Can Diet And Lifestyle Reduce The Risk Of Recurrence
You may have heard that diet and lifestyle can affect the risk of breast cancer coming back, also known as recurrence.
The World Cancer Research Fund recommends that women who have had breast cancer follow advice to reduce their risk of cancer coming back. This includes eating a healthy diet that is high in fibre and low in saturated fats, being physically active, maintaining a healthy weight and limiting alcohol .
What Is My Prognosis
This is a very common question that isnt always easy to answer. There are many factors involved in working out prognosis. Remember that a prognosis is just a figure at the point at which you receive it. For most people, the prognosis gets better with time.
Sometimes we use a five-year figure because we know that if cancer comes back, most of the time it comes back within five years. If the cancer has not come back within five years, then the chance of it coming back within ten years is quite low, and if it does not come back within ten years, then you have an almost normal life expectancy.
Its a bit like buying a second hand car. You dont really know how long its going to last, but if it lasts year after year without breaking down, then the car starts to look more and more reliable to make that long trip.
Working out prognosis can be difficult.
Who Should A Woman Talk To When Considering Surgery To Reduce Her Risk Of Breast Cancer
The decision to have any surgery to reduce the risk of breast cancer is a major one. A woman who is at high risk of breast cancer may wish to get a second opinion on risk-reducing surgery as well as on alternatives to surgery. For more information on getting a second opinion, see NCI’s Finding Health Care Services page.
A woman who is considering prophylactic mastectomy may also want to talk with a surgeon who specializes in breast reconstruction. Other health care professionals, including a breast health specialist, medical social worker, or cancer clinical psychologist or psychiatrist, can also help a woman consider her options for reducing her risk of breast cancer.
Many factors beyond the risk of disease itself may influence a womanâs decision about whether to undergo risk-reducing surgery. For example, for women who have been diagnosed with cancer in one breast, these factors can include distress about the possibility of having to go through cancer treatment a second time and the worry and inconvenience associated with long-term breast surveillance . For this reason, women who are considering risk-reducing surgery may want to talk with other women who have considered or had the procedure. Support groups can help connect women with others who have had similar cancer experiences. The searchable NCI database National Organizations That Offer Cancer-Related Services has listings for many support groups.
Selected References
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Types Of Recurrent Cancer
There are three types of recurrent breast cancer:
Local recurrence: When cancer returns to the same part of the breast as the initial diagnosis, the disease is classified as a local recurrence.
Regional recurrence: This type is diagnosed when the breast cancer is found in nearby lymph nodes and/or the chest wall.
Distant recurrence: Also called metastatic breast cancer, this occurs when cancer cells travel away from the original tumor in the breast to other parts of the body through the lymphatic system or bloodstream. Common metastatic areas include the bones, liver and lungs. Even when a metastatic breast tumor spreads to a different part of the body, it contains the same cancerous cells that developed in the breast.
How Much How Often
In the study, the researchers say that breast cancer survivors should be encouraged to get at least 150 minutes of moderate-intensity or 75 minutes of vigorous aerobic exercise in addition to at least two strength-training sessions weekly. That’s the same amount of exercise the U.S. Department of Health and Human Services guidelines recommended for all of us.
Always get your doctors clearance before you begin an exercise program, especially if youve had breast surgery. Work with a physical therapist at first to make sure your workout is appropriate for your range of motion, Gilchrist advises.
Walking, says Gilchrist, is a great place to start for most breast cancer patients. The study authors also point out that many hospitals and cancer-care centers now offer exercise programs for breast cancer survivors, so check with your doctor.
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If All The Cancer Was Removed With Surgery Why Do I Need Any Additional Treatment
It has long been recognized that breast cancer is not always cured by locoregional treatment alone.
The goal of treating early breast cancer is to remove the cancer and keep it from coming back . Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at potential risk of recurrence, and that is why in most cases, there is a recommendation for treatment in addition to surgery, which is known as adjuvant therapy. The risk of recurrence can never be entirely eliminated, but the aim of adjuvant therapy is to reduce recurrence risk to the absolute minimum.
Take Your Prescribed Meds
“Being compliant with medications that have been prescribed is critically important to giving a woman the lowest possible risk of recurrence,” Dr. Port says.
Multiple studies, including a 2016 paper in the New England Journal of Medicine, have shown anti-estrogen agents and aromatase inhibitors can block breast cancer from coming back. But because of side effects and other factors, a lot of women stop taking these meds, or don’t take them as prescribed, Dr. Port says.
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How Do I Decrease The Risk Of Breast Cancer Recurrence
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How do I decrease the risk of breast cancer recurrence?
It can be unpleasant to even entertain the notion that your cancer might return. However, its impossible to guarantee that your cancer wont return after youve completed the treatment.
But all hope is not lost, there are some steps you can take little tweaks to your everyday life- that will certainly shift the statistics in your favour:
Get moving:
Youve been in and out of hospitals for a while now and it can be tempting to lay down and take rest, but research shows that getting your blood pumping is the way to go. Research indicates maintaining a healthy weight is vital to reduce your risk of recurrence of breast cancer.
Exercise regularly, aim to squeeze in at least 150 to 300 minutes per week of moderate intensity activity. Even a small amount of physical activity is better than none build-up slowly and find low impact exercises like yoga to get you started.
Eat well:
Emotional wellbeing:
Stress and its effects on your health dont disappear overnight, but we can find ways to limit or cope with stress.
Each womans method of dealing with stress may be different, it is important to find practical ways that work for you. Put your needs first, ask for help when you need it, there is no shame in this. It can also be helpful to connect with people who have survived similar circumstances, find and attend a support group of breast cancer survivors.
Cut out the alcohol:
Take supplements:
Treatments To Reduce Your Risk
Your level of risk is determined by factors such as your age, your family’s medical history, and the results of genetic tests.
If you have an increased risk of developing breast cancer, treatment is available to reduce your risk.
You’ll usually be referred for specialist genetic testing if it’s thought you have an increased risk of breast cancer. Healthcare professionals at these services should discuss treatment options with you.
The 2 main treatments are surgery to remove the breasts or medicine.
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Combined Diet And Pa And Risk Of Breast Cancer Recurrence: Epidemiologic Evidence
Although the focus of this manuscript is on lifestyle intervention effects on breast cancer recurrence, it is important to recognize a hallmark epidemiologic study including combined diet and PA as it influences mortality due to the long-term observations afforded by this study. This includes the WHEL study previously mentioned in the diet portion of this review that will be expanded upon here as it pertains to diet and PA .
The WHEL is a prospective cohort study including 1490 women treated for early-stage breast cancer between 1991 and 2000 who enrolled approximately 2 years post-diagnosis. Interactions between lifestyle factors and mortality were examined. Dietary patterns were assessed at baseline using 2 24-h dietary recalls on random days during a 3-week period using a telephone-based dietary assessment with associated analysis software. PA was assessed at baseline using a 9-item questionnaire on usual PA with queries on frequency, duration, and intensity used to determine metabolic equivalent values.
Despite the observational nature of the WHEL study, it emphasizes the relation between lifestyle factors and disease prognosis in a large cohort of women with early-stage breast cancer. These results have since been used to implement intervention trials as will be discussed in the subsequent section.
Maintain A Healthy Body Weight
Maintaining a healthy weight appears to lower the risk of breast cancer recurrence. If you’ve been frustrated in attempts to lose weight in the past, it may be encouraging to know that some other practices on this list are associated with weight loss, not just exercise, but intermittent fasting, and even upping the fiber in your diet to improve the diversity of the bacteria in your gut.
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What Kinds Of Surgery Can Reduce The Risk Of Breast Cancer
Two kinds of surgery can be performed to reduce the risk of breast cancer in a woman who has never been diagnosed with breast cancer but is known to be at very high risk of the disease.
A woman can be at very high risk of developing breast cancer if she has a strong family history of breast and/or ovarian cancer, a deleterious mutation in the BRCA1 gene or the BRCA2 gene, or a high-penetrancemutation in one of several other genes associated with breast cancer risk, such as TP53 or PTEN.
The most common risk-reducing surgery is bilateral prophylactic mastectomy . Bilateral prophylactic mastectomy may involve complete removal of both breasts, including the nipples , or it may involve removal of as much breast tissue as possible while leaving the nipples intact . Subcutaneous mastectomies preserve the nipple and allow for more natural-looking breasts if a woman chooses to have breast reconstruction surgery afterward. However, total mastectomy provides the greatest breast cancer risk reduction because more breast tissue is removed in this procedure than in a subcutaneous mastectomy .
Even with total mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future can be removed. The chest wall, which is not typically removed during a mastectomy, may contain some breast tissue, and breast tissue can sometimes be found in the armpit, above the collarbone, and as far down as the abdomenâand it is impossible for a surgeon to remove all of this tissue.
Can A Woman Have Risk
Yes. Some women who have been diagnosed with cancer in one breast, particularly those who are known to be at very high risk, may consider having the other breast removed as well, even if there is no sign of cancer in that breast. Prophylactic surgery to remove a contralateral breast during breast cancer surgery reduces the risk of breast cancer in that breast , although it is not yet known whether this risk reduction translates into longer survival for the patient .
However, doctors often discourage contralateral prophylactic mastectomy for women with cancer in one breast who do not meet the criteria of being at very high risk of developing a contralateral breast cancer. For such women, the risk of developing another breast cancer, either in the same or the contralateral breast, is very small , especially if they receive adjuvant chemotherapy or hormone therapy as part of their cancer treatment .
Given that most women with breast cancer have a low risk of developing the disease in their contralateral breast, women who are not known to be at very high risk but who remain concerned about cancer development in their other breast may want to consider options other than surgery to further reduce their risk of a contralateral breast cancer.
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Can I Lower My Risk Of Breast Cancer Progressing Or Coming Back
If you have breast cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as getting or staying active, eating a certain type of diet, or taking nutritional supplements. Fortunately, breast cancer is one of the best studied types of cancer in this regard, and research has shown there are some things you can do that might be helpful.
Staying as healthy as possible is more important than ever after breast cancer treatment. Controlling your weight, being physically active, and eating well may help you lower your risk of breast cancer coming back, as well as help protect you from other health problems.
Have Your Vitamin D Level Checked
While there has been some controversy over vitamin D levels and breast cancer, some studies have found that people assigned female at birth who have low 25-hydroxyvitamin D levels have a higher recurrence risk. The benefits of vitamin D, however, go beyond reducing recurrence, and getting adequate vitamin D may improve your quality of life while living with breast cancer.
Many people ask about whether or not they should use a supplement, but fortunately, a simple blood test can determine your levels, and whether they are deficient, low normal, or adequate.
Even if the laboratory range for vitamin D at your cancer center is wide , some researchers believe a level of 50 or greater is optimal in those who have had cancer.
Getting vitamin D via dietary sources is challenging, at least to get the optimal 2000 IU/day recommended by some .
Sunshine is also a source of vitamin D, though excess sun exposure is important to avoid for other reasons. .
If a healthcare provider recommends a supplement, it’s important to purchase a good product to reduce your mercury exposure. And, too much of a good thing is not better. One potential side effect of taking excess vitamin D is painful kidney stones.
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Why Werent These Escaping Cells Identified The First Time The Cancer Was Treated
Although scans of the body can detect if there is obvious spread to these other organs, for women with early stage breast cancer there rarely is anything that shows up on a scan. There is a limit to what scans can tell us: they wont show extremely tiny spots of cancer, and they definitely cant show us if there are individual cells circulating in the body. Neither will any blood test, or any other test for that matter. So the first time around we perform our surgery and give our treatmentschemotherapy, hormonal therapy, radiationwith the hope that if microscopic spread has already taken place, the treatments will scavenge those cells and kill them before they take up residence someplace in the body.
Unfortunately, these treatments dont work 100 percent of the time. So if cells have spread, and if the treatments we give dont affect them, the cancer cells can persist and take hold someplace, developing into metastases, or spread. This is why and how recurrence happens.
What Are The Cancer Risk Reduction Options For Women Who Are At Increased Risk Of Breast Cancer But Not At The Highest Risk
Risk-reducing surgery is not considered an appropriate cancer prevention option for women who are not at the highest risk of breast cancer . However, some women who are not at very high risk of breast cancer but are, nonetheless, considered as being at increased risk of the disease may choose to use drugs to reduce their risk.
Health care providers use several types of tools, called risk assessment models, to estimate the risk of breast cancer for women who do not have a deleterious mutation in BRCA1, BRCA2, or another gene associated with breast cancer risk. One widely used tool is the Breast Cancer Risk Assessment Tool , a computer model that takes a number of factors into account in estimating the risks of breast cancer over the next 5 years and up to age 90 years . Women who have an estimated 5-year risk of 1.67 percent or higher are classified as “high-risk,” which means that they have a higher than average risk of developing breast cancer. This high-risk cutoff is widely used in research studies and in clinical counseling.
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Breast Cancer Recurrence Risk Lingers Years After Treatment Ends
Steady rates of recurrence in women with estrogen receptor-positive disease could influence decisions about long-term therapy.
Even 20 years after a diagnosis, women with a type of breast cancer fueled by estrogen still face a substantial risk of cancer returning or spreading, according to a new analysis from an international team of investigators published in the New England Journal of Medicine.
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Standard treatment for estrogen receptor-positive, or ER-positive, breast cancer includes five years of the endocrine-based treatments tamoxifen or aromatase inhibitors, both of which are taken daily as a pill.
Researchers from the Early Breast Cancer Trialists Collaborative Group analyzed data from 88 clinical trials involving 62,923 women with ER-positive breast cancer. The patients all received endocrine therapy for five years and were free of cancer when they stopped therapy.
Over the next 15 years, however, a steady number of these women saw their cancer spread throughout the body, as late as 20 years after the initial diagnosis.
Even though these women remained free of recurrence in the first five years, the risk of having their cancer recur elsewhere from years five to 20 remained constant, says senior study author Daniel F. Hayes, M.D., Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center.