Weight Loss Programmes For Overweight And Obese Breast Cancer Survivors: What Are Their Benefits And Harms And Do They Help Survivors To Live Longer
What is a healthy weight?
Body mass index assesses whether people are a healthy weight for their height. A BMI of 18 to 25 shows a healthy weight, a BMI over 25 indicates being overweight, and a BMI over 30 indicates obesity.
Breast cancer and weight
People with a BMI over 25 are more likely to develop a recurrence of their breast cancer. Obesity can also affect people’s quality of life and can lead to serious and life-threatening conditions, including type 2 diabetes, coronary heart disease and stroke. After successful treatment for breast cancer, people with a BMI over 25 are advised to lose weight.
The most common method for losing weight is to reduce the number of calories eaten and to increase physical activity. A healthy, reduced-calorie diet and regular exercise may be combined with psychosocial support. Some weight loss programmes include all three elements.
Why we did this Cochrane Review
We wanted to identify which weight-loss programmes work best to help overweight and obese breast cancer survivors to lose weight and whether the programmes had advantages or unwanted effects.
What did we do?
We wanted to know how weight loss programmes affected: -how long people lived -whether their breast cancer returned -the length of time before the cancer returned -how many people died -people’s quality of life or -had any unwanted effects.
Search date: we included evidence published up to June 2019.
What we found
What are the results of our review?
When Should I Schedule A Mammogram
If you have lost weight, you may wonder when you should schedule a mammogram. If you lose a pound here and there, this shouldnt be enough to change the composition of your breasts. Your mammogram will only be affected if you have experienced significant weight loss since your last mammogram. With this being said, there is no right or wrong time when to get a mammogram.
It is generally recommended to schedule a mammogram if you are unsure if weight loss has changed the composition of your breasts. While self-examinations are a useful tool to consider, you may want to follow these guidelines to determine if you should schedule a mammogram:
- If you have lost a considerable amount of weight
- If you have experienced changes in the texture or thickness of the skin on your breasts
- If you experience a drastic change in size or shape of one of your breasts
- If you have experienced discharge
- If you have a family history of breast cancer
- If there are new lumps in the breasts or changes in the way they feel
- If you are experiencing pain in your breasts
- If you are 45 to 54 years old, you should begin to get annual mammograms
Dietitians Offer Strategies For Controlling Weight After Cancer Treatment
Michelle Churches walks 11,000 steps during her 10-hour nursing shift at an outpatient surgery center in Trenton.
She knows this because she wears a pedometer. After walking those 11,000 steps, she comes home and pulls together a homemade dinner in about 30 minutes. She chats with her husband and kids, cleans up the kitchen and heads out to walk the dog. Some weeks, depending on her work schedule, she’ll fit in an extra 12-hour shift to help fund a gift she wants to give her three children: a debtfree ride through college.
To say that Churches is active would draw an affectionate chuckle from her friends. When the season is right, Churches has been known to work from dawn to dusk in her herb garden, stopping only long enough for occasional water breaks. So when she was diagnosed in 2005 with breast cancer, weight wasn’t a concern for her. She was 5 feet 7 inches and 138 pounds. But after a mastectomy, chemotherapy, radiation and hormone therapy, Churches has found it’s more difficult to maintain her weight.
“I work my butt off so that now when I look at a Reese’s Peanut Butter Cup, I have a little calculator in my head: How much will it take to burn this off? Is it worth it?” she says.
It may be more difficult to lose weight, but Daniels and Burke stress that it’s still important to try to control what you can: diet and exercise.
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Weight Loss And Breast Cancer Recurrence: Small Steps Can Make A Big Difference
By Katie Taylor
Breast cancer survival rates are increasing. Medical advances, early detection, and increased awareness mean that more women are surviving breast cancer. As of 2016, the 5-year survival rate for breast cancer patients was 91%. Its wonderful that breast cancer survival rates are increasing, but for those who have lost loved ones, 91% is still much too small of a number. For those who do make it through breast cancer, the focus shifts to limiting the risk of recurrence.
It doesnt seem right that cancer, once beaten, might return. But its estimated that 30% of people diagnosed with early-stage breast cancer will develop metastatic cancer later on. While there is no way to guarantee that cancer will not return in some form, there are strategies for reducing your risk.
Unfortunately, the best ways of reducing risk of cancer recurrence are also the hardest: losing weight and exercising.
In a University of California study, fat loss was found to be one of the best methods for decreasing the chance of facing cancer a second time. Female breast cancer survivors who perform moderate weekly exercise have a significantly reduced rate of recurrence. A consistent exercise routine can help reduce recurrence risk by 20% to 80%. Thats huge. And losing even a small amount of weight can make a difference in recurrence risknot to mention your overall health. But even losing a small amount can be a big challenge.
How Can I Lose Weight After Treatment
Losing weight is not always easy and can take time. But theres a good reason to maintain a healthy weight, besides the way you look. Theres evidence that being overweight could increase the risk of breast cancer coming back, says Lucy Eldridge, dietetic team leader at the Royal Marsden NHS Foundation Trust.
Avoid fad diets that promise rapid weight loss. Often theyre not based on scientific evidence,says Lucy, and youre more likely to keep the weight off if you lose it slowly and steadily.
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Weight Loss Linked To Poorer Survival Outcomes In Her2
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Weight loss after diagnosis of HER2-positive early breast cancer appeared associated with poorer survival outcomes, according to study results published in Journal of the National Comprehensive Cancer Network.
The finding that weight loss, not weight gain, was associated with worse outcomes is unexpected,Samuel Martel, MD, researcher at University of Sherbrooke in Quebec, Canada, said in a press release. We were unable to make a distinction between intentional vs. unintentional weight loss, so it is a matter of speculation whether worse outcomes were due to weight loss or vice versa.
J Natl Comp CancNetw
For the unplanned exploratory analysis of the randomized, phase 3 ALTTO BIG 2-06 trial, Martel and colleagues assessed the impact of BMI at baseline and changes in weight 2 years after HER2-positive early-stage breast cancer diagnosis on DFS, distant DFS and OS.
The analysis included 8,381 patients in the trial who had been randomly assigned to one of four treatments, including trastuzumab alone lapatinib alone trastuzumab for 12 weeks followed by lapatinib for 34 weeks or trastuzumab plus lapatinib .
Researchers grouped patients into four categories according to WHO BMI classification: underweight , normal weight , overweight and obese .
DFS, distant DFS and OS served as the studys endpoints.
Median follow-up was 4.5 years.
For Women 50 And Over Losing Weight Is Not Enough
byLeah Lawrence, Contributing Writer, MedPage Today December 17, 2019
Women age 50 or older who were able to lose weight and keep it off over a 10-year period had a lower risk of breast cancer than women who maintained a stable weight, a new study showed.
In fact, those women who were able to lose the greatest amount of weight were able to lower risk for breast cancer by as much as one-quarter, reported Lauren R. Teras, PhD, of the American Cancer Society in Atlanta, and colleagues.
For the team’s study online in the Journal of the National Cancer Institute, weight change and breast cancer risk were assessed in 180,885 women age 50 or older, in data taken from 10 cohorts in the Pooling Project of Prospective Studies of Diet and Cancer. Weight was determined at three timepoints: baseline, approximately 5 years later, and then about 4 years after that.
The results showed that the larger the amount of weight loss, the lower the risk of breast cancer, the researchers reported.
Compared with women in the study with stable weight, women who lost the following amounts of weight had lower risks of breast cancer:
- 4.4 to 10 lbs: HR 0.87 95% CI 0.77-0.99
- 10 to 20 lbs: HR 0.84 95% CI 0.73-0.96
- 20 or more lbs: HR 0.74 95% CI 0.58-0.94
“This message is particularly important for the two-thirds of the U.S. population who are overweight/obese, and therefore at higher risk for breast cancer,” Teras and colleagues wrote.
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How Does A Mammogram Work
Mammograms can diagnose breast cancer in its early stages before any lump can be felt and detected through self-examination. In this stage, the cancer is easier to treat. Each year, approximately 281,550 women are diagnosed with breast cancer. If you notice any change, it is a good idea to get your breast examined in a mammogram.
A mammogram uses a machine designed only to examine breast tissue. During a mammogram, a machine with two plates compresses the breasts to flatten and spread the tissues. This makes the breast tissue easier to examine and requires lower x-rays doses. X-ray images of each breast are taken, usually from a few different angles. The radiologist will then examine these x-rays for tumors or any abnormal tissues.
Although screenings can come back with abnormal areas in the breast, it can not always be determined if the area is cancerous. This information will help to decide whether more testing is needed. If a screening mammogram shows changes to your breast or if you display breast cancer symptoms, you may need a diagnostic mammogram. Diagnostic mammograms include extra images and views not included in a screening mammogram.
Within mammograms, there are usually three main things radiologists look for:
Weight And Other Adverse Outcomes In Women With Breast Cancer
Second Primary Malignancies
Obesity increases the risk that survivors of breast cancer will develop a second primary malignancy. A recent meta-analysis found that obesity was associated with a 37% increase in the relative risk of contralateral breast cancer, a 97% increase in the RR of endometrial cancer and an 89% increase in the RR of colorectal cancer in breast cancer survivors. These findings are likely to be related to the fact that obesity is a risk factor for developing breast, endometrial, and colorectal primary cancers in the general population.
Chemotherapy-induced peripheral neuropathy has been reported in up to 44% of patients receiving chemotherapy, particularly taxanes, and is more common in obese patients, Higher BMI is associated with a higher incidence of neuropathy, with studies demonstrating a prevalence of 48.4% in participants with normal weight, 60.2% in overweight participants, and 66.7% in obese participants. Neuropathy was significantly more likely to occur in overweight patients compared with normal-weight patients receiving taxane treatment at 24 months, and less likely to occur in patients with high moderate-to-vigorous physical activity levels compared with those with lower activity levels at 24 months. While studies have not shown that weight loss can reverse neuropathy, these data suggest that physical activity may help.
How Your Weight May Affect Your Risk Of Breast Cancer
Managing weight is a challenge for most people in the US. In fact, according to the Centers for Disease Control and Prevention , more than 70% of American adults are overweight.
This puts them at higher risk for serious conditions including diabetes, heart disease, and some types of cancer. For women, being overweight or obese after menopause increases the risk of breast cancer.
Having more fat tissue can increase your chance of getting breast cancer by raising estrogen levels. Also, women who are overweight tend to have higher levels of insulin, another hormone. Higher insulin levels have also been linked to some cancers, including breast cancer.
But the connection between weight and breast cancer risk is complicated. Studies suggest the risk appears to be increased for women who gained weight as an adult but may not be increased among those who have been overweight since childhood. Also, having extra fat in the waist area may raise risk more than having extra fat in the hips and thighs.
And even though gaining weight can raise your cancer risk, its not clear whether losing weight reduces your risk. This turns out to be a tough question for scientists to answer, mainly because very few people actually lose weight during adulthood, and those who do lose weight don’t usually keep it off over a long period of time. So it is difficult to find a large enough group of people to study or to be able to study them over an extended length of time.
Let’s Talk About Carbs
Assuming that youve discussed daily calorie needs with a professional, especially if weight loss is a goal, then the spotlight needs to be on grains. This food group needs special attention because processed carbohydrates have overwhelmed the American diet. Choose whole grains as the primary ingredient and make sure the ingredient list is short. Labels should say 100 percent whole wheat or the unprocessed grain should be the first and primary ingredient. Use portion control and decide how many portions to have daily.
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How Can Losing Weight Change Your Mammogram
Breast density is directly affected by weight loss. If you are losing fatty tissue in your breasts, you will have increased breast density since there is less fatty tissue compared to glandular tissues. Denser breasts are linked to a higher risk of breast cancer.
Women whose mammogram shows extremely dense breasts can get a mammogram call-back after weight loss. Dense breasts make it more difficult to detect cancer since dense breast tissue looks white, and masses or tumors would also appear white in a mammogram image. Fatty tissue shows up dark, almost black, so there is more contrast in a mammogram with less dense breasts.
The lack of contrast with dense breasts makes it difficult to properly determine normal versus abnormal breast growths and may require more testing to detect if cancer is present. It also makes it easier for cancerous growth to hide behind the normal breast tissue. Mammograms are an essential imaging test because breast cancer, behind skin cancers, is the most common cancer in American women.
Weight Loss Versus Cachexia
Weight loss and cancer cachexia are different. Cachexia is a syndrome that is caused by the underlying cancer. Although weight loss is part of cachexia, it is not associated with the increased metabolism that occurs with cachexia. Therefore, weight loss as part of cachexia does not always improve with more calories.
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Reducing Cancer Risk If You Are Overweight Or Obese
Eating well and being more active are the best ways to improve your health if you are overweight or obese. Losing as little as 5% to 10% of your total body weight can reduce your risk of developing cancer. It may seem like a small amount, but research shows that it can improve your health. Even if you find losing weight hard, eating a more balanced diet and exercising regularly helps lower your cancer risk.
Here are some things you can do to help you make healthier choices:
Make small changes in your food choices and exercise routine. If you struggle with being more active and eating less, members of your health care team can help. A registered dietitian, exercise specialist, psychologist, or doctor who specializes in weight loss are professionals who can help you make changes.
Get support. It is important to feel supported when trying to make lifestyle changes. Most weight loss programs include sessions with a dietitian or weight loss specialist. They can help you make healthier changes and stick with them over time. Talk to your family about the changes you want to make and ask them to help. It is much easier to make changes if the people you live with make them, too.
Medication. Some health care providers may recommend taking medication if diet and exercise do not work and your obesity is causing other serious health conditions.
Cancer Symptoms In Men
Blood in urine or semen. A pink, brown, or red tinge to your pee or semen is usually nothing to panic over. Infections, kidney stones, injuries, and noncancerous prostate growth can all cause bleeding.
Less often, bladder or prostate cancer might be to blame. Your doctor can do urine tests and other exams to find the source of the blood.
Lump in the testicle. A painless one is a possible warning sign of testicular cancer. Yet the bump could also be from an injury, fluid buildup, or a hernia. It’s hard to tell the cause from your symptoms alone, so go to your doctor for an exam.
Pain during ejaculation or urination. If it hurts when you pee or have an orgasm, you may have an infection or swelling of your prostate gland or urethra. There’s a chance that these symptoms might be because of prostate cancer. If the pain doesn’t improve, have your doctor take a look.
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