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What is the relationship between breast cancer and taking weight?
Dr. David Elia There increasingly survivors cancer and in particular breast cancer . This is related to medical advances and treatments more effective. In France, 40,000 new cases of breast cancer are diagnosed annually and 75-80% of women survive during the first year and resume their lives forever. Among the problems after breast cancer , figure the weight gain. In fact, women who have had breast cancer are on average 2.5 to 4 kg in a year, especially if they followed chemotherapy (1). In some women, this increase in weight can reach up to 12 kg. We also observe that obese women often have cancer recurrence than thinner? The question is whether losing weight is actually beneficial in the prevention of recurrence cancer. Indeed, if after the ordeal of cancer, it is necessary to fight for weight management, you really make it worth the shot (beyond the cardiovascular benefit).
What are the causes of weight gain after cancer?
Dr. David Elia: Chemotherapy is a factor contributing to weight gain .Specifically, chemotherapy tends to increase fat mass and lean mass decrease slightly. Stress and anxiety generated by cancer and supported, can lead to changes in eating behavior and overweight. Age also plays a role because with time the basic metabolism decreases and energy needs. Thus, it naturally tends to gain weight with age, which is particularly visible between 50 and 60 years. Fatigue and depression, almost inevitable in cancer, logically accompanied by a decline in untreated menopause physique.La activity (hormone treatment is cons-indicated in cases of breast cancer) and estrogen deficiency which promotes the localization of fat on the abdomen and upper body, as in hommes.Et finally, adjuvant hormonal therapies (anti-aromatase), which administered for several years after surgery, chemotherapy and / or radiotherapy, are the source of great fatigue and joint pain are not conducive to physical activity and conducive to weight gain .
All women are equal in front of this weight gain?
Dr. David Elia: It seems that menopausal women take less weight than younger women. A study shows for example that pre-menopausal women at the time of diagnosis of cancer breast tend to take 2 kg on average, against 1.3 kg when they are in their first year of menopause or no while when postmenopausal for many years, as if menopause was a protective factor. Body mass index ( BMI ) at diagnosis appears to play a role: they are the thinnest women who take the most weight . Conversely, those who were obese are those who take the least. However, do not enact major rules, here are indications of trends. Changes in weight are based on each person.
Weight gain does deteriorates prognosis of cancer?
Dr. David Elia: Apparently so, if we compare the risk of death from breast cancer. According to an American study, a weight stable or decrease in weight has no influence. In contrast, a significant increase in BMI increases the risk of death.
How to explain the influence of weight on breast cancer prognosis?
Dr. David Elia: It is likely that this relationship is explained by the increase in the secretion of insulin, inherent in overweight. A growth factor called IGF-1 also intervene in stimulating malignant cells. Meanwhile, excess adipose tissue (fat) results in high production of estrogen (from adrenal androgens), hormones stimulate the proliferation of cancer cells. Thus, obese women, even if they are menopausal, have higher levels of circulating estrogen than women without overweight . We know that this is one of the mechanisms of the increased risk of death and risk of recurrence.
What can we do to maintain a healthy weight and not fat?
Dr. David Elia: Some studies have focused on two strategies: reducing the amount of fat provided daily through diet or increase the amount of fruits and vegetables . In the first case, the goal was to reduce dietary fat to less than 15% of daily intake (which is very restrictive: Food most of us understands 30-35% fat or even 40%). Five years later, the risk of recurrence decreased by 24% compared to women who did not change their diet. Considering that some women have positive hormonal receptors called (the majority of women, 80-90%) and other negative hormone receptors, things get complicated: the former have a lower risk of recurrence by 15 % (which is very little compared to the severity of the regime) and the second 42%. In other words, the benefit of reducing dietary fat is important for a minority of women and modest for most, but that we understand why. The second protocol included two groups: the first group of women was assigned to follow a diet with 5 fruits and vegetables a day, more than 30% fat and 20g of fiber. In the second, women have more binding regime with 5 servings per day of vegetables, 3 servings of fruits, one fruit juice , from 15 to 20% fat and 30% fiber. Women who adhere perfectly to the first plan and who are physically active have a halving of the risk of recurrence compared with women who continued to eat normally. The second scheme provides no additional benefit, especially after 7 years, adherence to recommendations is very poor. In other words, no need to impose a very strict diet, which may not be followed. Increase consumption of fruits and vegetables to 5 servings per day and reduce fat intake to 30% is more than enough to obtain benefits. We find this notion with physical activity is beneficial in moderate doses, while a very intense practice does not have much extra interest, unless you have a significant obesity.
What are the current recommendations?
Dr. David Elia: The American Society of Clinical Oncology (ASCO) has made the following recommendations: If normal BMI: ensuring maintain poids.En case of BMI between 25 and 30 (overweight): lose weight moderate way (3-5 kg) .If obese (BMI over 30) lose weight by setting reasonable target of 10% of the body weight. To do this, reduce overall daily intake, reduce the share of 20% fat and practice regular physical activity (3-5 hours of sport per week). We note that chemotherapy tends to gain weight, it is beneficial to ensure counter this, without having to join a drastic diet.
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