So much evidence has been produced to make a clear link between obesity and breast cancer. Now new evidence also links breast cancer recurrence and post reconstruction complications in obese survivors. Here is a review of the new studies:
Women diagnosed with breast cancer often get conflicting views from their health care providers on the role of obesity and breast cancer treatment. While these women are generally told about the importance of good weight management and maintaining a healthy lifestyle, both pre and post surgery, focus still remains on cancer recurrence management without much emphasis on how to limit the risk of recurrence outside of general and standard oncological care. This is why so many patients seek our supportive nutritional and environmental cancer care program. These are issues we address.
In many studies there is no clear distinction between survivorship in obese and non-obese women
Cancer research surgeons who examine women post-surgery, with obvious reason, focus on the long-term outcomes of their surgeries. In many studies there is no clear distinction between survivorship in obese and non-obese women. This is pointed out most recently by a November 2018, in the American Journal of Surgery, (1) researchers found that while accommodating surgical treatments for the obese woman, “Obese patients with operable breast cancer receive different treatment than non-obese patients, however survival and recurrence outcomes were similar among the two groups.”
So there is an idea that obese women and non-obese women have similar outcomes and recurrence risks after breast surgery. We have seen many women, ready to embark on cancer treatments including surgery, or in the middle of cancer treatment, or in post-management phase who have told us that they were given basic instructions on food avoidance during treatment but not offered any real guidance after treatment. Part of the reasoning may be a belief that nutritional interventions and weight management may not offer any added benefit and that if the woman really wanted to pursue healthy lifestyles, they could find that information readily available online. These are things we here all the time.
The amount of fat in your hips and thighs vs. your abdomen
A September 2019 study (2) built on the above research. Here a group of researchers “aimed to evaluate the association between abdominal-to-gluteofemoral adipose tissue distribution and recurrence-free survival in breast cancer patients.” So what is happening here is that the researchers were measuring a comparison of fat distribution in the abdominal area vs. the amount of fat carried in the hips and thighs in patients who were recurrence free.
If you carried a lot of fat in your abdominal area you were at a high risk of recurrence
If you carried a lot of fat in your hips and thigh area you were at a lower risk of recurrence than higher fat levels in the abdomen.
The reason, it is speculated, that gluteofemoral adipose tissue may play a more protective role in disease spread and that abdominal fat increases risks for disease and cancer because of its unique ability to create runaway inflammation. Too much fat is not good, the right amount of fat can be beneficial, abdominal fat in heavy, overweight, or obese women is not a good thing.
Mounting evidence to suggest that obesity does play a role in higher risk of complications in breast reconstruction surgery.
A June 2018 study lead by plastic surgeons at Brigham and Women’s Hospital, Harvard Medical School published in the Journal of reconstructive microsurgery (3) found obesity was a problem in reconstructive breast surgery. This is what they wrote:
“Increased rates of both breast cancer and obesity have resulted in more obese women seeking breast reconstruction.
Studies demonstrate that these women are at increased risk for perioperative complications.
The most common complication, wound dehiscence (wound rupture at the site of the incision)
“This study provides evidence that obesity increases the risk of complications in both implant-based and autologous reconstruction.”
The suggestion of this study was that doctors and patients should explore weight reduction prior to surgery.
But there is mounting evidence to suggest that obesity does play a role in higher risk of breast cancer recurrence
Clinical observations and published research strongly suggests that we should not turn away from the management of obesity in breast cancer survivors. Doctors in London writing in the medical journal Current treatment options in oncology (4) had this to say:
“Obesity not only is an independent risk factor of postmenopausal breast cancer. . . it is also a prognostic factor of the disease. . . .” In other words, obese women are at higher risk for breast cancer.
“Substantial evidence has shown that obesity, as measured by body mass index is linked to breast cancer outcomes. All-cause and breast cancer-specific mortality risk increase for each BMI (Body Mass Index) unit increase in pre- and postmenopausal breast cancer survivors is estimated to range from 8 to 29 % . . .” Simply as breast cancer survivors gain weight the risks for recurrence is that much greater.
“Furthermore, the negative impact of abdominal obesity on breast cancer survival highlights the need of using fat distribution (waist circumference, waist-hip-ratio) as well as general obesity to evaluate prognosis in the clinical setting. . . . Oncologists should recommend their patients to be physically active and control body weight when the conditions of the patient allow it.”
There is mounting evidence to suggest that obesity does play a role in developing cancer in the other breast
A collaborating team of researchers including those from Stanford, New York University (NYU), Sloan-Kettering, and the University of Texas MD Anderson Cancer Center among others studied the relationship between body mass index and the risk of contralateral (the other side) breast cancer. The same research teams had previously showed that obese postmenopausal women with estrogen receptor (ER)-negative breast cancer have a five-fold higher risk of contralateral breast cancer compared with normal weight women.
In the new findings researchers confirmed that women with an estrogen receptor-negative first primary cancer who are obese at the first diagnosis or who experience a large weight gain afterward should be watched with “heightened surveillance,” for risk of secondary cancer from obesity.(5)
A better lifestyle and controlling body weight in breast cancer survivorship
We place particular emphasis on an anti-inflammatory diet and lifestyle, and biologic agents that quiet the inflammatory pathways since inflammation has been found to foster the growth of cancer cells.
Most of our patients have already been through the rigors of conventional treatments but either experienced untoward side effects or unsatisfactory outcomes as the cancer continued to grow. The sooner we begin treatment, the better, since there is usually less damage to the immune system and to the vital organs. Your body then has a better chance to recover.
Our program emphasizes the concept of Thriving While Surviving. We strive to transform cancer from an acute disease into more of a chronic illness, one that can be lived with for many months or even years.
If you would like to explore more information, please contact our office so we can start a conversation with you.
1 Burkheimer E, Starks L, Khan M, Oostendorp L, Melnik MK, Chung MH, Wright GP. The impact of obesity on treatment choices and outcomes in operable breast cancer. The American Journal of Surgery. 2018 Nov 14.
2 Lee JW, Kim SY, Lee HJ, Han SW, Lee JE, Lee SM. Prognostic Significance of Abdominal-to-Gluteofemoral Adipose Tissue Distribution in Patients with Breast Cancer. J Clin Med. 2019;8(9):1358. Published 2019 Sep 1. doi:10.3390/jcm8091358
3 Panayi AC, Agha RA, Sieber BA, Orgill DP. Impact of Obesity on Outcomes in Breast Reconstruction: A Systematic Review and Meta-Analysis. Journal of reconstructive microsurgery. 2018 Jun;34(05):363-75.
4 Chan DS, Norat T. Obesity and breast cancer: not only a risk factor of the disease. Curr Treat Options Oncol. 2015 May;16(5):22.
5 Brooks JD, John EM, Mellemkjaer L, Lynch CF, Knight JA, Malone KE, Reiner AS, Bernstein L, Liang X, Shore RE, Stovall M; WECARE Study Collaborative Group., Bernstein JL. Body mass index, weight change, and risk of second primary breast cancer in the WECARE study: influence of estrogen receptor status of the first breast cancer. Cancer Med. 2016 Oct 3. doi: 10.1002/cam4.890.