Role of weight in BC, post treatment weight goals

edwsmom

Hi all,

I guess we never really know what caused us to get BC in the first place...I'm sure we all have speculated about it.

I had a child late (at 40) - did that play a role? I did IVF - did that play a role? I've been overweight - did that play a role? I ate too much sugar - did that play a role? It's all very scary, really.

As I'm nearing the end of active treatment, I'm realizing that what's done is done and there are only so many things I can control about this whole thing. But, I would like to do what I can to reduce my risk of recurrence - what the the biggest factors I should focus on? Weight?

I just know that there are a ton of people here that are more educated than I am about recurrence. Is weight the top thing I should be working on to hopefully reduce my risk?

I've struggled with weight most of my adult life. I'm 5'4 and have never really weighed less than 160, even when very active.

I gained quite a bit in my early 30's (190's - ugh, sedentary desk job), then in my mid-30's I got off my butt and lost 25 lbs and kept it off until I started trying to get pregnant (long stressful process).

At my top weight I was 250 (at the end of my pregnancy). I lost quite a bit easily after giving birth, then also dieted and got down to 190.

Since then I've lost another 10 lbs. I'm 180 right now.

I have these moments where I'm paralyzed with fear regarding my weight and the role it could play in a cancer recurrence. I'm working on losing weight (slowly right now as I'm finishing radiation), and I'm super scared that tamoxifen might cause me to gain weight.

Is there a particular BMI that one should stay below to reduce risk? Are there other things I should focus on as well to reduce recurrence (I've already started changing my diet - I eat a ton of brussel sprouts, broccoli, green leafy veggies, organic everything, take a probiotic, cut down on sugar)

Any advice would be greatly appreciated. Thank you!

dtad

I have read that weight loss and exercise can reduce recurrence rates significantly. The reason being that estrogen is generated from our fat cells. I find it contradictory that we are then being treated with drugs that make both weight loss and mobility more difficult! I don't think a BMI has been established specifically for bc, but what a good idea! There are however general BMI guidelines we can follow. Good luck in your weight loss journey. It seems like it's a never ending battle

dtad

I have read that weight loss and exercise can reduce recurrence rates significantly. The reason being that estrogen is generated from our fat cells. I find it contradictory that we are then being treated with drugs that make both weight loss and mobility more difficult! I don't think a BMI has been established specifically for bc, but what a good idea! There are however general BMI guidelines we can follow. Good luck in your weight loss journey. It seems like it's a never ending battle

MsPharoah

edwsmon, I have been out of active treatment for almost 3 years and I definitely know how you are feeling. You are very smart to consider what changes you can make that will reduce your recurrence risk. My oncologist provided me with a ranking that may or may not be true.....but I trust him, so I am following it. He says the most important thing is adherence to the anti-hormonal medication....then it is maintaining a healthy BMI which he says is the combination of healthy food choices, regular exercise AND........limited alcohol consumption. I also find that regular exercise helps with the stiffness I get from the AI I take. The way I look at it.....limiting alcohol (I love wine and miss it!) helps tremendously with weight control and so does exercise and none of that is bad for me....even if it doesn't reduce my recurrence. I haven't removed sweets or meat, dairy, etc. from my diet. That would be too severe for me, but I do count calories and balance calories in versus out with portion control.

Good luck in your healthy endeavors, MsP

edwsmom

Thanks very much for sharing that, it helps a lot.

Are we talking eliminating alcohol or limiting it? I probably have a max of 1-2 glasses of red wine per week (sometimes none at all). No mixed drinks. Do you think that's reasonable or should I never have any?

MsPharoah

Well, I have about 2 glasses of wine a week...usually with our Saturday date night. I did not eliminate it all together. I was having a glass each night.......Yikes! Lots of empty calories, for sure.

There is a lot of conflicting information about alcohol and BC......I have reduced alcohol because it helps me achieve the weight control I want. I cannot underestimate the power of exercise. I started out with a 1 mile walk at home video right after I finished active treatment. Just google Leslie Sansone Walk at Home You tube. Lots of 15 minute work out videos and then you can work up to 2 or 3 mile and there is a lot of variety of workouts. I also walk about 2 miles a day in my neighborhood when the weather permits.

There are a lot of forums on BC.org for fitness. It really helps to have friends working by your side when you are trying to stay healthy.

MsP

BarredOwl

For motivation, here is a recent article on the SHAPE-2 study in postmenopausal women, containing a good Discussion section and bibliography:

"Effect of weight loss, with or without exercise, on body composition and sex hormones in postmenopausal women: the SHAPE-2 trial"

http://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-015-0633-9

BarredOwl

Hopeful82014

I will second the Leslie Sansone walk at home videos. I found them especially helpful in working out the tightness in my tissues that resulted from radiation. And they're great when it's too hot/cold/dark/wet to walk outdoors.

ChiSandy

Interesting, BarredOwl. But that study (since women who already had BC were excluded, and therefore presumably so were those on AIs) begs a few questions:

1) Can the statistics for prevention of breast cancer be extrapolated to the prevention of recurrence?

2) How much does AI therapy negate the effects of body fat and moderate (3-5 “drinks”/wk) alcohol consumption on circulating estrogen levels?

3) What effect does weight loss have on preventing (or preventing recurrence of) hormone-negative breast cancers?

4) How much weight lost actually consisted of fat vs. water or lean muscle mass? And does it matter what type of fat (e.g., brown vs. yellow) and its location (abdominal vs. gluteal and femoral)?

5) Is muscle-mass conservation (and building), by increasing metabolism (muscle requires more calories than fat to maintain) and thus causing further fat loss (presumably), more protective than loss of fat alone?

I know that since our knowledge thus is limited to that and contemporaneous studies, all we can do is say “better safe than sorry” and recommend general weight loss (regardless of composition of weight lost and type & location of fat) for all women dx’ed with hormone-positive bc regardless of adjuvant AI therapy. After all, encouraging a healthful lifestyle is cheaper than research and has no downside. But I’d love to know if fat loss by other-than-lifestyle means (liposuction, “cool-sculpting,” other surgical or medical means of fat removal) can confer a similar benefit---or an extra benefit once one’s desired BMI has been reached? I wonder just how much good an AI is doing in any given woman (conceding that it IS beneficial)--and whether one’s diet, mild-to-moderate drinking & exercise habits can sabotage it, or--conversely--whether taking an AI makes lifestyle changes less crucial. And whether higher doses might be indicated in different women, both because of higher body mass and differences in measured hormone levels.

Just tossing it out there.....

Shopgal2

hi edwsmom great post. That question is always top on my mind too. I was also overweight since my teens and gained a lot of weight in the 2 years since before my dx. During chemo my heaviest was 220. Since I finished chemo in December I have lost 47 lbs and now weigh 173. I went from a size 16 in Jan to a size 8 now. I asked my mo what would be a target weight for me and his answer was a healthy bmi of 25 or less. I didn't lose weight due to chemo. I lost the weight as part of a clinical trial for radiation to restrict my caloric intake by 25%. My ro ran the study to see if calorie restriction helped lessen the toxic effects of rads.

I worked hard to change my diet and started working out 2-3x a week. I usually do about 10,000-15,000 steps a day on my Fitbit. I also use my fitness pal to track my food and have it set to 1150 calories I usually eat under 1000 per day. It helps to learn portion sizes and measure my food. I do eat mostly fruits and veggies and chicken or fish. I dont really eat processed foods either. I find it was pretty easy to change my mindset to change my lifestyle. Fear of reoccurrence scares me the most and if changing my lifestyle helps then that's a good thing. My target goal weight to get to a bmi of 25 is around 150. My ideal weight goal is 130 as I am 5'6 and a medium frame.

BarredOwl

Hi ChiSandy:

It does beg a number of questions, but it is what I happened to have in my files.

I'll comment on the first three:

1) Can the statistics for prevention [reducing risk] of breast cancer [from this study] be extrapolated to the prevention [reducing the risk] of recurrence?

Unclear, but not an unreasonable proposition (though it would require another study in an appropriate population to demonstrate it).

As you noted, the general health benefits are well-established, so these interventions likely cannot hurt, and may help those already diagnosed. In addition, while recurrence may pose a greater risk for many, potentially reducing the risk of a new breast cancer (especially in those who had lumpectomy or unilateral mastectomy) would be good (this also entails some extrapolation).

2) How much does AI therapy negate the effects of body fat and moderate (3-5 "drinks"/wk) alcohol consumption on circulating estrogen levels?

I have no idea, and it conceivably may vary from individual to individual. They noted that "Aromatase inhibitors reduce oestradiol by 83–89 % in patients with breast cancer [48–50] . . ." So if the blockade is not complete, perhaps there may be room for such lifestyle changes to help (which is speculation.)

Personally, I am not on endocrine therapy, so that leaves me with controlling weight, limiting alcohol (except for special occasions), and exercising for whatever it is worth.

3) What effect does weight loss have on preventing (or preventing recurrence of) hormone-negative breast cancers?

Surprisingly, it may be potentially be greater in hormone receptor-negative disease than in hormone receptor-positive disease. See for example these articles, and some discussion suggesting that the effect observed may have been related to weight loss and not diet per se:

"Low-Fat Diet Reduces Mortality in Breast Cancer Subset"

ASCO Post: http://www.ascopost.com/issues/january-25-2015/low-fat-diet-reduces-mortality-in-breast-cancer-subset/

"Women With Triple-Negative Breast Cancer May Reap Greater Survival Benefit From Nutrition Intervention"

OncLive: http://www.onclive.com/conference-coverage/SABCS-2014/Women-With-Triple-Negative-Breast-Cancer-May-Reap-Greater-Survival-Benefit-From-Nutrition-Intervention

BarredOwl

dtad

chi sandy....I always enjoy reading your posts. IMO you are not going to see too many studies on the effect of excercise and weight loss on recurrence. Mostly because they are not fueled by pharmaceutical companies. My issue is that it seems most women with breast cancer seem to gain weight while in active treatment. That can't be good for your overall health as well as for recurrence. Of course I realize there are many other factors that contribute to it. However like you stated there is no down side to it.

kaybe....no MOs very rarely test our hormone levels and I have a huge problem with that. IMO most MOs know very little about female hormones and this is why we are not monitored. We do know however that weight loss decreases our estrogen levels and excercise is a key component.

Good luck to all fighting this disease....

Heidihill

Great questions, chisandy!

edws, yes, tamoxifen can cause you to gain weight but it is not foreordained. Walking can ease you into an exercise routine. It's important to make it a habit. Join an exercise thread and the Wednesday Weigh In Thread.

I'm in the 10% club. I started exercising during chemo (bone mets at get-go at age 49) and it is now 8.5 years later and I am still exercising daily. I NEED the exercise to combat aches and pains, regulate funky moods, rev up my immune system, help control allergies, improve digestion. I also changed the way I eat. So I managed to lose most of my chemo kilos.

My MO does monitor my estrogen. Maybe also because tumors can produce estrogen? I'm NED but you never know. Anyway it is about half of its peak level since I've been on Tamoxifen, despite drinking 1 deciliter of red wine 3 times a day. He also tests my CRP which is always very low. Exercise must be helping there and maybe affecting my estrogen levels as well.

dtad

Heidi....Good for you! I give you so much credit. Im glad you MO monitors you hormone levels unfortunately it seems like its only done for stage 4. Continue to be well....

Paxton29

I was 45 when diagnosed last year, 5'11", 136 lbs, and a barre class devotee. Being thin and fit didn't prevent my developing cancer so it's hard for me to see why it would prevent a recurrence. I'm still in favor of exercise and weight control for overall health and wellbeing but whether it will prevent a recurrence ... Who knows