A Woman’s Diet Might Help Her Avoid Breast Cancer

Amy Norton wrote . . . . . . . . .

Women whose diets tend to feed inflammation may have a heightened risk of breast cancer, a preliminary study suggests.

The study, of more than 350,000 women, found that the more “pro-inflammatory” foods women consumed, the higher their breast cancer risk.

The term refers to foods thought to contribute to chronic low-grade inflammation throughout the body — a state implicated in various disease processes.

The findings do not prove cause and effect, the researchers said. But they do add to evidence that diet can affect the likelihood of developing breast cancer.

Unsurprisingly, a pro-inflammatory diet is full of the usual suspects.

It’s high in red and processed meats, sugar and saturated fats, said Carlota Castro-Espin, the lead researcher on the study.

That type of diet, she said, might contribute to breast cancer because it promotes inflammation, and also because it’s lacking in foods that fight inflammation.

Those foods are no surprise, either. They include vegetables, fruits, beans, fiber-rich grains and “good” unsaturated fats.

So the findings square with the general advice on healthy eating, according to Castro-Espin, a PhD student at the Catalan Institute of Oncology, in Barcelona, Spain.

She is scheduled to present the results this week at the annual meeting of the American Society for Nutrition. Studies released at meetings are usually considered preliminary until published in a peer-reviewed journal.

Diet habits have been linked to the risk of numerous cancers, breast cancer among them.

Marjorie McCullough is senior scientific director of epidemiology research at the American Cancer Society. She said, “There is some evidence that dietary patterns rich in plant foods and lower in animal products and refined carbohydrates are associated with a lower risk of postmenopausal breast cancer.”

McCullough added that one clinical trial — the type of study considered to give the strongest evidence — found benefits with the traditional Mediterranean diet. Women assigned to the diet (and supplied with olive oil) had a lower risk of developing breast cancer than those who were told to cut fat from their diets.

The Mediterranean diet bears many of the features of an anti-inflammatory one — being rich in fish, vegetables, whole grains and good fats, and low in red meat and processed foods.

The cancer society does not endorse any specific diet for curbing cancer risk. Instead, it advises following a “healthy eating pattern” that includes plenty of plant foods and limits on sugar, refined grains and red meat.

McCullough, who was not involved in the new study, said it reinforces that advice.

Diet, of course, affects body weight, and obesity is believed to boost the risk of various cancers. But, McCullough said, studies suggest that eating habits affect cancer risk above and beyond their impact on weight.

Inflammation may be one avenue, Castro-Espin said.

For the study, she and her colleagues used data from a long-running research project on diet and cancer risk among European adults. They focused on more than 318,000 women who were free of breast cancer at the outset.

The researchers assigned each woman a score rating the “inflammatory potential” of her diet, based on the nutrients and other compounds in the foods she reported eating.

Over about 15 years, more than 13,200 women were diagnosed with breast cancer. That risk was 12% higher among the one-fifth of women with the most inflammatory diets, versus the one-fifth eating the fewest pro-inflammatory foods.

The link was stronger among women who developed the cancer before menopause, rather than after, Castro-Espin said.

Other factors were taken into account, she noted, including body weight, drinking habits and exercise. And the connection between inflammatory diets and breast cancer risk still held.

Castro-Espin agreed that it all supports the existing diet advice.

Along with its guidance on food choices, McCullough said, the cancer society advises limiting alcohol. Drinking is linked to several cancers, including breast tumors.

The group also encourages people to maintain a healthy weight and get regular exercise — at least 150 to 300 minutes of moderate activity, like brisk walking, each week.

Source: HealthDay

Freezing Tumors Could Be New Treatment for Low-Risk Breast Cancers

Alan Mozes wrote . . . . . . . . .

A first-of-its-kind study suggests that slow-growing breast cancers can be treated with a highly targeted tumor-freezing technique, eliminating the need for invasive surgery.

Testing to date suggests that the technique is effective among women over 60 diagnosed with relatively low-risk breast cancer.

“Cryoablation is a minimally invasive solution that destroys breast tumors safely, quickly and painlessly, without the need for surgery,” said study author Dr. Richard Fine, a breast surgeon with West Cancer Center & Research Institute in Germantown, Tenn.

“The procedure exposes diseased tissue to extreme cold [cryo] to destroy [ablate] it,” he added. “It is performed in the office while the patient is awake.”

The new study — which involved nearly 200 women — found that when cryoablation was performed on women with low-grade/low-risk breast cancer nearly all the patients remained cancer-free three years out.

“The therapy is already well established for the treatment of bone, kidney, prostate and other cancers,” Fine noted.

Average age of patients in the study was 75, and all were diagnosed with “invasive ductal carcinoma” breast cancer. Tumors were relatively small, measuring no more than 1.5 centimeters in size. All the patients had “hormone receptor-positive” tumors, meaning tumors that were ER+, PR+ and/or HER2-.

“In general, tumors that are ER+ and/or PR+ are slightly slower growing, and have a slightly better prognosis than tumors that are hormone receptor-negative,” Fine said.

All the patients in the study underwent cryoablation, which involved direct insertion of a probe through the skin and into the tumor site, under localized anesthesia. In turn, liquid nitrogen was applied to freeze the targeted tumors from the inside out. Treatment lasted between 20 and 40 minutes, ultimately turning tumors into balls of ice.

The procedure removed the need for follow-up surgery, the researchers reported, although nearly 15% of the women also underwent radiation, while about 3/4 were further treated with endocrine therapy. One patient underwent chemotherapy.

Patients were checked twice yearly, as far out as five years following treatment. The result: By an average follow-up point of nearly three years post-treatment just 2% (four patients) had seen their cancer return. No serious side effects were reported, and nearly all the patients and attending physicians reported being satisfied with the treatment (95% and 98%, respectively).

“For both benign and cancerous tumors, benefits over traditional surgery include office-based procedures, [that were] faster, [entailed] almost immediate recovery, improved cosmetic results, greater patient comfort, less procedural risk and lower cost,” Fine said.

Unlike a conventional lumpectomy or mastectomy, he added, cryoablation preserves breast volume and minimizes infection risk. And the process usually produces “excellent cosmetic results with no scarring,” while allowing patients to quickly resume normal activity.

Fine noted that the European Union approved cryoablation for breast cancer in 2010, with the procedure similarly approved for use in Australia, South Africa, Thailand, Singapore and Hong Kong.

In the United States, “the treatment is in experimental use”, explained Dr. Shawna Willey, chair of breast cancer research with the Inova Schar Cancer Institute at the Inova Fairfax Hospital in Fairfax, Va.

“If it continues with similar success, data will be submitted to the FDA [U.S. Food and Drug Administration] to obtain the first-ever approval for use of a specific cryoablation device in breast cancer treatment for the tumor and patient parameters studied,” Willey added.

Though not part of the study team, she noted that Fine’s trial “is the largest of its kind, and may lead the way to cryoablation being far more widely available as a treatment option for older women with low-risk breast cancers, while it continues to be studied in broader patient populations.”

Still, Willey cautioned that cryoablation has only been tested among carefully selected breast cancer patient groups. So its effectiveness, she stressed, “is not backed by extensive data with long-term follow-up, or by data on a broad range of tumor types across women of all age groups.”

Fine and his colleagues presented their findings this week at a virtual meeting of the American Society of Breast Surgeons. Such research is considered preliminary until published in a peer-reviewed journal.

Source: HealthDay

Close Monitoring for Heart Risk Needed if Breast, Prostate Cancer Treatment Includes Hormones

The hormonal therapies used to treat many breast and prostate cancers raise the risk of a heart attack and stroke, and patients should be monitored regularly and receive treatment to reduce risk and detect problems as they occur, according to a new American Heart Association scientific statement, published today in the Association’s journal Circulation: Genomic and Precision Medicine.

“The statement provides data on the risks of each type of hormonal therapy so clinicians can use it as a guide to help manage cardiovascular risks during cancer treatment,” said Tochi M. Okwuosa, D.O., FAHA, chair of the scientific statement writing group, an associate professor of medicine and cardiology and director of Cardio-Oncology Services at Rush University Medical Center in Chicago.

Hormone-dependent cancers, such as prostate and breast cancer, are the most common cancers in the United States and worldwide not including skin cancers. As improvements in treatment – including increased use of hormonal therapies – allow people with these cancers to live longer, cardiovascular disease has emerged as a leading cause of illness and death in these patients.

Hormonal treatments for breast cancer include selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). SERMs block estrogen receptors in cancer cells so the hormone can’t spur tumor growth, while letting estrogen act normally in other tissues such as bone and liver tissue; examples of SERMs include tamoxifen and raloxifene. Aromatase inhibitors lower the amount of estrogen produced in post-menopausal women and include exemestane, anastrozole and letrozole. Endocrine treatments for prostate cancer, called androgen deprivation therapy, include some medications that decrease production of testosterone by their action on the brain and others that block testosterone receptors found in prostate cells and some prostate cancer cells.

The writing group reviewed existing evidence from observational studies and randomized controlled trials and found that:

  • Tamoxifen increases the risk of blood clots, while aromatase inhibitors increase the risk of heart attack and stroke more than tamoxifen. For breast cancer patients who require more than one type of hormonal therapy because of developed resistance to the initial medication, , there is an improvement in cancer outcomes. However, treatment with multiple hormones is associated with higher rates of cardiovascular conditions such as high blood pressure, abnormal heart rhythms and blood clots.
  • Androgen deprivation therapy (to reduce testosterone) for prostate cancer increases cholesterol and triglyceride levels, adds body fat while decreasing muscle and impairs the body’s ability to process glucose (which may result in type 2 diabetes). These metabolic changes are associated with a greater risk of heart attacks, strokes, heart failure and cardiovascular death.
  • The longer people receive hormonal therapy, the greater the increased risk of cardiovascular problems. Further research is required to better define the risks associated with duration of treatment.
  • The hormonal therapy-associated increase in CVD risk was highest in people who already had heart disease or those who had two or more cardiovascular risk factors – such as high blood pressure, obesity, high cholesterol, smoking or a family history of heart disease or stroke – when they began treatment.

“A team-based approach to patient care that includes the oncology team, cardiologist, primary care clinician, dietician, endocrinologist and other health care professionals as appropriate is needed to work with each patient to manage and reduce the increased risk of heart disease and strokes associated with hormonal therapy in breast and prostate cancer treatment,” Okwuosa said.

There are currently no definitive guidelines for monitoring and managing hormonal therapy-related heart risks. The statement calls for clinicians to be alert for worsening heart problems in those with prior heart disease or risk factors, and to recognize that even those without pre-existing heart problems are at higher risk because of their exposure to hormonal therapies.

“For patients who have two or more cardiovascular risk factors, it is likely that referral to a cardiologist would be appropriate prior to beginning hormone treatment. For patients already receiving hormonal therapies, a discussion with the oncology team can help to determine if a cardiology referral is recommended,” Okwuosa said.

The statement also calls for additional research in several areas, including:

  • Further evaluation of racial and ethnic disparities among breast and prostate cancer patients who have received hormone therapy. In the few studies that exist, racial and ethnic differences detected may be related to health inequities and other factors, and these are important areas to address.
  • Heart disease and stroke outcomes and risks should be added as primary endpoints in randomized trials of hormonal therapies.
  • Studies of specific hormonal medications are needed since each one may have different heart risks even if they work in the same way to treat breast or prostate cancer.

Source: American Heart Association

In Breast Cancer Survivors, Obesity Raises Odds for Cancer’s Return

Cara Murez wrote . . . . . . . . .

Most people know obesity can lead to diabetes or heart disease, but excess weight can play a role in cancer, too, researchers say.

A new study found that breast cancer survivors who are overweight have a statistically significant increased risk of developing a second primary cancer – one not connected to their previous cancer.

The risk likely owes to shared risk factors between the two cancers – of which obesity is one – as well as genetic susceptibility and long-term effects of breast cancer treatment, the study authors said.

“The risk is comparable to what we would see for an initial breast cancer,” said Heather Spencer Feigelson, senior investigator at the Kaiser Permanente Colorado Institute for Health Research, in Aurora. “It’s just another piece of evidence showing us how [excess weight] is really important.”

For the study, the researchers reviewed data from nearly 6,500 women treated at Kaiser Permanente in Colorado and Washington state. Roughly equal percentages were normal weight, overweight and obese.

Women who had an invasive breast cancer had a small, but significantly higher risk for a second cancer as their body mass index (BMI) increased, the study found. (BMI is an estimate of body fat based on height and weight.)

That link was more pronounced when the analysis focused on obesity-related cancers or second breast cancers, the researchers said. The link was strongest for a diagnosis of estrogen receptor-positive second breast cancer.

Of the 14 cancers listed by the International Agency for Research on Cancer as obesity-related, some are common and some are harder to treat, Feigelson said.

The investigators found that 822 (nearly 13%) of the women developed a second cancer after an average follow-up of just over seven years. Of those, nearly 62% were an obesity-related cancer and 40% were a second breast cancer.

The 508 obesity-related cancers included 283 postmenopausal breast cancers; 70 colon/rectal cancers; 68 uterine cancers; 21 ovarian cancers; 23 pancreatic cancers; and 14 kidney cancers. There were fewer than 10 cases each of thyroid, esophageal, gallbladder, multiple myeloma, meningioma, liver and upper stomach cancers.

Though having excess weight appears to increase risk, evidence that shedding pounds and keeping them off reduces risk is limited, because losing weight is hard, Feigelson said.

“The science suggests that, yes, if you lose weight you should reduce your risk, but really the best studies … are studies of women who have gotten bariatric [weight-loss] surgery, and those who lose that large amount of weight do have lower risk of cancer,” Feigelson said.

About 55% of all cancers in women occur in those who are overweight or obese.

Feigelson noted there are a lot of breast cancer risk factors that women can’t do much about.

“For example, for these second breast cancers or second cancers after breast cancer, one risk factor is treatment, and obviously you’re not going to forgo treatment,” she said. “But this is something that women actually can have control over. And I think if you’re worried about cancer or you’re a cancer survivor, having those things that you can control and do something about can be very important to you.”

Building some healthy habits into your everyday life can help with cancer prevention. Maintain a healthy body weight, be active and don’t sit so much, Feigelson advised.

The findings were recently published in the Journal of the National Cancer Institute.

The researchers noted that one limitation of the study was a lack of diversity, because about 82% of the participants were white women.

Dr. Jennifer Ligibel, director of the Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute in Boston, reviewed the findings.

“I think this paper really provides a compelling rationale for why thinking about weight loss after being diagnosed with breast cancer is important,” she said.

Excess weight has a multipronged effect on a person’s body, increasing levels of insulin and other metabolic markers, as well as inflammation, Ligibel said. It probably also depresses the immune system, she added.

In addition, she noted that excess weight raises levels of sex hormones that can also lead to the development of certain types of cancer.

“It’s probably not one thing, but the complex interplay between these different systems,” said Ligibel, who is part of another study that is investigating whether a weight-loss program as part of breast cancer treatment can lead to lower rates of new cancers.

For many years, she noted, the American Cancer Society has made recommendations about nutrition, physical activity and weight for cancer prevention and for cancer survivors. They include trying to achieve and maintain a healthy weight.

“Unfortunately, [a lot of people have] gained weight as a result of the quarantining and everything else through this last year, but I think that this is a goal that we really need to be thinking about on a societal level,” Ligibel said.

Source : HealthDay

Statins May Protect the Heart from Chemotherapy Treatment of Early Breast Cancer

Statins, common cholesterol-lowering medications, may protect women’s hearts from damage caused during chemotherapy for early-stage breast cancer, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

“Two types of cancer medications, anthracyclines and trastuzumab, are effective treatments for many women with breast cancer, however, the risk of heart muscle damage has limited their use, particularly in women who are at higher risk for heart problems because of their age or other medical issues,” said Husam Abdel-Qadir, M.D., Ph.D., lead author of the study, assistant professor of medicine at the University of Toronto’s Institute of Health Policy, Management and Evaluation, and a cardiologist at Women’s College Hospital and the Peter Munk Cardiac Centre, part of the University Health Network in Toronto.

“The mechanisms for these medications are essential to kill breast cancer cells, however, these processes can also damage the cells of the heart muscle, leading to weakening of the heart,” he said.

Previous small studies have suggested that women taking statins may have less heart muscle damage from these types of chemotherapy. The exact mechanisms of how statins protect against the cardiac cell damage remains unknown. It is believed that statins have antioxidative and anti-inflammatory actions.

For the current study, researchers used several administrative health databases in Ontario, Canada, to review the occurrence of heart failure in women ages 66 and older who received anthracyclines or trastuzumab for newly diagnosed early-stage breast cancer between 2007 and 2017. Each woman already taking statins was matched with a peer who was not taking statins as well as a variety of medical and social background factors. The two groups were compared to understand how many required hospitalizations or an emergency room visit for heart failure within the five years after chemotherapy. None had previously been diagnosed with heart failure.

Researchers found:

  • In the 666 pairs of women (median age 69) treated with anthracyclines, those taking statins were 55% less likely to be treated at the hospital for heart failure (1.2% vs. 2.9%).
  • In the 390 pairs of women (median age 71) treated with trastuzumab, those taking statins were 54% less likely to be treated at the hospital for heart failure (2.7% vs. 3.7%), a trend that did not reach statistical significance.

“Our findings support the idea that statins may be a potential intervention for preventing heart failure in patients receiving chemotherapy with anthracyclines and potentially trastuzumab,” Abdel-Qadir said.

This observational study found an association but cannot conclude that there is a cause-and-effect relationship between taking statins and a lower risk of heart failure.

“This study does not conclusively prove statins are protective,” Abdel-Qadir said. “However, this study builds on the body of evidence suggesting that they may have benefits. For women with breast cancer who meet established indications for taking a statin, they should ideally continue taking it throughout their chemotherapy treatment. Women who do not have an indication for a statin should ask their health care team if they can join a clinical trial studying the benefits of statins in protecting against heart muscle damage during chemotherapy. Otherwise, they should focus on measures to optimize their cardiovascular health before, during and after chemotherapy.”

Findings from this study in older women may not be generalizable to younger women or to those at low cardiovascular risk who do not meet current indications for a statin. Because the populations are similar in terms of demographics, these results from Canada are likely generalizable to women in the United States. Other limitations include that the study is a retrospective analysis that relied on administrative data, and the researchers could not account for potentially important factors that were not available, including the heart’s pumping ability and heart biomarkers.

Source: American Heart Association