Breast cancer survivors gain more weight than cancer-free women

Breast cancer survivors with a family history of the disease, including those who carry BRCA1 and BRCA2 gene mutations, gained more weight over the course of four years than cancer-free women – especially if they were treated with chemotherapy, according to a prospective study by Johns Hopkins Kimmel Cancer Center researchers.

Data from earlier studies suggest that breast cancer survivors who gain weight may have a higher risk of having their cancer return, the researchers say, noting that gains of 11 pounds or more are also associated with a higher risk of developing cardiovascular disease.

For the study, the researchers reviewed a baseline questionnaire and a follow-up one completed four years later by 303 breast cancer survivors and 307 cancer-free women enrolled in an ongoing and long-term study at the Kimmel Cancer Center of women with a family history of breast or ovarian cancer. Study participants completed a baseline and at least one follow-up questionnaire between 2005 and 2013, and one-quarter of the subjects were premenopausal.

In the four-year span, survivors gained significantly more weight – 3.6 pounds on average – than cancer-free women. Among 180 survivors diagnosed with cancer during the last five years of the study period, 37 (21 percent) gained at least 11 pounds over a four-year period compared with 35 of 307 (11 percent) of their cancer-free peers. The weight change findings remained the same after accounting for other factors associated with weight gain, such as increasing age, transition to menopause and level of physical activity, the researchers say.

Our study suggests that chemotherapy may be one of the factors contributing to weight gain among survivors,” says Kala Visvanathan, M.B.B.S., M.H.S., an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and director of the Clinical Cancer Genetics and Prevention Service at the Kimmel Cancer Center. Women who completed chemotherapy within five years of the study were 2.1 times as likely as cancer-free women to have gained at least 11 pounds during the study.

There is limited data on weight change in breast cancer survivors, including those at higher risk for the disease compared to the general population,” Visvanathan says. “A lot of studies have focused on breast cancer survivors alone, so we don’t get a sense of whether women without cancer gain more or less weight, or whether the gain is due to the cancer or the treatment.”

Results of the study by Visvanathan and her colleagues appear online in Cancer Epidemiology, Biomarkers & Prevention.

Using information from study subjects’ answers in detailed questionnaires, along with their medical records, the scientists controlled for such factors as age, menopausal status, physical activity, the presence of cancer-linked mutations in the BRCA genes, and weight at the start of the study when they compared gains in survivors and cancer-free women.

The researchers say they also found a high prevalence of overweight women among the group of 303 breast cancer survivors and 307 cancer-free women with a family history or inherited predisposition for breast cancer, including those who carry BRCA1 or BRCA2 gene mutations, with 46.9 percent of survivors and 55.1 percent of cancer-free women who were overweight or obese.

In addition, breast cancer survivors diagnosed within five years before their baseline weight measurement and who had invasive disease and cancer cells lacking receptors for estrogen gained an average of 7.26 pounds more than cancer-free women.

Statin users among breast cancer survivors treated with chemotherapy also gained more weight – an average of 10 pounds more – than cancer-free women who used statins, as well as survivors and cancer-free women who did not use the cholesterol-blocking drug.

Above and beyond age and menopausal status, there seems to be a weight gain associated with treatment of cancer, particularly in women having chemotherapy and those diagnosed with estrogen receptor-negative, invasive cancers,” says Amy Gross, M.H.S., a doctoral candidate in epidemiology at the Bloomberg School of Public Health.

The Johns Hopkins study adds to an emerging body of evidence that chemotherapy can lead to weight gain in cancer survivors, Visvanathan noted, but it’s not clear why the treatment has this effect. Some scientists suggest that chemotherapy increases inflammation and insulin resistance, disrupting metabolism and producing weight gain. Patients treated with chemotherapy may also be less physically active and prone to weight gain as a result.

We’re looking at biomarkers in urine and blood in our survivors and in women who are cancer-free to look for the biochemical changes that may be related to this higher weight gain,” Visvanathan says.

The researchers plan to continue following the full study group every three to four years to determine how the women’s weight changes over a longer period of time.

Noting the limits of the study and the need for longer follow-up, Visvanathan cautions that “we’re not yet suggesting any weight gain intervention at the time of chemotherapy.”

But we are suggesting that oncologists, internists or anyone treating breast cancer survivors, including those with a family history of the disease, could help them monitor their weight over the long term,” she adds.

The scientists note that the majority of subjects in the current study are Caucasian, which limits their ability to apply their findings to women of other ethnic backgrounds. The study’s reliance on self-reported weight also can be subject to bias or error, but the scientists found a high degree of similarity between self-reported and measured weight among a subgroup of the study participants.

Gross et al. Weight Change in Breast Cancer Survivors Compared to Cancer-Free Women: A Prospective Study in Women at Familial Risk of Breast Cancer. Cancer Epidemiol. Biomarkers Prev. 2015; doi:10.1158/1055-9965.EPI-15-0212 [Abstract]


Breast cancer diagnoses, survival varies by race, ethnicity

Among nearly 375,000 U.S. women diagnosed with invasive breast cancer, the likelihood of diagnosis at an early stage, and survival after stage I diagnosis, varied by race and ethnicity, with much of the difference accounted for by biological differences, according to a study in JAMA.

In the United States, incidence rates of breast cancer among women vary substantially by racial/ethnic group. Race/ethnicity and sociodemographic factors may influence a woman’s adherence to recommendations for clinical breast examination, breast self-examination, or screening mammogram and the likelihood of her seeking appropriate care in the event that a breast mass is noticed. A growing body of evidence suggests that biological factors may also be important in determining stage at diagnosis (i.e., the growth rate and metastatic potential of small-sized breast cancer tumors may vary between women due to inherent differences in grade and other or unknown pathological features), according to background information in the article.

Javaid Iqbal, M.D., of Women’s College Hospital, Toronto, and colleagues examined the proportion of breast cancers that were identified at an early stage (stage I) in different racial/ethnic groups in the United States and whether ethnic differences may be better explained by early detection or by intrinsic biological differences in tumor aggressiveness. The study included women diagnosed with invasive breast cancer from 2004 to 2011 who were identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database (n = 452,215). For each of 8 racial/ethnic groups, biological aggressiveness (triple-negative cancers [negative for estrogen receptor, progesterone receptor, and ERBB2 (formerly HER2 or HER2/neu)], lymph node metastases, and distant metastases) of small-sized tumors of 2.0 cm or less was estimated. In addition, the odds were determined for being diagnosed at stage I compared with a later stage, as was the risk of death from stage I breast cancer by racial/ethnic group.

Of 373,563 women with invasive breast cancer, 268 675 (71.9 percent) were non-Hispanic white; 34,928 (9.4 percent), Hispanic white; 38,751 (10.4 percent), black; 25,211(6.7 percent), Asian; and 5,998 (1.6 percent), other ethnicities. Average follow-up time was 40.6 months. The researchers found that Japanese women were significantly more likely to be diagnosed at stage I (56.1 percent) than non-Hispanic white women (50.8 percent), while black women were less likely to be diagnosed at stage I (37.0 percent), as were women of South Asian ethnicity (Asian Indian, Pakistani) (40.4 percent).

The 7-year actuarial risk for death from stage I breast cancer was highest for black women (6.2 percent) compared with white women (3.0 percent); it was 1.7 percent for South Asian women. The probability of a woman dying due to small-sized breast cancer tumors (2.0 cm or less) was significantly higher for black women (9.0 percent) compared with non-Hispanic white women (4.6 percent).

The authors write that much of the difference in diagnosis and survival could be statistically accounted for by intrinsic biological differences such as lymph node metastasis, distant metastasis, and triple-negative behavior of tumors.

Iqbal et al. Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA. 2015;313(2):165-173. doi:10.1001/jama.2014.17322 [Article]

14 Inspiring Breast Cancer Quotes

Being diagnosed with breast cancer is a life-changing experience. It can be hard to handle the news at first, and even harder to know how to proceed, no matter your prognosis.

While everyone’s journey is unique, knowing that others before you have been through something similar can give you the strength and inspiration you need to keep everything in perspective.

Click through slideshow for the type of wisdom gained from great personal struggle, and know that you’re not alone.

Written by Rachael Maier

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Expressive writing may help breast cancer survivors

Chinese-speaking breast cancer survivors are the focus of this study

Writing down fears, emotions and the benefits of a cancer diagnosis may improve health outcomes for Asian-American breast cancer survivors, according to a study conducted by a researcher at the University of Houston (UH).

The key to developing an expressive writing intervention is the writing instruction. Otherwise, writing is just like a journal recording facts and events. Writing a journal can be therapeutic, but often we don’t get the empirical evidence to determine whether it’s effective or not,” said Qian Lu, assistant professor and director of the Culture and Health Research Center at UH.

In my research study, I found long-term physical and psychological health benefits when research participants wrote about their deepest fears and the benefits of a breast cancer diagnosis,” she said.

Lu and colleagues published a study titled, “A Pilot Study of Expressive Writing Intervention Among Chinese-Speaking Breast Cancer Survivors,” in Health Psychology. The goal of her research is to reduce the psychological burden among minority patients particularly among breast cancer survivors.

Cancer patients, like war veterans in Iraq, can experience post-traumatic stress symptoms. Many times when cancer patients get diagnosed, they face lots of emotional trauma. There’s a sense of loss, depression, anxiety about going into treatment and how they are going to face the future,” said Lu. “They have a lot of emotional events going on in their life.”

In her research, Lu, found little attention paid to Asian-American breast cancer survivor’s psychological needs. Previous studies largely focused on non-Hispanic white samples, and she found a need to research this understudied population. Some of the challenges she noted with this population were feeling stigmatized, shame associated with cancer, cultural beliefs of bearing the burden alone to avoid disrupting harmony, suppressing emotions, and a lack of trained mental health professionals with cultural and linguistic competency.

We thought of a very interesting way to help this problem. It’s actually fairly basic. It’s to express emotions using writing,” she said. “What’s so interesting is that it has been proven as a scientific paradigm.”

According to Lu, previous research found that writing about emotionally difficult events for just 20 to 30 minutes at a time over three or four days increased the immune function. The release offered by writing had a direct impact on the body’s capacity to withstand stress and fight off infection and disease.

I based my study for Chinese-speaking breast cancer survivors on Pennebaker’s research paradigm, and we have conducted a series of studies to modify the paradigm for Asian-Americans” said Lu.

Rather than going to a hospital, Lu worked with a community-based partner to recruit participants. Lu’s research team asked participants to complete a standardized health assessment and then they were asked to write 20 minutes each week for three weeks. Three sealed envelopes were mailed simultaneously to the participants with each envelope containing different writing instructions for the corresponding week. Questionnaires assessing health outcomes were mailed to participants at three and six months after the completion of the writing assignments. Semi-structured phone interviews were conducted after the 6-month follow-up.

The findings from the study suggest participants perceived the writing task to be easy, revealed their emotions, and disclosed their experiences in writing that they had not previously told others. Participants reported that they wrote down whatever they thought and felt and perceived the intervention to be appropriate and valuable,” said Lu.

Lu added that health outcomes associated with the expressive writing intervention include a decrease of fatigue, intrusive thoughts, and reducing posttraumatic stress after three months. She also noted a decrease of fatigue, posttraumatic stress, and the increase of qualify of life and positive affect after six months.

Lu notes this research study contributes to the growing literature of expressive writing by illustrating the feasibility and potential benefits among Chinese-speaking breast cancer survivors using a community-based participatory research approach and a mixed method design. The results of the intervention demonstrate that writing was associated with health benefits at long-term follow-ups and how to adapt and utilize expressive writing intervention for minorities.

Lu et al., (2014). A Pilot Study of Expressive Writing Intervention among Chinese Speaking Breast Cancer Survivors. Health Psychol., 31: 548–551. doi: 10.1037/a0026834 [Article]