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]

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Cancer overtakes cardiovascular disease as UK’s No. 1 killer – but only among men

Cardiovascular disease still primary cause of death among women

Cancer has overtaken cardiovascular disease, which includes heart disease and stroke, as the UK’s No 1 killer- but only among men, reveals research published online in the journal Heart. Cardiovascular disease is still the most common cause of death among women, and kills more young women than breast cancer, the figures show.

The researchers used the latest nationally available data (2012-13) for each of the four UK countries and the Cardiovascular Disease Statistics 2014 report compiled for the British Heart Foundation (BHF) to quantify the prevalence of cardiovascular disease, and find out how it’s treated, how much it costs, and how many deaths it causes. Cardiovascular disease includes coronary heart disease, stroke, high blood pressure, circulatory system disease, and other vascular/arterial disease.

The researchers analysed entries to the Clinical Practice Research Datalink GOLD database, the world’s largest repository of anonymised records for primary care, plus information from the family doctor (GP) quality improvement scheme known as QOF, and figures on episodes of inpatient hospital care. The analysis indicated that just short of 2.3 million people were living with some form of coronary heart disease in 2012. Around half a million were living with heart failure and a further 1.1 million were living with abnormal heart rhythm (atrial fibrillation).

England had the lowest prevalence of all cardiovascular conditions out of the four UK countries. But there were regional variations, with higher rates of cardiovascular disease in the North of England than in the South of the country. Scotland had the highest prevalence of coronary heart disease, stroke, and peripheral vascular disease, while Wales had the highest prevalence of high blood pressure, heart failure, and atrial fibrillation.

For the first time since the middle of the 20th century, cancer overtook cardiovascular disease as the primary cause of death in 2012. The proportion of deaths attributable to cancer was 29% while cardiovascular disease accounted for 28%.

But this was only true of men; cardiovascular disease still killed more women than cancer.

Almost one in three deaths (32%) in men were caused by cancer compared with 29% for cardiovascular disease. The equivalent figures were 27% and 28%, respectively, for women.

Cardiovascular disease accounted for a total of nearly 42,000 premature deaths (before the age of 75) in 2012, accounting for more than one in four premature deaths in men and around one in five (18%) in women. But it still killed more young women than did breast cancer.

Once again, there were wide regional variations in death rates. There were higher rates in Scotland (347/100,000 of the population) and the North of England (320/100,000), and lower rates in the South of England. The City of Glasgow topped the league table for death rates from cardiovascular disease for all ages, including premature deaths.

The number of surgical procedures and drugs prescribed to treat and prevent cardiovascular disease has risen substantially over the past two decades, and in 2012-13 the NHS spent just under £7 billion in England alone on cardiovascular disease, the largest chunk of which was spent on hospital care.The equivalent cost in Wales was £442.3 million, £393 million in Northern Ireland, and more than £750 million in Scotland.

Cardiovascular disease remains a substantial burden to the UK, both in terms of health and economic costs,” write the researchers, highlighting the “stark regional inequalities in the mortality and prevalence of cardiovascular disease.”

In a linked editorial, Dr Adam Timmis, of the NIHR Cardiovascular Biomedical Research Unit at Barts Health, London, describes the more than 40% drop in cardiovascular disease death rates since 1960 as “among the greatest public health triumphs in the past 50 years.” But the continuing North-South divide is a “stain on the UK’s public health record,” he writes.

The BHF report provides a timely reminder that in young women too cardiovascular disease kills more women than breast cancer. Most of these deaths in young women are caused by myocardial infarction heart attack which is largely preventable through modification of risk factors,” he points out.

And if the national effort put into the detection of breast cancer could be matched in protecting young women against myocardial infarction many more lives would probably be saved,” he insists.

Bhatnagar et al. The epidemiology of cardiovascular disease in the UK 2014. Heart. 2015; doi:10.1136/heartjnl-2015-307516 [Article]

Physical activity seems to significantly extend lives of cancer survivors

Reduces mortality by up to 48 percent according to study

Physical activity significantly extends the lives of male cancer survivors, a new study of 1,021 men has found. During the period while the men were followed, those who expended more than 12,600 calories per week in physical activity were 48 percent less likely to die than those who burned fewer than 2,100 calories per week.

Kathleen Y. Wolin, PhD, of Loyola University Chicago Stritch School of Medicine, is co-author of the study, published in the Journal of Physical Activity & Health, the official journal of the International Society for Physical Activity and Health.

Many cancer survivors are living longer, due to earlier diagnosis and better treatment, and their numbers are increasing rapidly. “Thus physical activity should be actively promoted to such individuals to enhance longevity,” researchers concluded.

There has been extensive research showing that among generally healthy, cancer-free populations, physical activity extends longevity. But there has been relatively little such research on physical activity among cancer survivors.

Researchers examined data from the Harvard Alumni Health Study, an ongoing study of men who entered Harvard as undergraduates between 1916 and 1950. Researchers looked at 1,021 men (average age 71) who previously had been diagnosed with cancer. In questionnaires conducted in 1988, men reported their physical activities, including walking, stair-climbing and participation in sports and recreational activities. Their physical activities were updated in 1993, and the men were followed until 2008.

Compared with men who expended fewer than 2,100 calories per week in physical activity, men who expended more than 12,600 calories per week were 48 percent less likely to die of any cause during the follow-up period. This finding was adjusted for age, smoking, body mass index, early parental mortality and dietary variables. (By comparison, a 176-pound man who walks briskly for 30 minutes a day, five days a week burns 4,200 calories.)

There were similar findings for mortality from cancer and cardiovascular disease: the most physically active cancer survivors were 38 percent less likely to die of cancer and 49 percent less likely to die of cardiovascular disease during the follow-up period.

Lee et al., (2014). Physical activity and survival after cancer diagnosis in men. J. Phys. Act. Health.,11:85–90 [Abstract]