breast cancer clinical outcome, potential hormonal mediating mechanisms, and the current status of weight loss interventions for chronic disease management. METHODS: A comprehensive, formal literature review was conducted to identify 5,687 citations with key information from 159 references summarized in text and tables. This process included a search for all breast cancer studies exploring associations among survival or recurrence and obesity at diagnosis or weight gain after diagnosis using prospective criteria. RESULTS: On the basis of observational studies, women with breast cancer who are overweight or gain weight after diagnosis are found to be at greater risk for breast cancer recurrence and death compared with lighter women. Obesity is also associated with hormonal profiles likely to stimulate breast cancer growth. Recently, use of weight loss algorithms proven successful in other clinical settings that incorporate die...

Weight Loss in Breast Cancer Patient Management

PURPOSE: Weight gain is common during the first year after breast cancer diagnosis. In this study, we examined clinical factors associated with body size at diagnosis and weight gain during the subsequent year. PATIENTS AND METHODS: An inception cohort of 535 women with newly diagnosed locoregional breast cancer underwent anthropometric measurements at baseline and 1 year. Information was collected on tumor- and treatment-related variables, as well as diet and physical activity. RESULTS: Mean age was 50.3 years; 57% of women were premenopausal. Mean baseline body mass index (weight [kg] divided by height [m] squared) was 25.5 kg/m2. Overall, 84.1% of the patients gained weight. Mean weight gain was 1.6 kg (95% confidence interval, 1.2 to 1.9 kg), 2.5 kg (95% confidence interval, 1.8 to 3.2 kg) in those receiving chemotherapy, 1.3 kg (95% confidence interval, 0.7 to 1.8 kg) in those receiving tamoxifen only, and 0.6 kg (95% confidence interval, 0.01 to 1.3 kg) in those receiving no adjuvant treatment. Meno...

Adjuvant Treatment and Onset of Menopause Predict Weight Gain After Breast Cancer Diagnosis

Lipids and lipoproteins have been associated with breast cancer risk; however, published results have been inconsistent. To clarify these associations, we measured fasting lipids in women undergoing breast biopsies. A case-control study examined the association of fasting levels of lipids with histologically defined breast cancer risk. Four groups of premenopausal women were assembled on the basis of histological appearance of breast tissue: 1) no epithelial proliferation (n = 102), 2) proliferation without atypia (n = 53), 3) atypical hyperplasia or carcinoma in situ (n = 53), and 4) node-negative invasive cancer (n = 102). A postoperative fasting blood specimen was analyzed for cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. Demographics, risk factors, diet, physical activity, fasting weight, and skin-fold thickness were measured. Triglyceride levels were significantly higher in women with node-negative invasive cancer (0.94 +/- 1.04 mg/ml) than in those with no epithelial proliferation (0.83 +/- 1.04 mg/ml, p = 0.03). This association persisted after adjustment for age, body size, lipids, reproductive and familial risk factors, and previous benign breast problems (p < 0.01), in keeping with an independent association of elevated triglycerides with breast cancer risk.

Elevated levels of plasma triglycerides are associated with histologically defined premenopausal breast cancer risk.

Cyclical mastopathy (CM) is a common clinical syndrome of premenstrual breast swelling and tenderness. Its symptoms are relieved by reduction in dietary fat intake and, because fat intake may be associated with breast cancer risk, it was hypothesized that CM may also be related to breast cancer risk. This case-control study included 192 premenopausal women with a recent history of axillary node-negative breast cancer and 192 age-matched premenopausal controls. Subjects provided information on diet and risk factors, and they recorded breast symptoms prospectively during one menstrual cycle. Symptoms in the non-cancerous breast of cases and the matched (right or left) breast of controls were examined. A cyclical pattern of symptoms was identified in both groups; breast tenderness scores were similar post-menstrually (p = 0.31) but were significantly higher premenstrually in the case group (p = 0.03). Cases also had a greater premenstrual increase in breast tenderness than controls (p = 0.03). When the effects of other risk factors for breast cancer were included in multivariate analyses, the association of cyclical tenderness with breast cancer persisted (p = 0.05), the odds ratio for severe tenderness being 3.32. Thus, we have identified an association of cyclical breast tenderness with breast cancer risk in premenopausal women. The association persists after consideration of diet and the effects of other breast cancer risk factors.

Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study.

Purpose: Weight gain is common during the first year after breast cancer diagnosis. In this study, we examined clinical factors associated with body size at diagnosis and weight gain during the subsequent year. Patients and Methods: An inception cohort of 535 women with newly diagnosed locoregional breast cancer underwent anthropometric measurements at baseline and 1 year. Information was collected on tumorand treatment-related variables, as well as diet and physical activity. Results: Mean age was 50.3 years; 57% of women were premenopausal. Mean baseline body mass index (weight [kg] divided by height [m] squared) was 25.5 kg/m2. Overall, 84.1% of the patients gained weight. Mean weight gain was 1.6 kg (95% confidence interval, 1.2 to 1.9 kg), 2.5 kg (95% confidence interval, 1.8 to 3.2 kg) in those receiving chemotherapy, 1.3 kg (95% confidence interval, 0.7 to 1.8 kg) in those receiving tamoxifen only, and 0.6 kg (95% confidence interval, 0.01 to 1.3 kg) in those receiving no adjuvant treatment. Menopausal status at diagnosis (P 5 .02), change in menopausal status over the subsequent year (P 5 .002), axillary nodal status (P 5 .009), and adjuvant treatment (P 5 .0002) predicted weight gain in univariate analysis. In multivariate analysis, onset of menopause and administration of chemotherapy were independent predictors of weight gain (all P I .05). Caloric intake decreased (P F .01) and physical activity increased (P F .05) during the year after diagnosis; these factors did not explain the observed weight gain. Conclusion: Weight gain is common after breast cancer diagnosis; use of adjuvant chemotherapy and onset of menopause are the strongest clinical predictors of this weight gain. J Clin Oncol 17:120-129. r 1999 by American Society of Clinical Oncology.

Sheila Redwood

Papers

Adjuvant Treatment and Onset of Menopause Predict Weight Gain After Breast Cancer Diagnosis

Elevated levels of plasma triglycerides are associated with histologically defined premenopausal breast cancer risk.

Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study.

Adjuvant T reatment a nd O nset o f M enopause P redict W eight Gain A fter B reast C ancer D iagnosis