Previously, I have reported on studies that regular exercise may play an important role in prevention of depression among breast cancer survivors. (For more details, read “Lifestyle Makes a Difference in Combating Depression After Breast Cancer“). There is also a growing body of scientific evidence links the risk of developing a first breast cancer or recurrent breast cancer with such lifestyle factors as weight, physical activity, and alcohol use. As this video above from the Dana-Farber Cancer Institute in Boston shows, as little as 30 minutes per day of regular exercise, such as walking, can help you reduce your risk of breast cancer.

Overweight and obese postmenopausal women have been shown to be up to twice as likely to develop breast cancer as women of normal weight. Higher rates of breast cancer have also been associated with an inactive lifestyle and consumption of more than seven drinks of alcohol per week for women.

Furthermore, obese women who lead a sedentary life have an increased risk of breast cancer recurrence. One study showed that women who were overweight at the time of their initial diagnosis were 50% more likely to get a second breast cancer compared with women who were not overweight. Women who consumed more than seven drinks a week after their first breast cancer diagnosis were found to have a 70% increased risk of developing cancer in the opposite breast when compared with nondrinkers.

There are, however, some health benefits to moderate drinking — one drink or less per day for women and two drinks or less for men, especially of red wine — such as lowering the risk of heart disease. In addition, if you are receiving chemotherapy, your nutritional needs change and it’s not a good idea to go on a low-calorie diet because you need to add calories and protein to your diet to help you fight infections and boost your energy.

For more information about good nutrition and regular exercise from our companion website, go to this link patientresource.net

References:
1. Nagaiah G, Hazard HW, Abraham J: Role of obesity and exercise in breast cancer survivors. Oncology 2010;24:342-346.
2. McCarthy AM, Visvanathan K: Breast cancer prognosis: weighing the evidence on weight and physical activity. Oncology 2010;24:342-346.
3. Ligibel JA: Could modification of lifestyle factors prevent second primary breast cancers? Journal of Clinical Oncology 2009;27(32):5301-5302.
4. Li CI, Daling JR, Porter PL, et al: Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor-positive invasive breast cancer. Journal of Clinical Oncology 2009;27:5312-5318.

Expert Analysis Highlights:

• Harvard Medical School study shows women who took an average of two-five aspirin a week were 60% less likely to develop metastatic breast cancer and 71% less likely to die of breast cancer
• This was a retrospective epidemiology type of study that does raise important questions but does not give definitive evidence that taking aspirin for breast cancer is a mandatory treatment.
• Since aspirin has such low toxicity in most individuals as well as a proven benefit across a range of diseases, it seems reasonable to recommend it as part of healthy lifestyle

What makes this drug so special?  Well, it’s inexpensive, widely available at any grocery store, non-toxic, and studies show that it increases breast cancer survival rates. It’s acetylsalicylic acid…also know simply as aspirin! A new study published in the February 16, 2010 issue of the Journal of Clinical Oncology suggests for the first time that pre-menopausal women who take two or more aspirin each week in the years after the diagnosis of early stage breast cancer could increase their probability of survival (or prognosis) compared to women who don’t take aspirin. So, those women who took aspirin were less likely to develop metastatic spread of their breast cancer, or to die of breast cancer or other causes of death.

It is important to point out that this was a retrospective epidemiology type of study that does raise important questions but does not give definitive evidence that taking aspirin for breast cancer is a mandatory treatment. The women self-reported the use of aspirin through an annual survey over the last 20 years, and the intent of aspirin use was not necessarily to treat breast cancer. It is likely that the women taking aspirin were following recommendations from the American Heart Association and other organizations to reduce the risk of heart attack and stroke.

Having said that, since aspirin has such low toxicity in most individuals as well as a proven benefit across a range of diseases, it seems reasonable to recommend that women (and men too!) take aspirin on a regular basis as part of healthy lifestyle.

Aspirin has been available for many years and is recommended as a preventative for heart and stroke disease. There’s also some evidence that it decreases the risk of colon cancer. The mechanism of action for such a simple compound is unknown. It may relate to its anticoagulation effects that prevent circulating tumor cells from lodging in blood vessels and then growing in a vital organ. It also decreases the invasive nature of cancer cells (i.e. the process of attaching to blood vessels, working its way into the blood stream, and spreading to other organs), lowers the level of the hormone estradiol, or may have an anti-inflammatory effect.

The results from the large population-based study mentioned above involving 4106 women nurses were impressive.  The investigators, Dr Michelle Holmes and others from Harvard Medical School, concluded that “aspirin use was associated with a decreased risk of breast cancer death.” Women who took an average of two-five aspirin a week were 60% less likely to develop metastatic breast cancer and 71% less likely to die of breast cancer. There was also a suggestion of a protective effect with other non-steroidal anti-inflammatory medicines besides aspirin, such as ibuprofen (Advil, Motrin, Nuprin) or naproxen (Aleve, Anaprox), but this could not be demonstrated with acetaminophen (Tylenol, Bayer).

It is important to note that women who took an average of one aspirin a week (or less) as opposed to two-five had the same risk of developing metastatic breast cancer or dying from breast cancer as women who didn’t take any aspirin at all. I also want to point out that taking aspirin regularly before the diagnosis of breast cancer did not affect prognosis. Only taking aspirin after the diagnosis improved the outcome.

I take aspirin myself as a preventive medicine. Whether you take the “low dose” aspirin, a regular dose, or one of the other nonsteroidal anti-inflammatory drugs (NSAID) is a personal decision that is also based upon your body’s tolerance to taking these medicines without any ill effects (such as stomach upset or bleeding tendencies). If you have any questions about this, you should ask your doctor.

Expert Analysis Highlights:

• Certain types of cancer like colon cancer have a slight association with a high-fat diet
• Avoid hydrogenated and trans fats, and seek out Omega 3 or Free Range products in your diet
• Big industries introduce products to market faster than the public health community can study them
• Until the research community catches up with the processed food industry, eat local food, organic food, and clean water seafood

Here are eight important diet tips, and read more below for an explanation of these points:

1) Look for free range milk, eggs and meats
2) Take Omega 3 supplementation
3) Seek wild-caught fish
4) Ask for clean water seafood
5) Buy organic foods (chemical-free)
6) Avoid hydrogenated fats
7) Avoid processed food
8) Eat local

50 years ago our food largely came from local farms with green pastures.  Today, most food we eat comes from factories and it travels 1,500 miles before it’s consumed.  At the same time we are seeing an increase in certain types of cancer, despite many medical advances.  Is there a connection?  Its simply too hard to study something that broad to say definitively.  But consider the following points when choosing your food.

Studying the cause of cancer is extremely complex.  Assessing the 20 or 30  year effects of environmental or nutritional changes on cancer is difficult to measure and costly to do right.  Also, the absence of research supporting a connection does not mean there isn’t one.

Historically, public health research has lagged behind the introduction of cancer-causing agents in the environment.  Big industries introduce products to market faster than the public health community can study them.  Take for example, cigarettes.  It took decades for public health researchers to confirm what they had long suspected–that they are bad for your health and cause cancer.  Cancer is believed to be multi-factorial, which means it could be caused by a combination of internal, genetic, and/or environmental factors.  What we do know is that certain types of cancer like colon cancer have a slight association with a high-fat diet.

Food increasingly is processed and not natural.  It has more fat, sugar and artificial ingredients.  Some in the public health community have warned that such processed food could be associated with certain types of cancer.   When animals are fed corn products and denied green pastures as they are when raised in factory farms, they concentrate the wrong types of molecules in their system.  This is so common that many doctors now recommend that patients take Omega-3 pills to balance out the high Omega-6 fats found in most processed food.  The use of Omega-3 has been studied and found to be beneficial in preventing repeat heart attacks, and that’s probably just the beginning of what we are learning about the Omega fat imbalance.  So avoid hydrogenated and trans fats, and seek out Omega 3 or Free Range products in your diet.

One great source of Omega 3′s are fish.  Specifically its high in fish livers which are purest in clean waters like Norway or Alaska.  Unfortunately, seafood increasingly come from areas where toxic metals are found, such as the Atlantic coast and the Gulf of Mexico.  Omega 3 pills extracted from small fish in Virginia, for example, are loaded with pollutants.  Alaskan fish on the other hand come from clean waters and are an excellent source of Omega 3′s.

Free Range food is important for good health because Free Range animals get more appropriate nutrition for their muscles.  Those muscles are what we eat as meat.  Most any fast food has factory-farm style animals raised under inhumane conditions, fed processed corn products.  The movie “Food Inc.” exposes this industry showing how the artificial food is even spray-painted green at times to trick the chickens into eating it.  Those chemicals can’t be good for your body.  Free Range foods are safer and more likely to be chemical free.  Free Range products taste better too.

Every nutritionist agrees that our consumer culture has minimized fruits and vegetables.  These are important for many reasons, including the magical potential of anti-oxidants.  Its believed that these compounds may have a slight benefit in preventing cancer, although further research is needed to know if they are really helping.  At minimum fruits and vegetables are important for balancing one’s diet.  A good variety of fruits and vegetables may eliminate the need to buy expensive vitamins, although Vitamin D and iron supplementation may still be recommended by your doctor if your levels are low.

Finally, the organic movement is good for public health.  There are many theories that genetically modifiable food and food grown with pesticides are not good for your health.  Trace amounts of pesticides have been detectable in people’s blood, and over years, such an accumulation of chemicals could be shown in the future to have an impact on cancer.  I highly recommend organic foods to young patients interested in taking care of their health and reducing their risk of cancer.  Until the research community catches up with the processed food industry, eat local food, organic food, and clean water seafood.

For related information, here’s another blog you might find helpful:

“Important Diet Tips for Cancer Prevention“

Expert Analysis Highlights:

• Psychological well-being ultimately improves one’s chances of surviving cancer
• Largest study that has been reported to date comes from China regarding factors that help prevent depression among breast cancer survivors
• Findings suggest strongly that regular exercise and tea consumption may offer an alternate or complementary approach to avoiding or minimizing depression symptoms in women with breast cancer

Mental health is an important component of cancer treatment and management. The video above is about research indicating that breast cancer patients with psychological support along with their medical treatment can improve their odds of beating the disease. As the study shows, psychological well-being ultimately improves one’s chances of surviving cancer, citing one statistic that the risk of dying from breast cancer dropped 60% when adding psychological support along with medical treatment compared to those with only medical treatment. So how does a cancer patient or survivor prevent depression and maintain a “healthy” mental condition?

Regular exercise and tea consumption may play an important role in prevention of depression among breast cancer survivors, according to a recent study  published in the prestigious Journal of Clinical Oncology from Shanghai, China (Journal of Clinical Oncology 28:991, February 20,2010). The authors performed a detailed study of 1,399 breast cancer patients who were followed for two years afterward treatment with a detailed analysis of their coping with the diagnosis of breast cancer.  They documented their daily exercise and nutritional intake, and also tested for depression and quality-of-life as reflected in validated test questions. They found that 26% of women reported depressive symptoms, while 13% met the criteria of clinical depression.

There were three important  findings:

1) Women who reported a higher exercise level were less likely to have depression compared to those who did not exercise.  Increased exercise level after diagnosis was also related to a significantly reduced risk of depression.

2) Women who had regular tea consumption (> 100 grams dried tea leaves/month) had a significantly lower incidence of depression

3) No associations were found for other forms of dietary intake or nutritional supplements (among those queried) , as reflected in the depression score.

This is one of several clinical trials that have observed some beneficial effect of short term life style interventions, such as exercise, on depression among women with breast cancer. This study from China is the largest that has been reported to date. All types of exercise decreased the risk for depression, while women with consistently higher levels of exercise had the lowest risk for depression.  Exercise may relieve depression symptoms through plausible mechanism, such as improved physical fitness, self-sufficiency, and distraction from common symptoms (such as sleep disturbances or pain) associated with cancer and cancer-related treatments.  More clinical studies are needed to evaluate the effect of exercise on depression.

According to the study, this is the first epidemiological evidence that tea consumption may be associated with a lower risk of depression among breast cancer survivors. Indeed, lifetime tea consumption was inversely related to depression. Tea is the most common beverage world-wide. Tea and its constituents contain high levels of caffeine and other substances that may be beneficial in adjusting mood disorders.  As the authors emphasize, even animal studies have shown an anti-depressant effect of tea extracts. A recent study has also reported that caffeine consumption, either from coffee or tea, reduced the risk of depression in the general population (that is, not just breast cancer patients). Clearly, more studies are needed to confirm the tea/depression association and to investigate the underlying mechanisms.

According to the study, there were no associations between depression  and habitual dietary intake (such as  meats, vegetables, soy foods), or with Chinese herbal medicine use and supplements, similar to that of previous studies. They pointed out that previous studies in the United States showed that neither alcohol consumption nor smoking was related to depression. This study confirms these results, since there was no association of alcohol consumption or smoking with depression. The authors concluded that regular exercise participation may play an important role in the prevention of depression among breast cancer survivors. Also, they did not identify any other nutritional or dietary supplements that were associated with a lower rate of depression.

These findings were based on the culture, cancer treatments, and dietary conditions of women with curable breast cancer in Shanghai China. They are likely to have application to a woman’s lifestyle in other parts of the world, but this would have to be proven with further studies. Nevertheless, these findings suggest strongly that modifiable lifestyle behaviors, exercise participation and tea consumption may offer an alternate or complementary approach to avoiding or minimizing depression symptoms in women with breast cancer.

*Other factors associated with depression symptoms occurred in women who were older, who were widowed or divorced/separated/single, had menopausal symptoms, or had lower education or income levels. The associations of exercise and tea consumption with depression remained significant even after adjustment for these factors.

An interesting and important article was published in the prestigious Journal of Clinical Oncology about a study of vitamin D levels in breast cancer patients. This is an important topic because vitamin D deficiency is associated with an increased breast cancer risk and decreased breast cancer survival.

At the onset of this trial, 74% of premenopausal women with breast cancer were vitamin D deficient (median,17 ng/mL). Vitamin D deficiency was slightly less common in white women (66%) compared with black (80%) and Hispanic (84%) women. After vitamin D supplementation for 1 year, less than 15% of white and Hispanic women, and no black women, achieved sufficient levels. Vitamin D levels were not altered by chemotherapy or bisphosphonate use.

The authors of the study concluded that vitamin D deficiency is highly prevalent in women with breast cancer and that the current recommended dietary allowance of vitamin D is too low.

For those of you who want all the details about Vitamin D, here is a one hour lecture by an expert in the field. Dr Michael Holick, MD, PhD is Director of the Vitamin D Skin and Bone Research Laboratory at the Boston University School of Medicine.

Reference:

High Prevalence of Vitamin D Deficiency Despite Supplementation in Premenopausal Women With Breast Cancer Undergoing Adjuvant Chemotherapy. J Clin Oncol. 2009 May 1;27(13):2151-2156, KD Crew, E Shane, S Cremers, DJ McMahon, D Irani, DL Hershman

Cancer fatigue is a debilitating condition that is different from usual “tiredness”.  Fatigue felt by people with cancer is different from fatigue felt occasionally by healthy individuals. Compared with “normal” fatigue, fatigue related to cancer treatment usually is more severe, lasts longer, and is unrelieved by sleep. For some people with cancer, fatigue is a more distressing symptom than pain and other symptoms because it can interfere with normal activities.

Now a report from the Mayo Clinic indicates a somewhat positive finding in a controlled study comparing three doses of ginseng compared to a placebo. Dr Deborah Barton reported their results of a pilot study involving 290 cancer patients ( just published in Supportive Care Cancer, 2010 Feb 18:179-187). They concluded that “there appears to be some activity and tolerable toxicity at 1000-2000 mg/day doses of American ginseng with regards to cancer-related fatigue.”

Remember that there are several preparations of ginseng roots: American ginseng (Panax quinquefolius) and Asian ginseng (Panex ginseng). This ingredient can be found in nutritional stores. Ginseng is also used in some popular “energy drinks”.

For more information about cancer-related fatigue and web-based resources, go to our companion website.