overweight postmenopausal women and bc risk
http://www.medpagetoday.com/Endocrinology/Obesity/...
"Overweight and obese postmenopausal women were at increased risk for invasive breast cancer, but losing weight didn't reduce that risk, according to a secondary analysis of data from the Women's Health Initiative (WHI) clinical trials...."
http://oncology.jamanetwork.com/article.aspx?artic...
Comments
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That is discouraging after I worked so hard to lose the extra weight after my BC diagnosis.
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grammakathy,
Still, you are better off for your general health and well being. And you may have less joint pain because you've lost the weight.
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Well if hormone therapy offers no protective benefit - doesn't that contradict the marketing strategy for taking Tamoxifen to prevent BC?
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The way I read the meaning of hormonal therapy was that it was HRT, not anti-hormone therapy. If you click on the link "one study" embedded in the first link the OP posted it references HRT.
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Thanks SpecialK - I should have opened both links to clarify the hormone therapy. My mind immediately thinks Tamox or AIs.
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I was dx'ed premenopausal, but I'm bummed about this too, since there is some evidence that weight affects risk even in premenopausal women. I hit my heaviest weight about 6 months before I found the lump. I started losing weight prior to dx but it was probably already too late. I've lost 30+ pounds total in the past two years but I worry that my fairly drastic weight gain back in 2012 did irreversible damage to my body. Stupid, stupid, stupid me.
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I am stating this in order to try and keep my later discussion understandable. The second link is the study, the first link is an analysis of the study. This bolded section is from the first analysis hyperlink by the original poster:
http://www.medpagetoday.com/Endocrinology/Obesity/...
Women with normal BMIs at baseline who gained more than 5% of their body weight increased their breast cancer risk by 36%. But women who were overweight or obese at baseline and then lost more than 5% of their body weight didn't benefit from any risk reduction, the study found.
"This was a surprise," Neuhouser told MedPage Today. "Several studies have looked at body weight and postmenopausal breast cancer risk, but there is not much data on weight change and risk, so this is kind of new."
I'm going to attempt to raise a different perspective on weight.
The BMI's at baseline were identified. The gain over the study period was identified i.e > 5%. The loss over the period of the study i.e. >5% was identified.
What was not identified in either the study or the analysis was what the overweight and obesity history was in time relationship prior to the inclusion in the study or time prior to the development to cancer. It was identified as linear meaning that it was a direct line. But I'm suggesting that the length of time to cancer is important to the weight gain. Why is this important? I have now had two primary cancers. With each one I had a stable weight. Both BMI's were in the overweight range. Then there was a sudden weight gain that did not correspond to change in diet or activity. It was a frustrating time before each one b/c I couldn't explain what was happening. With the second cancer I was suspicious b/c of what happened with the first cancer.
The first cancer was BC. The second primary cancer was Thyroid. Weight gain can be commonly associated with thyroid dysfunction. The weight gain started in Nov/Dec 2012 and rapidly moved up. TSH was normal. Docs denied there could be a thyroid problem. May 2013, a goiter was found during yearly CT. I said "SEE". Follow-up TSH and thyroid bx didn't identify any abnormality. Jan 2014, I said we need some basic blood work. I requested autoantibodies test along with the TSH, T3, and T4.
The auto antibodies test: Thyroglobulin was 52(normal range 0-30) and antibodies were normal. Indicative of cancer. (long story very shortened). Thyroid came out. Thyroglobulin drawn day after thyroid removal was 109. Pathology was negative. From the day of receiving the results of the original autoantibodies value, I insisted I had cancer. With the pathology report being negative and my belief I had cancer, my surgeon went behind the scene and insisted that a second opinion be obtained on the pathology. Quest labs found cancer in both lobes. The original pathologist admitted after doing a relook at original bx done in July 2013 and slides from thyroidectomy in Feb 2014 that cancer was present in both samples.
What was common to the two cancers was a sudden unexplained weight gain prior to each cancer diagnosis. Needless to say if they're is another sudden unexplained weight gain I'll be even more pushy than I was after the last one.
We know cancers can be present for a long period in the body before they are manifested. In reference to the study and analysis, does my observation of a sudden weight change have any signaling of cancer developing to point that it can be diagnosed by imaging or labs? For this question to be answered, they're would need to be another study done to look at that specifically. I doubt they could do a relook by meta-analysis at this study b/c it doesn't appear that was included in the specific data inclusion at the beginning of the study.
Interesting?
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Doxie - I am definitely healthier and feeling better with this weight off. I know it is the shock of the MO looking me in the eye at my first appointment and stating that there is estrogen in the extra fat on my body that prodded me into doing something about it. I hadn't believed I could lose the extra pounds that accumulated slowly year after year. Suddenly I was motivated and it worked. I have a simplified view of the cancer in my body. My genes screwed up and didn't shut down the abnormal cells that developed in my breast. Of course, there are many factors that affect how our genes work, and how our immune system works. I am thankful this document wasn't published before December 2013 when I saw my MO for the first time. I wouldn't go back and do it differently, even knowing what I know now.
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Okay, officially done tweeking the post. I contacted the WHI clinical coordinator phone line. I'm going to request the email of the lead researcher re: my question. If I ever get a response I'll let you know.
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Sas-Schatzi -- I found your post to be fascinating and almost didn't read it because I almost didn't read it all the way through. I get sick and tired of breast cancer being blamed on overweight women. Through my breast cancer blog over the past 3.5 years, I have talked to hundreds if not over a thousand women. They are a wide assortment of sizes - MOSTLY normal weight, some overweight, some downright underweight. So as a plus size woman, it angers me that when normal weight women read articles that breast cancer is caused from being fat, they look the other way and think they have a pass because they are not overweight.
But I DEFINITELY could relate to what you said about a SUDDEN unexplained weight gain. I gained about 35 pounds over the 18 months before my Stage 3a diagnosis - had not changed my diet. Then recently, my 55 year old sister gained 35 pounds with no explanation. Guess what? She was just diagnosed Stage 3c (dense breast tissue - mammogram didn't pick up tumor previously) - in fact she is undergoing Chemo #2 today. I wondered about my weight gain, but then when I saw hers and her diagnosis, it really made me wonder--wonder so much I have been trying to research this connection to no avail.
Until I read all of your post!
Thanks for your post and sharing your experiences
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Denise, Yes, it's a wonder isn't it. I also tried to research it and couldn't find anything. We were cross posting. I added to my last post that I'm contacting the clinical coordinator of the WHI. What would be marvelous is if the data related to weight gain history was there in the data and the significance was "not seen".
I would suggest that you reread my original post because I tweeked it a little bit even after I said I was done.
When I brought this question up to my docs their eyes glazed over individually. Question dismissed. The doc that I was disappointed in when he dismissed the observation was my world class thyroid doc. His primary thing for his career has been research.
Here we have four examples just in these limited number of 7 posters ---you, your sister, Bad_at_User, me--4. Possibly Gramma.
Gramma and Bad what was your history of gain related to diagnosis of BC?
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I am not sure in retrospect I should have posted this article. I felt it was interesting but only mildly relevant to most of us........
In this paper researchers are studying women who have NEVER BEEN DIAGNOSED WITH BC ( also including a small number of women who were diagnosed more than 10 years before the start of the study). I think it is an error to assume that these results apply to most of us ---- women who have already been diagnosed with bc and are concerned about a 2nd primary bc or more importantly to a distal recurrence. I don't think we can even assume the results apply to women who are high risk for bc but haven't already been diagnosed. The only thing we can say is that these results may apply to some women in the general population and to be fairly certain of that more studies are needed. Look at the 2nd link at the bottom of my original post and read the details in the published JAMA Oncology article.
I for one am going to keep my weight down and if I gain weight I am going to try to lose it!
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I just pmed this to Sas abd thought it may help to add it here:
Fascinating stuff. I know I had quit smoking 2 years ago and had always been 98 pounds. I gained thirty pounds in a year. That is a lot of weight at 5 foot. I have been working on loosing the weight and have lost 12 of those 30 pounds.
I can tell you I put the 30 pounds on in like 6 months. The lump suddenly appeared right after the weight gain. I really thought the lump was going to come back as fat necrosis.
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Oh Besa, Au Contraire, I think it's fantastic that you posted these links. It gives me a point place to seek more info.
This is the link to the WHI
https://www.whi.org/SitePages/WHI%20Home.aspx
This is the opening statement on the WHI Homepage. ( Included here in case the link is broken)
"Welcome to the Women's Health Initiative
The Women's Health Initiative (WHI) is a long-term national health study focused on strategies for preventing heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Launched in 1993, the WHI enrolled 161,808 women aged 50-79 into one or more randomized Clinical Trials (CT), testing the health effects of hormone therapy (HT), dietary modification (DM), and/or calcium and Vitamin D supplementation (CaD) or to an Observational Study (OS). At the end of the initial study period in 2005, the WHI Extension Study (2005-2010, 2010-2015) continued follow-up of all women who consented.
This ground-breaking study changed the way health care providers prevent and treat some of the major diseases impacting postmenopausal women. Results from the WHI Hormone Trials have been estimated to have already saved $35.2 billion in direct medical costs in the US alone. To date, WHI has published over 1,000 articles and approved 340 ancillary studies.
Interested scientists are encouraged to submit paper and ancillary study proposals for using WHI data. To assist in this, this website includes an overview of WHI, study documentation, and information on how to submit a paper or ancillary study proposal. "
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With a study like this the enrollee's have to answer sooooo many questions. Researchers then do meta-analysis study by developing a core group of questions. Those questions then are plugged into the computer to search the parameters of keywords that answer the specific search. This study specifically address BMI, Weight gain > %5, Weight loss >5%, and BC. The researcher in this case defined the...... "Objective To investigate in this secondary analysis( ancillary study) the associations of overweight and obesity with risk of postmenopausal invasive breast cancer after extended follow-up in the Women’s Health Initiative (WHI) clinical trials."
The researcher et all had a theory. She and the cohort sought material to support their theory. They think they have proven their point. The analysis quoted this from the study: "Women with normal BMIs who gained more than 5% of their body weight during follow up increased their breast cancer risk relative to women with stable weight (HR 1.36; 95% CI 1.11-1.65). The investigators speculated that weight-gain induced increases in breast adipocytes, and exposure to cytokines and estrogens might explain this finding".
"The investigators speculated". Speculation doesn't make it true. They identified that women with normal body weight that gained > 5% during the follow-up had an increased risk.
My theory: Is there is a protective mechanism within the body to gain weight as a means to help the body fight off cancer".
If the Women's Health Initiative included a time line from weight gain to diagnosis of BC, and that time line could be defined within a statistically significant range, then that would be a beginning to a new area of study.
They're was a study so many years ago, I wouldn't even begin to know how to find it. But this is what I remember of it, people that had a 25-30 lb higher weight than the weight charts (of the time since revised-higher) had a better ability to fight off illness than those in the normal weight range(of the time). The reason I remember this is b/c I thought to myself --Good, I'm right there.
Conversely, If the body does have a protective mechanism of gaining weight, does that explain the weight loss in cancer when that protective mechanism fails. Weight loss of unknown origin has it's own ICDM-9 code. The reason is when weight loss is unexplained, it is associated with certain diseases. I'll state the most common. Diabetes, thyroid, and cancer. Those are the three biggy rule outs when a doc is presented with a patient that presents with unusual weight loss.
So, to combine the two thoughts as specific to cancer.
According to the scientific method the first step is the question. Is there is a protective mechanism within the body to gain weight as a means to help the body fight off cancer? If the body does have a protective mechanism of gaining weight, does the weight loss in cancer mean that protective mechanism failed? Can that protective mechanism be reversed once it has failed?
Hypothesis(Theory next step in the scientific method that directs the study): The body has a protective mechanism to gain weight when internal mechanisms identify cancer. That protective mechanism can fail. Once it fails, it can be reversed.
Cool, those that have a science background will get this. Those that don't won't. They will think I'm bonkers. LOL.
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I went from 183.5 pounds down to 125 pounds in 6 months after maintaining that weigh approximately 1 years I was diagnosed with one ilc and one idc er+ tumors.
With the AI meds weight started going up.
I loved being 125 and plan to achieve it again I felt so good. I did 1 hour on the treadmill everyday and counted calories. The exemestane seems to be fighting with me but I will get the weight off.
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My weight gain was gradual, starting with my first pregnancy in 1973. In July of 2012, I was at a high of 207. When I was diagnosed with BC in September 2012, I was 201. When I met with the MO in early December 2012, I weighed 199 pounds, and started Arimidex. That is when I got serious about losing the extra pounds and believed I was doing it to improve my health and decrease my cancer recurrence risk. At the end of June 2014, I was at 193 (not a huge decrease). We headed north in our motorhome for three months and I stopped Arimidex for three months because of capillaritis in my right leg. I didn't weigh myself until the end of September and was at 170. I restarted Arimidex because the capillaritis did not go away. The next month, I was at 165 and have wavered between 165 and 168. At my December 2014 appointment with my MO, he switched me to Tamoxifen (and I can sleep once again). Recently I have been consistently below 165 and the low point is 163.
I can't blame my increase of weight on my BC. I honestly didn't believe I could lose weight without going to a gym five days a week. And I wasn't willing to commit to that. I did commit to walking 7500 steps a day though and enjoy that (so does our little dog). And the combination of eliminating sugar, selecting foods more carefully, drinking tons of water and walking seems to have made a huge difference in my life. I don't know that I could have done this without the threat hanging over me. Cancer was a life changing event in my life.
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Interesting theory about BC causing weight gain but I doubt it was true in my case. I had just come back from living in a small rural African village where food was scarce and I was walking miles a day. I simply ate too much and didn't move enough. In fact, I was sedentary for July 2012-May 2013. That's very unusual for me as I love swimming, walking, hiking and otherwise being active. I don't even understand why I stopped exercising - I think I may have been mildly depressed (long, fruitless job search, in a long distance relationship that I didn't see the end of). And this was the only time in my life I hadn't been exercising regularly.
When I moved to NYC for a job in May 2013, I started walking everywhere, lap swimming and eating less. I lost 10 pounds in a few months. But the tumor must've been developing the whole time as I found it at the end of October.
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Hey Besa I did a new topic on sudden weight gain. It's a subject that's been rambling around in my head for awhile. I hope some researcher wanders by and takes a look.
sassyhttps://community.breastcancer.org/forum/73/topic/832722?page=1#idx_2
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