Poor adolescent diet associated with premenopausal breast cancer

“During adolescence and early adulthood, when the mammary gland is rapidly developing and is therefore particularly susceptible to lifestyle factors, it is important to consume a diet rich in vegetables, fruit, whole grains, nuts, seeds, and legumes and to avoid soda consumption and a high intake of sugar, refined carbohydrates, and red and processed meats.”

– lead author Karin B. Michels, ScD, PhD, professor and chair of the Department of Epidemiology at the UCLA Fielding School of Public Health, Los Angeles

Key points: Women who consumed a diet associated with chronic inflammation  as adolescents or young adults appear to have a higher risk of developing premenopausal breast cancer, as compared with those who had a diet not linked to inflammation.

Background: Researchers used data from 45,204 women in the Nurses’ Health Study II who had completed a food frequency questionnaire in 1998, when they were ages 33 to 52, about their diet during high School. The investigators then assed adult diet by first using a food frequency questionnaire in 1991, when participants were ages 27 to 44, and then every 4 years thereafter. They gave each woman’s diet an inflammatory score using a previously method that links diet with inflammatory markers in the blood.

During 22 years of follow-up, 870 of the women who completed the high school food frequency questionnaire were diagnosed with premenopausal breast cancer and 490 were diagnosed with postmenopausal breast cancer. When women were divided into five groups based on the inflammatory score of their adolescent diet, those in the highest score group had a 35 percent higher risk for premenopausal breast cancer relative to those in the lowest score group. When the same analysis was done based on early adulthood diet, those in the highest inflammatory score group had a 41 percent higher risk for premenopausal breast cancer relative to those in the lowest score group.

I’m Michael Hunter, the Breast Cancer Doctor.

Should doctors prescribe exercise?

“Although the data vary by different cancer types, there is a consistent trend suggesting that moderate daily exercise has a beneficial effect on preventing certain cancers. If you are a reasonably healthy adult, your should exercise regularly.” 

Let’s look at the relationship of exercise and selected cancers. The American Society of Clinical Oncology (ASCO) has done a nice job of summarizing:

Breast Cancer

While the amount of risk reduction varies among studies (20-80%), most suggest that 30 to 60 minutes of moderate to high-intensity exercise per day lowers breast cancer risk. Women who are physically active throughout their life appear to benefit the most, but those who increase physical activity after menopause also fare better than inactive women.1

Colon Cancer

Research suggests that people who increase their physical activity can lower the chance of developing colon cancer by 30 to 40% relative to sedentary adults.1,2 A decrease in colon cancer risk can be achieved regardless of body mass index (BMI) and people who are most active benefit the most. There is insufficient evidence of a protective effect of physical activity on the risk of rectal cancer (a protective effect was seen in some case-control studies, but not in cohort studies).3

Endometrial, Lung and Ovarian Cancer

A handful of studies have suggested that women who are physically active have a 20-40% reduced risk of endometrial cancer compared to those who don’t exercise.1 Higher levels of physical activity seem to also protect against lung cancer (up to 20% reduction in risk), particularly among men.1Although less consistent, research suggests that physical activity possibly reduces the risk of ovarian and prostate cancer.

What about Other Cancers?

While observational data on the benefits of exercise for prevention of the types of cancers listed above are fairly consistent, evidence of the effects of exercise on prevention of any other type of cancer either is either insufficient or inconsistent.2,4

Prostate Cancer

Prostate cancer is one disease in which the data are not consistent, however prostate cancer is a heterogeneous disease and risk factor associations for total non-aggressive disease are different from aggressive / lethal disease. Most population based studies show similar findings, with little effect of exercise on overall incidence of prostate cancer but lower risk of aggressive prostate cancers for those with the highest levels of VIGOROUS activity (rather than any type of activity). In the Health Professionals Follow-up Study men 65 years or older who engaged in vigorous physical activity, such as running, jogging, biking, swimming or tennis at least three hours per week  had a 67% lower risk of advanced prostate cancer and 74% lower risk of fatal prostate cancer.5

Conflicting data for other malignancies

For example, one recent study found no association between physical activity and risk of developing gastric, rectal, pancreatic, bladder, testicular, kidney and hematological cancers.4 In contrast, a pooled analysis of data from prospective trials with 1.4 million participants found that physical activity was linked to lower risk of 13 cancers: esophageal, lung, kidney, gastric, endometrial, myeloid leukemia, myeloma, colon, head and neck, rectal, bladder, and breast.6Interestingly, leisure-time physical activity was associated with a higher risk of melanoma (presumably due to time spent outdoors) and prostate cancer, although it is not clear from these data whether that association was with nonaggressive or aggressive prostate cancer.

While we wait for confirmation and clarity on the role of exercise in preventing all the 200+ types of cancer – should doctors prescribe exercise? The answer is simple: yes, because evidence of the protective role of exercise is already strong for some of the most common cancers.

References

  1. Lee I, Oguma Y. Physical activity. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
  2. Slattery, ML. Physical activity and colorectal cancer. Sports Medicine 2004; 34(4): 239–252.
  3. Pham NM, et al. Physical activity and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol. 2012 Jan;42(1):2-13.
  4. Friedenreich CM, Neilson HK, Lynch BM. Eur J Cancer. State of the epidemiological evidence on physical activity and cancer prevention. 2010 Sep;46(14):2593-604.
  5. Giovannucci E, Liu Y, Leitzmann MF, et al. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165(9):1005-1010.
  6. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25.
  7. http://www.asco.org/about-asco/press-center/asco-resources-media/cancer-perspectives/should-cancer-doctors-prescribe?et_cid=38723632&et_rid=463715101&linkid=Read+more

I’m Dr. Michael Hunter. Of course, the disclaimer: Do not begin an exercise program without input from an appropriate medical professional. Many can simply start with a brisk walk for 30 minutes daily, 5 days per week. Have a wonderful day!

Should doctors prescribe exercise?

young woman running city park

“Although the data vary by different cancer types, there is a consistent trend suggesting that moderate daily exercise has a beneficial effect on preventing certain cancers. If you are a reasonably healthy adult, your should exercise regularly.” 

Let’s look at the relationship of exercise and selected cancers. The American Society of Clinical Oncology (ASCO) has done a nice job of summarizing:

Breast Cancer

While the amount of risk reduction varies among studies (20-80%), most suggest that 30 to 60 minutes of moderate to high-intensity exercise per day lowers breast cancer risk. Women who are physically active throughout their life appear to benefit the most, but those who increase physical activity after menopause also fare better than inactive women.1

Colon Cancer

Research suggests that people who increase their physical activity can lower the chance of developing colon cancer by 30 to 40% relative to sedentary adults.1,2 A decrease in colon cancer risk can be achieved regardless of body mass index (BMI) and people who are most active benefit the most. There is insufficient evidence of a protective effect of physical activity on the risk of rectal cancer (a protective effect was seen in some case-control studies, but not in cohort studies).3

Endometrial, Lung and Ovarian Cancer

A handful of studies have suggested that women who are physically active have a 20-40% reduced risk of endometrial cancer compared to those who don’t exercise.1 Higher levels of physical activity seem to also protect against lung cancer (up to 20% reduction in risk), particularly among men.1Although less consistent, research suggests that physical activity possibly reduces the risk of ovarian and prostate cancer.

What about Other Cancers?

While observational data on the benefits of exercise for prevention of the types of cancers listed above are fairly consistent, evidence of the effects of exercise on prevention of any other type of cancer either is either insufficient or inconsistent.2,4

Prostate Cancer

Prostate cancer is one disease in which the data are not consistent, however prostate cancer is a heterogeneous disease and risk factor associations for total non-aggressive disease are different from aggressive / lethal disease. Most population based studies show similar findings, with little effect of exercise on overall incidence of prostate cancer but lower risk of aggressive prostate cancers for those with the highest levels of VIGOROUS activity (rather than any type of activity). In the Health Professionals Follow-up Study men 65 years or older who engaged in vigorous physical activity, such as running, jogging, biking, swimming or tennis at least three hours per week  had a 67% lower risk of advanced prostate cancer and 74% lower risk of fatal prostate cancer.5

Conflicting data for other malignancies

For example, one recent study found no association between physical activity and risk of developing gastric, rectal, pancreatic, bladder, testicular, kidney and hematological cancers.4 In contrast, a pooled analysis of data from prospective trials with 1.4 million participants found that physical activity was linked to lower risk of 13 cancers: esophageal, lung, kidney, gastric, endometrial, myeloid leukemia, myeloma, colon, head and neck, rectal, bladder, and breast.6Interestingly, leisure-time physical activity was associated with a higher risk of melanoma (presumably due to time spent outdoors) and prostate cancer, although it is not clear from these data whether that association was with nonaggressive or aggressive prostate cancer.

While we wait for confirmation and clarity on the role of exercise in preventing all the 200+ types of cancer – should doctors prescribe exercise? The answer is simple: yes, because evidence of the protective role of exercise is already strong for some of the most common cancers.

References

  1. Lee I, Oguma Y. Physical activity. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
  2. Slattery, ML. Physical activity and colorectal cancer. Sports Medicine 2004; 34(4): 239–252.
  3. Pham NM, et al. Physical activity and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol. 2012 Jan;42(1):2-13.
  4. Friedenreich CM, Neilson HK, Lynch BM. Eur J Cancer. State of the epidemiological evidence on physical activity and cancer prevention. 2010 Sep;46(14):2593-604.
  5. Giovannucci E, Liu Y, Leitzmann MF, et al. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165(9):1005-1010.
  6. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25.
  7. http://www.asco.org/about-asco/press-center/asco-resources-media/cancer-perspectives/should-cancer-doctors-prescribe?et_cid=38723632&et_rid=463715101&linkid=Read+more

 

I’m Dr. Michael Hunter. Of course, the disclaimer: Do not begin an exercise program without input from an appropriate medical professional. Many can simply start with a brisk walk for 30 minutes daily, 5 days per week. Have a wonderful day!

Omega-3 Fatty Acids for the Control of Breast Cancer Medicine–Induced Musculoskeletal Pain

Purpose Musculoskeletal symptoms are the most common adverse effects of aromatase inhibitors (AIs) and can result in decreased quality of life and discontinuation of therapy. Omega-3 fatty acids (O3-FAs) can be effective in decreasing arthralgia resulting from rheumatologic conditions and reducing serum triglycerides.

Patients and Methods Women with early-stage breast cancer receiving an AI who had a worst joint pain/stiffness score ≥ 5 of 10 using the Brief Pain Inventory–Short Form (BPI-SF) were randomly assigned to receive either O3-FAs 3.3 g or placebo (soybean/corn oil) daily for 24 weeks. Clinically significant change was defined as ≥ 2-point drop from baseline. Patients also completed quality-of-life (Functional Assessment of Cancer Therapy–Endocrine Symptoms) and additional pain/stiffness assessments at baseline and weeks 6, 12, and 24. Serial fasting blood was collected for lipid analysis.

Results Compared with baseline, the mean observed BPI-SF score decreased by 1.74 points at 12 weeks and 2.22 points at 24 weeks with O3-FAs and by 1.49 and 1.81 points, respectively, with placebo. Adjusting for the baseline score, osteoarthritis, and taxane use, 12-week BPI-SF scores did not differ by arm (P = .58). Triglyceride levels decreased in patients receiving O3-FA treatment and remained the same for those receiving placebo (P = .01). No between-group differences were seen for HDL, LDL, or C-reactive protein.

Conclusion There was a substantial (> 50%) and sustained improvement in AI arthralgia for both O3-FAs and placebo but no meaningful difference between the groups.

My Take: A strong illustration of the power of a placebo. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Reference: Published online before print May 4, 2015, doi: 10.1200/JCO.2014.59.5595 JCO May 4, 2015 JCO.2014.59.5595                                   

 

Can a New Blood Test Predict Future Breast Cancer?

blood vessel artery vein

What You Need to Know: By analyzing a simple blood sample, scientists have succeeded in predicting if a woman will get breast cancer within two to five years. The method — a metabolic blood profile — is still in the early stages but over time the scientists expect it could be used to predict breast cancer and more generally to predict chronic disease.

“The method is better than mammography, which can only be used when the disease has already occurred. It is not perfect, but it is truly amazing that we can predict breast cancer years into the future,” said Rasmus Bro, a professor of chemometrics in the Department of Food Science at University of Copenhagen. He stressed the method has been tested and validated only for a single population (cohort) and needs to be validated more widely before it can be used practically.

Food science showed the way

The researchers’ approach to developing the method was adopted from food science, where it is used for control of complex industrial processes. Basically, it involves handling and analysing huge amounts of biological data in a holistic and explorative way. The researchers analysed all compounds a blood sample contains instead of — as is often done in health and medical science — examining what a single biomarker means in relation to a specific disease. The model does not reveal anything about the importance of the single biomarkers in relation to breast cancer, but it does reveal the importance of a set of biomarkers and their interactions.

“No single part of the pattern is actually necessary nor sufficient. It is the whole pattern that predicts the cancer,” said Professor Dragsted.

A metabolic blood profile describes the amounts of all compounds (metabolites) in our blood. The scientists measured metabolic blood profiles for this project. When you are in a pre-cancer state, the pattern for how certain metabolites are processed apparently changes.

While a mammography can detect newly developed breast cancer with a sensitivity of 75 per cent, the new metabolic blood profile is able to predict the likelihood of a woman developing breast cancer within the next two to five years with a sensitivity of 80 per cent.

Based on population study

The research is based on a population study of 57,000 people followed by the Danish Cancer Society over 20 years. The participants were first examined in 1994-96, during which time their weight and other measurements were recorded and they answered a questionnaire. They also provided a blood sample that was stored in liquid nitrogen.

The scientists used the 20-year-old blood samples and other available data from 400 women who were healthy when they were first examined but who were diagnosed with breast cancer two to seven years after providing the first sample, and from 400 women who did not develop breast cancer.

The method was also used to test a different dataset of women examined in 1997. Predictions based on the new set of data matched the first dataset, which indicates the validity of the model.

I’m Dr. Michael Hunter, and that is your glimpse into the future.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

References:

  • Faculty of Science – University of Copenhagen. “New blood test can predict future breast cancer.” ScienceDaily. ScienceDaily, 15 April 2015. <www.sciencedaily.com/releases/2015/04/150415103154.htm>.
  • Rasmus Bro, Maja H. Kamstrup-Nielsen, Søren Balling Engelsen, Francesco Savorani, Morten A. Rasmussen, Louise Hansen, Anja Olsen, Anne Tjønneland, Lars Ove Dragsted. Forecasting individual breast cancer risk using plasma metabolomics and biocontours. Metabolomics, 2015; DOI: 10.1007/s11306-015-0793-8

Prostate Cancer Family History Linked to Breast Cancer Risk

What You Need to Know: Family history is a significant risk factor for breast cancer, especially in women who have first-degree relatives with the disease. That risk might be even higher if there is a first-degree relative with prostate cancer, a new study suggests.

  • In women with a family history of prostate cancer, there was a 14% increase in the relative risk of developing breast cancer. However, in women with a family history of both breast and prostate cancer, the relative risk increased to 78%.
  • In addition, the risks associated with a family history of both breast and prostate cancer was higher in black women than in white women.

“While this study is limited to largely postmenopausal women, one might expect to see a similar or stronger risk in younger women,” said first author Jennifer Beebe-Dimmer, MPH, PhD, from the Karmanos Cancer Institute and Wayne State University School of Medicine in Detroit. “We tend to see a stronger family history of breast cancer among women diagnosed at younger ages, and the same may be true for a family history of prostate cancer,” Dr Beebe-Dimmer told Medscape Medical News. We believe that physicians may want to consider family history of prostate cancer in addition to breast cancer before making recommendations about screening,” she added.

Dr Beebe-Dimmer pointed out that there is some evidence that men might have a higher risk for prostate cancer if they have first-degree relatives with breast cancer.

“We and others have shown the opposite association, particularly when female relatives are diagnosed with early-onset disease,” she said. “It has been suggested that a relatively small proportion of the prostate cancer cases diagnosed in families with breast and/or ovarian cancer are related to BRCA1/2, suggesting that there may be other genes and/or shared environmental exposures that explain the clustering.”

Multiple Relatives Increases Risk

  • The study included  78,171 women who participated in the Women’s Health Initiative Observational Study from 1993 to 1998. The women were followed for a median of 132 months from the date of enrollment, and there was a median of 60 months between enrollment and the diagnosis of breast cancer. There were 3506 cases of incident breast cancer diagnosed in the cohort up to August 31, 2009.
  • Participants with breast cancer were more likely than those without to be white non-Hispanic and college educated, and to have a history of hormone use and benign breast disease. They were also more likely to have undergone mammography screening within 2 years of the baseline examination.
  • Median age at the time of breast cancer diagnosis was 69 years (range, 50 – 90 years).
  • A positive family history of breast cancer was reported by 11,608 women in the cohort, and women with breast cancer were more likely than those without to report a family history of the disease (20.5% vs 14.6%).
  • Having a single family member with breast cancer was associated with an increase in risk of approximately 40%, after adjustment for cofounders (hazard ratio [HR], 1.42; 95% CI, 1.30 – 1.55). Having multiple family members with breast cancer increased that risk (adjusted HR [aHR], 1.66; 95% confidence interval [CI], 1.32 – 1.88).
  • Women with breast cancer were also more likely than those without to report that at least one first-degree relative had been diagnosed with prostate cancer (11.6% vs 10.1%). This family history was associated with a significant, albeit modest, increase in breast cancer risk after adjustment for confounders such as a family history of breast cancer (aHR, 1.14; 95% CI, 1.02 – 1.26).
  • The risk was highest for those with a family history of both breast and prostate cancer (aHR, 1.78; 95% CI, 1.45 – 2.19).
  • When the data were stratified by race, the risk was highest in black women who had “multiple affected first-degree family members” (aHR, 2.85; 95% CI, 1.33 – 2.08). A family history of prostate cancer was modestly predictive in both white and black women, but only reached statistical significance in white women. Although black women with a family history of both diseases appeared to be at greater risk of developing breast cancer (aHR, 2.34; 95% CI, 1.09 – 5.02), “the risk estimates were not significantly different as evidenced by the overlapping CIs,” note Dr Beebe-Dimmer and colleagues.

Reference: Cancer. Published online March 9, 2015. Abstract    

Triple-negative breast cancer: Even Low-androgen Tumors Respond to Anti-androgen Therapy

What You Need to Know: Only about 1 percent of triple-negative breast cancer cells in a tumor must be “androgen-receptor-positive” to show benefit from anti-androgen therapies. There are no FDA-approved targeted therapies for triple-negative breast cancer. Clinical trials currently underway are showing promising preliminary results of anti-androgen-receptor therapies against triple-negative breast cancers expressing a higher percentage of androgen-receptor-positive cells.

Background: Triple-negative breast cancers are those without known hormone or genetic drivers — specifically, breast cancers that do not drive their growth with the hormones estrogen or progesterone, or with the gene HER2. Without a known driver, there has been no “target” in triple-negative breast cancer to treat with targeted therapies, and the triple-negative subtype has the worst five-year survival rate of any breast cancer.

“What we’re showing is that the threshold for benefit from anti-androgen-receptor therapies in triple-negative breast cancer may be far lower than we previously thought. This is an extremely optimistic finding for many people who have been without options for targeted cancer therapy,” says Valerie Barton, the study’s first author and PhD candidate in the lab of CU Cancer Center investigator Jennifer Richer, PhD. “We’re getting closer to being able to call some triple-negative breast cancers, androgen-receptor-positive breast cancers. And we may have to start referring to the remaining triple-negative breast cancers that are completely without androgen receptors as quadruple-negative breast cancers,” Barton says.

The current study treated triple-negative breast cancer cells with the anti-androgen-receptor drug Enzalutamide, currently FDA approved for use as an anti-androgen against prostate cancer. It has been previously shown that Enzalutamide is active against “luminal” triple-negative breast cancer cells that tend to have abundant androgen receptors. The researchers tested Enzalutamide against non-luminal triple-negative breast cancer cell lines that have far fewer androgen receptors.

“Even in these cells and in mouse models of tumors with low percentage of androgen receptor positive breast cancer cells, we observed that Enzalutamide was significantly effective at reducing proliferation, growth, migration and invasion of cancer cells,” Barton says.

My Take: These results suggest that anti-androgen receptor therapy may benefit a larger percentage of triple negative breast cancers than previously thought. We look forward to results from human clinical trials. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

 

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Journal References:

  1.  Valerie N. Barton, Nicholas C. D’amato, Michael A. Gordon, Hanne T. Lind, Nicole S. Spoelstra, Beatrice L. Babbs, Richard E. Heinz, Anthony Elias, Paul Jedlicka, Britta M. Jacobsen, and Jennifer K. Richer. Multiple Molecular Subtypes of Triple-Negative Breast Cancer Critically Rely on Androgen Receptor and Respond to Enzalutamide In Vivo. Molecular Cancer Therapeutics, February 2015 DOI: 10.1158/1535-7163.MCT-14-0926
  2. University of Colorado Cancer Center. “In triple-negative breast cancer, even low-androgen tumors respond to anti-androgen therapy.” ScienceDaily. ScienceDaily, 24 February 2015. <www.sciencedaily.com/releases/2015/02/150224131201.htm>.