Why should overweight and obese breast cancer patients lose weight?

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– Have you been diagnosed with breast cancer?

 

Here is why you should lose weight if you were overweight or obese before diagnosis, or if you gained weight during breast cancer treatment:

 

a) Obesity decreases breast cancer treatment efficacy:

 

  1. Triple negative patients without positive lymph nodes have a worst prognosis than normal weight patients.  – Bonsang-Kitzis si colab., 2015
  2. Obesity decreases ER+/PR±/HER2+ breast cancer survival by diminishing Tamoxifen and Herceptin treatments efficacy. – Pande et al., 2014
  3. Overweight and obese non-metastatic breast cancer patients have a lower response to neoadjuvant chemotherapy – Litton et al., 2008
  4. Weight gain during chemotherapy increases the risks of recurrence and mortality – Thivat, 2010
  5. The antiestrogenic treatment with aromatase inhibitors (Letrozole, Anastrozole or Exemestane) has less efficacy in postmenopausal obese breast cancer patients – Ioannides et al. 2014

 

b) Obesity increases the incidence and amplitude of breast cancer treatment side effects:

 

  1. Obesity increases the risk of risk of persistent pain after breast cancer surgery. – Ding et al., 2017
  2. Obesity is associated with a nearly 12-fold increased odds of a postoperative complication after elective breast procedures. – Chen et al., 2011
  3. Obesity increases breast cancer secondary lymphedema risk. – DiSipio et al., 2013
  4. Obesity increases radiotherapy skin toxicity. – Kraus-Tiefenbacher et al., 2012
  5. Obesity associates an increased risk of depression – Ishii et al., 2016
  6. Increased adiposity decreases vitamin D bioavailability – Parikh et al., 2004

 

c) Breast cancer patients obesity increases the risk of metastasis:

 

  1. Obesity increases metastasis risk and decreases survival in  ER-/PR±/HER2+ breast cancer patients – Mazarella et al., 2013
  2. Obesity increases the risk of lung and liver metastasis, and chemotherapy is less efficient in obese breast cancer patients – Osman and Hennessy, 2014
  3. Obesity increases metastasis risk – Strong et al., 2015; Dowling et al., 2016
  4. Obesity increases lung metastatis risk – Nagahashi et al., 2016
  5. Obesity increases metastasis risk and decreases survival in  ER-/PR±/HER2± breast cancer patients – Wu et al., 2017

 

d) Obesity decreases breast cancer patients overall survival:

 

  1. Obesity is an indepenedent factor that increases the risks of metastasis and breast cancer specific mortality, adjuvant therapies efficacy being lower in obese and overweight breast cancer patients – Ewertz et al., 2010
  2. Obesity decreases overall survival independently of lymph node positivity – Kaviani et al., 2013
  3. Obesity and diabetes have a negative impact on breast cancer survival – Jiralerspong et al., 2013
  4. Obesity is an independent factor risk that decreases overall survival in ER+/PR±/HER2- postmenopausal breast cancer patients with lymph node involvment – Arce-Salinas et al., 2014Scholtz et al., 2015
  5. Obesity decreases overall survival in ER+ breast cancer patients younger than 40 years of age – Copson et al., 2015
  6. Obesity increases breast cancer patients risk of mortality  – Chan and Norat, 2015

 

References:

 

Arce-Salinas, C., et al. “Overweight and obesity as poor prognostic factors in locally advanced breast cancer patients.” Breast cancer research and treatment 146.1 (2014): 183-188.

 

Bonsang-Kitzis, Hélène, et al. “Beyond axillary lymph node metastasis, BMI and menopausal status are prognostic determinants for triple-negative breast cancer treated by neoadjuvant chemotherapy.” PloS one 10.12 (2015): e0144359.

 

Chan, Doris SM, and Teresa Norat. “Obesity and breast cancer: not only a risk factor of the disease.” Current treatment options in oncology 16.5 (2015): 1-17.

 

Chen, Catherine L., et al. “The impact of obesity on breast surgery complications.” Plastic and reconstructive surgery 128.5 (2011): 395e-402e.

 

Copson, E. R., et al. “Obesity and the outcome of young breast cancer patients in the UK: the POSH study.” Annals of Oncology 26.1 (2015): 101-112.

 

Ding, Yuan-Yuan, et al. “Body mass index and persistent pain after breast cancer surgery: findings from the women’s healthy eating and living study and a meta-analysis.” Oncotarget 8.26 (2017): 43332.

 

DiSipio, Tracey, et al. “Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis.” The lancet oncology 14.6 (2013): 500-515.

 

Dowling, R. J. O., et al. “Abstract P2-02-09: Obesity associated factors are inversely associated with circulating tumor cells in metastatic breast cancer.” (2016): P2-02.

 

Ewertz, Marianne, et al. “Effect of obesity on prognosis after early-stage breast cancer.” Journal of Clinical Oncology 29.1 (2010): 25-31.

 

Ioannides, S. J., et al. “Effect of obesity on aromatase inhibitor efficacy in postmenopausal, hormone receptor-positive breast cancer: a systematic review.” Breast cancer research and treatment 147.2 (2014): 237-248.

 

Ishii, Shinya, et al. “The association between sarcopenic obesity and depressive symptoms in older Japanese adults.” PloS one 11.9 (2016): e0162898.

 

Kaviani, Ahmad, et al. “Effects of obesity on presentation of breast cancer, lymph node metastasis and patient survival: a retrospective review.” Asian Pac J Cancer Prev 14.4 (2013): 2225-9.

 

Kraus-Tiefenbacher, Uta, et al. “Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS).” Radiation Oncology 7.1 (2012): 217.

 

Mazzarella, Luca, et al. “Obesity increases the incidence of distant metastases in oestrogen receptor-negative human epidermal growth factor receptor 2-positive breast cancer patients.” European Journal of Cancer 49.17 (2013): 3588-3597.

 

Nagahashi, M., et al. “Abstract P2-05-11: Sphingosine-1-phosphate signaling promotes metastatic niches and lung metastasis in obesity-related breast cancer.” (2016): P2-05.

 

Osman, Mohammed A., and Bryan T. Hennessy. “Obesity Correlation With Metastases Development and Response to First-Line Metastatic Chemotherapy in Breast Cancer.” Clinical Medicine Insights. Oncology 9 (2014): 105-112.

 

Parikh, Shamik J., et al. “The relationship between obesity and serum 1, 25-dihydroxy

 

Pande, Mala, et al. “Association between germline single nucleotide polymorphisms in the PI3K-AKT-mTOR pathway, obesity, and breast cancer disease-free survival.” Breast cancer research and treatment 147.2 (2014): 381-387.

 

Jiralerspong, S., et al. “Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients.” Annals of oncology (2013): mdt224.

 

Litton, Jennifer K., et al. “Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer.” Journal of Clinical Oncology 26.25 (2008): 4072-4077.

 

Scholz, Christoph, et al. “Obesity as an independent risk factor for decreased survival in node-positive high-risk breast cancer.” Breast cancer research and treatment 151.3 (2015): 569-576.

 

Strong, Amy L., et al. “Leptin produced by obese adipose stromal/stem cells enhances proliferation and metastasis of estrogen receptor positive breast cancers.” Breast Cancer Research 17.1 (2015): 112.

 

Thivat, Emilie, et al. “Weight change during chemotherapy changes the prognosis in non metastatic breast cancer for the worse.” BMC cancer 10.1 (2010): 648.

 

Wu, Yong, et al. “Aberrant phosphorylation of SMAD4 Thr277-mediated USP9x-SMAD4 interaction by free fatty acids promotes breast cancer metastasis.” Cancer Research (2017): canres-2012.

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About the Author

Diana Artene

Sunt Nutritionist-Dietetician, Master in Nutritie si Doctor in Nutritie Oncologica, Nutritionist Sportiv acreditat de Societatea Internationala de Nutritie Sportiva si membru al American Society for Nutrition și al European Society of Medical Oncology.