Diet & exercise & breast cancer

27
Diet & exercise & breast cancer Mary Pegington Research Dietitian Genesis Prevention Centre & Nightingale Breast Screening Centre, University Hospital of South Manchester

description

Diet & exercise & breast cancer. Mary Pegington Research Dietitian Genesis Prevention Centre & Nightingale Breast Screening Centre, University Hospital of South Manchester. Breast cancer rates are increasing 1-2% per year 2011 : 50,285 cases / year . Breast cancer incidence trends. - PowerPoint PPT Presentation

Transcript of Diet & exercise & breast cancer

Page 1: Diet & exercise  & breast cancer

Diet & exercise & breast cancer

Mary Pegington Research Dietitian

Genesis Prevention Centre &Nightingale Breast Screening Centre,

University Hospital of South Manchester

Page 2: Diet & exercise  & breast cancer

Breast cancer rates are increasing1-2% per year

2011 : 50,285 cases / year

Page 3: Diet & exercise  & breast cancer

Breast cancer incidence trends

Bray et al Breast Cancer Research 6: 229, 2004

Europe120

100

807060

50

40

30

20

101960 1970 1980 1990 2000

Year

Age

sta

ndar

dise

d ra

te (w

orld

)

Americas120

100

807060

50

40

30

20

101960 1970 1980 1990 2000

Year

Age

sta

ndar

dise

d ra

te (w

orld

)

Asia/Oceania120

100

807060

50

40

30

20

101960 1970 1980 1990 2000

Year

Age

sta

ndar

dise

d ra

te (w

orld

)

UKFINLAND

SPAIN

SLOVAKIA

USA

CANADA

PUERTO RICO

COLUMBIA

AUSTRALIA

JAPAN

INDIA

Page 4: Diet & exercise  & breast cancer

Western lifestyle & breast cancer risk

Page 5: Diet & exercise  & breast cancer

loss orgain 2.0

gain2.1-10.0

gain10.1-20.0

gain>20.0

Weight gain (kg)

Mul

tivar

iate

RR

Adult weight gain increases risk of post menopausal breast cancer

1.01.2

1.6

2.0

0

0.5

1

1.5

2

Huang et al JAMA 287: 1407, 1997, Colditz GA et al Arch Int Med 122: 481, 1995

Page 6: Diet & exercise  & breast cancer

loss orgain 2.0

gain2.1-10.0

gain10.1-20.0

gain>20.0

Weight gain (kg)

Mul

tivar

iate

RR

Adult weight gain increases risk of post menopausal breast cancer

1.01.2

1.6

2.0

0

0.5

1

1.5

2

12 Diabetes

3 Cardiovascular

disease

Huang et al JAMA 287: 1407, 1997, Colditz GA et al Arch Int Med 122: 481, 1995 Willett W et al JAMA 273: 461, 1995Aleksandrova K et al Eur J Cancer. 2013 49:3526-36.

1.5 Colorectal

cancer

Page 7: Diet & exercise  & breast cancer

Weight loss reduces breast cancer incidence

Cohort studies Population Weight loss RR

Harvie et al2005

34,000 postmenopausal women

>5% ~3.5 kg

0.61 (0.46 – 0.80)

Eliassen et al2006

87,000 postmenopausal women

>10kg ~ 15%

0.43 (0.25 – 0.86)

Prentice et al2006

48,835 postmenopausal women

2 kg ~3%

0.91 (0.83 – 1.01)

Teras et al2011

Bariatric surgery

13,055 overweight & obese postmenopausal women

>5 kg ~7%

0.78 (0.55 – 1.10)

Page 8: Diet & exercise  & breast cancer

Obesity and Cancer

Hursting SD & Hursting MJ Arterioscle Thomb Vasc Biol 32: 1766, 2012

Page 9: Diet & exercise  & breast cancer

Premenopausal weight is important

• Excess weight increases risk age >35yrs

- General population (Peacock et al Am J Epidemiol. 1999)

- Family History (Cecchini et al Cancer Prev Res 2012)

• Pre menopausal weight gain increases postmenopausal risk

UK data shows 10/12 kg of adult weight gain occurs by age of 50

(Health Survey England 2012)

Page 10: Diet & exercise  & breast cancer

Exercise & breast cancer

• Each hour of exercise/ week reduces risk of breast cancer by 6%

• Aim for 3 hours of exercise / week

Friedenreich Recent Results Cancer Res. 2011;188:125-39

Page 11: Diet & exercise  & breast cancer

-27%

-24%

-18%

<1%

<22

22-24.9

25-29.9

>30

Friedenreich Recent Results Cancer Res. 2011;188:125-39.

BC risk reduction

BMI

“Fit and Fat” does not protect against breast cancer

Page 12: Diet & exercise  & breast cancer

Alcohol 10 units / week vs. no drinking increases BC risk by 10%

BUT

No alcohol increases risk of heart disease by 40%

No alcohol increases risk of dying from any cause by 13% Lowest risk for dying from any cause with 3–15 g/day Higher risk for dying from any cause with >60 g/day

Ronksley P E et al. BMJ 2011;342:bmj.d671

Page 13: Diet & exercise  & breast cancer

Recommended Mediterranean diet

Page 14: Diet & exercise  & breast cancer

Weight control and energy restriction after diagnosis

Page 15: Diet & exercise  & breast cancer

Niraula S et al Breast Cancer Res Treat. 2012 134:769-81

Obesity & overall survival

Obesity & breast cancer survival

20% more likely to die from any cause

26% more likely to die from breast cancer

Page 16: Diet & exercise  & breast cancer

Weight gain after diagnosis

• 60 - 75% of patients gain weight after diagnosis

• Most weight gained during first year

• Weight gain persists - long term problem

• Greatest weight gain in:

premenopausal, adjuvant chemotherapy,

thinner women, chemotherapy induced menopause

Page 17: Diet & exercise  & breast cancer

Dietary interventions - RCT WINS – 1994-2004 WHEL 1995 - 2006

N 2437 3088

Age 48 – 79 18 - 70

Time post diagnosis Up to 1 year Up to 4 years

Intervention 5 years

Sustained fat reduction 20% vs 29%

6 years Transient fat reduction

20% vs 29%12 vs 6 fruit & veg / day

Weight change- kg -2.7 vs + 0.7 +0.5 vs +0.4

Disease free survival

0.76 (0.6 – 0.98) 0.96 (0.8 – 1.14)

Page 18: Diet & exercise  & breast cancer

Kwan ML et al CEBP 2013 22(1): 32–41.

Trend for increased alcohol & reduced overall mortality & cardiovascular mortality

Alcohol after diagnosis

Page 19: Diet & exercise  & breast cancer

2.5 hours of moderate activity /week & outcome (n = 13,302)

Recurrence Breast cancer mortality

All cause mortality

Normal weight 0.93 (0.81 – 1.07)

0.72 (0.61 – 0.86)

0.72 (0.63 – 0.83)

Overweight 0.98 (0.85 – 1.14)

0.78 (0.65 – 0.94)

0.69(0.59 – 0.81)

Obese 0.96 (0.77 – 1.19)

0.72 (0.61 – 0.86)

0.86(0.7 – 1.06)

Beasley et al Breast Cancer Res Treat 2012 ; 131 : 637 - 643

Page 20: Diet & exercise  & breast cancer

Calorie restriction is difficult to achieve and maintain in humans!

• 25-30% adherence to low cal diets at 12 months

• 20%-40 achieve > 5% weight loss at 1 year

• Only 20% of our women at high risk of breast cancer maintain > 5% weight loss at 5 years

Dansinger et al . JAMA 2005;293:43-53.

Page 21: Diet & exercise  & breast cancer

Our first intermittent study RCT of IER vs. daily restriction 2006-2009

1. Is intermittent energy restriction acceptable & easier to follow than daily restriction?

2. Does IER have better effects on risk markers for breast cancer, diabetes, CVD compared to daily restriction?

Page 22: Diet & exercise  & breast cancer

-8

-6

-4

-2

0

0 1 2 3 4

Chan

ge fr

omBa

selin

e M

ean

Months

WeightIECRICRDER

-6

-5

-4

-3

-2

-1

0

0 1 2 3 4

Chan

ge fr

om

Base

line

Mea

n

Months

Body FatIECRICRDER

Change in weight & body fat including drop outs (N = 115)

P<0.05

P<0.01

Page 23: Diet & exercise  & breast cancer

Intermittent diet study 2 -Summary

• IER superior to daily restriction for reducing body

fat and insulin.

• 1 day of restriction / week maintains weight loss

Page 24: Diet & exercise  & breast cancer

Intermittent diets may reduce chemotherapy toxicity

• Animal studies and case studies suggest IER may reduce chemotherapy toxicity

• May reduce oxidative stress & upregulate stress response mechanisms.

• B-AHEAD 2 will look at the effects on chemotherapy toxicity: self report data and two novel blood biomarkers

Safdie et al Aging (Albany NY) 2009 1:988-1007Lee et al Sci Transl Med 2012 7;4 (124)

Page 25: Diet & exercise  & breast cancer

B-AHEAD 2 Study

Outcomes 3 weeks post final chemotherapy• Weight, body fat (DXA), waist, hips• Breast cancer prognosis marker – insulin• Oxidative stress markers• Chemotherapy toxicity (self report & Cytokeratin 18 & FMS Like Tyrosine

Kinase 3 ligand markers)• CVD risk parameters: lipids, blood pressure • Fitness, Quality of life, Dietary intake, Physical activity

n = 170Scheduled to receive adjuvant or neoadjuvant chemotherapy

2 day / week IER (& exercise)Individual advice and telephone support

Group 1: n = 85

Group 2: n = 85

Daily energy restricted diet (& exercise)Individual advice and telephone support

4 ½ to 6 months of chemotherapy

Page 26: Diet & exercise  & breast cancer

Acknowledgements

FAMILY HISTORY CLINIC/PROCAS

Tony HowellGareth EvansPaula StavrinosLouise DonnellyR GreenhalghJenny AffenJayne Beesley

LIFESTYLE

Michelle HarvieMary PegingtonDebbie McMullenKath Sellers Ellen MitchellPam CoatesLesley CoatesCheryl BarlowNina BrogdenGenesis Volunteers

FUNDING

Genesis Breast Cancer PreventionNational Institute of Health ResearchBreast Cancer CampaignWCRFBreast Cancer Research Trust

Rob Clarke – Patterson InstituteKath Spence – Patterson InstituteAndy Sims – Breakthrough EdinburghRoy Goodacre - UOMMark Mattson – NIH Baltimore

COLLABORATORS

The Patients

Page 27: Diet & exercise  & breast cancer

Any questions?