Challenge Your Expert:
Supportive Care in Breast Cancer
The Significance of Life Style
Alessandra Fabi
Bologna, 29-30 Marzo 2017
VOLONTA’
WILL
VOLUNTAD
WERDEN
VOLONTE’
Cause Prevenibili di Neoplasia
33%
33%
8%
5%
4% 17% Stili di Vita
Fumo
Infezioni Virali Fattori
occupazionali Cause ambientali Altro/Non noto
Rapporto AIRTUM 2016 Tutti i tipi di neoplasia
• Abuso di alcol
• Obesità
• Inattività fisica
Management of Comorbidities
The presence of cardiovascular disease, chronic obstructive pulmonary disease or diabetes increased breast cancer-specific mortality by between 10% and 24%
Age and Comorbidities at the time of diagnosis:
the largest effects on mortality from causes other than breast
cancer
1) Phisycal Exercise
2) Diet & Weight gain
1) Alcohol & Smoke
Nell’ambito della Prevenzione Primaria diversi studi hanno valutato la correlazione Attività Fisica/Incidenza per alcuni tumori.
Esercizio fisico e cancro
TIPO DI TUMORE Numero
di studi Trend di efficacia in base al livello di AF e grado di evidenza scientifica
TUMORE AL COLON +++ Buone evidenze di riduzione di incidenza di patologie
TUMORE AL RETTO +++ Nessuna differenza tra categorie di “fitness” e livelli di AF
TUMORE ALL’ENDOMETRIO +++ Buone evidenze di riduzione di incidenza di patologie
TUMORE ALLA MAMMELLA +++ Ottime evidenze di riduzione di incidenza di patologie
TUMORE ALLA PROSTATA +++ Alcune evidenze di riduzione di incidenza di patologie
TUMORE AI POLMONI +++ Nessuna differenza tra categorie di “fitness” e livelli di AF
TUMORE AL PANCREAS ++ Nessuna differenza tra categorie di “fitness” e livelli di AF
+ Pochi studi scientifici ++ Tra 5 e 10 studi scientifici +++ Più di 10 studi scientifici
Mod. da: ACSM’s Guidelines for exercise testing and prescription, 7°
edition, 2005
Moore SC JAMA Intern Med 2016
A higher level of leisure-time physical activity was associated with lower risk for 13 of the 26 types of cancer
1. Che tipo di attività fisica?
Non esistono studi di confronto aerobica vs anaerobica
2. Come misurare l’attività fisica?
Equivalente Metabolico –o MET- cioè ml di O
2consumato per kg di massa corporea per minuto
Ma…
116.304 women
Stratified analysis Prizot, Eur J Cancer 2016
highest versus lowest category of physical activity
hours per week or in hours of metabolic equivalent per week (MET-h/week).
a physically inactive women engaging in at least 150 min per week of vigorous physical activity would reduce their lifetime risk of breast cancer by 9%, a reduction that might be
two times greater in women who never used HRT.
Physical activity and never use HRT: excellent double win
Pizot, Eur J Cancer 2016
Nessuna differenza fra gli stadi (II vs III) Maggiore beneficio per la malattia ER+
older/post-menopausal women;
those engaging in at least 10 MET- hours of physical activity per week had a 27 % reduction in all-cause mortality) and a 25 % reduction in breast cancer-specific mortality (compared with women per- forming \10 MET-hours/week
adhesion to the PA Guidelines may be an important intervention target for reducing
mortality among breast cancer survivors
Fatigue
HR-QoL
Yoga & Breast Cancer
Wheight gain (after BC diagnosis)
Weight gain after diagnosis has been associated with a higher rate of breast cancer recurrences and with worse OS
-Analysis in stage I to III BC, each 5-kg gain was associated with a 12% increase in all-cause mortality, a 13% increase in breast cancer specific mortality, and a 19% increase in cardiovascular disease mortality (1).
- Weight gain of greater than 10% was associated with breast cancer–specific mortality (p=.05); but no amount of weight gain was associated with an increase in breast cancer recurrences. (2)
1. Nichols HB, Cancer Epidemiol Biomarkers Prev. 2009;
2. laydon MC, J Natl Cancer Inst 2015
Analysis 3993 pts
Quali sono le cause?
Le basi fisiopatologiche sono da ricercarsi nella disregolazione metabolica ed endocrinologica tipica dell’obesità.
Insulino resistenza (Insulina e IGF-1)
Stato proinfiammatorio (IL-6, TNFα, PCR)
Neoangiogenesi (PAI-1, VEGF)
Incremento di Leptina ed Adiponectina
Proliferazione Sopravvivenza Invasività
Metastatizzazione
BMI and Breast Cancer
Guenancia, J Clin Oncol 2016
Obesity As a Risk Factor for Anthracyclines and Trastuzumab
Cardiotoxicity in Breast Cancer: Systematic Review and Meta-Analysis
Overweight BMI 25-29=
Obesity BMI > 30=
8745 pts
How to avoid or improve weight gain after BC?
Interventions
✔ Avoid side effects from therapy….but…
✔ diet, physical activity, and behavior modification, personalized lifestyle telephone counseling with face-to-face group-based education. Several studies used a commercial weight loss programs, such as Weight Watchers and/or Curves , teleconferencing for breast cancer survivors in rural locations.
BUT
limited number of interventional studies, small sample sizes, and short duration of follow-up in many studies limit our ability to draw conclusions regarding the most efficacious weight-loss intervention after a breast cancer diagnosis
Playdon M, Curr Breast Cancer Rep. 2013
SABCS 2016
The Intestinal Microbiome and ER+ BC
Kwa, JNCI 2016
Alcohol and BC
Lace Cohort
1867 pts early BC Whel Trial
3088 pts early BC After BC Pooling Project 9329 pts
The association between alcohol
intake and recurrence may
depend on
menopausal status at BC diagnosis
Alcohol intake was not associated with overall
mortality, possibly because of a
cardioprotective effect and a reduction in
noncancer deaths
Light alcohol intake did not increase the risk of BC recurrence or all-cause mortality
in middle-aged women previously diagnosed with BC
Alcohol intake was associated with other
favorable prognostic indicators that may explain its apparent
protective effect in non-obese women Alcohol increased
risk of breast cancer and death
as a result of BC The increased risk of recurrence was most pronounced in postmenopausal
overweight/obese and women
Sternfeld, 2009 Kwan, 2013 Flatt, 2010
Smokers pack-yr
20 -> 34.9 35 -> more current
Recurrence 22% 37% 41%
All cause-mortality 26% 54% 60%
Pierce et al, JNCI 2014
