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Preventing breast cancer and its recurrence with diet and exercise. Dr Michelle Harvie Transforming Knowledge: Closing the Research Evidence-Practice Gap. April 29 th /30 th 2009. Breast Cancer Prevention The Genesis Prevention Centre Breast cancer rates in UK and worldwide

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preventing breast cancer and its recurrence with diet and exercise

Preventing breast cancer and its recurrence with diet and exercise

Dr Michelle Harvie

Transforming Knowledge: Closing the Research Evidence-Practice Gap.

April 29th /30th 2009

slide2
Breast Cancer Prevention

The Genesis Prevention Centre

Breast cancer rates in UK and worldwide

The potential role of diet and exercise for prevention

Our prevention research

  • After diagnosis

The importance of lifestyle after diagnosis

Our research amongst breast cancer patients

  • Developments which may arise from work
breast cancer rates 1975 2005 uk
Breast cancer rates 1975 -2005- UK

screening

140

Incidence

Mortality

120

100

80

Rate per 100,000 population

60

40

20

0

1975

1978

1981

1984

1987

1990

1993

1996

1999

2002

2005

Year of Diagnosis/death

breast cancer incidence trends in developed developing countries
Breast cancer incidence trends in developed & developing countries

Americas

Asia/Oceania

Europe

120

120

120

USA

100

100

100

CANADA

UK

80

80

AUSTRALIA

80

FINLAND

70

70

70

60

60

60

PUERTO RICO

SPAIN

50

50

50

40

40

40

SLOVAKIA

COLUMBIA

JAPAN

Age standardised rate (world)

Age standardised rate (world)

Age standardised rate (world)

30

30

30

INDIA

20

20

20

10

10

10

2000

2000

2000

1970

1980

1990

1970

1980

1990

1960

1960

1970

1980

1990

1960

Year

Year

Year

Bray et al Breast Cancer Research 6: 229, 2004

our prevention research
Our Prevention Research
  • Epidemiology: assessing risk/ protective factors from population studies ( Iowa Women’s Health Study)
  • Designing and testing optimum diets to prevent cancer (randomised trials) Intermittent energy restriction
  • How does diet weight control reduce risk ? Small mechanistic studies
  • Qualitative research to understand behavioural & psychosocial factors which influence adherence to diet and exercise recommendations amongst high risk women
population study iowa women s health study
Population study :Iowa Women’s Health Study

(N=33,660 women - 1987 breast cancers)

Gained 5% body wt (age 30-50yrs)

(1.0)

1.0

Stable

Lost 5% body wt

(0.78)

(0.61)

Relative risk

0.5

0

513 400 310

BC incidence 100,000 women yrs

Harvie M ,HowellA et al CBEP 14: 656, 2005

our prevention research7
Our Prevention Research
  • Epidemiology: assessing risk/ protective factors from population studies ( Iowa Women’s Health Study)
  • Designing and testing optimum diets to prevent cancer (randomised trials) Intermittent energy restriction
  • How does diet weight control reduce risk ? Small mechanistic studies
  • Qualitative research to understand behavioural & psychosocial factors which influence adherence to diet and exercise recommendations amongst high risk women
rct of intermittent vs continuous energy restriction
RCT of intermittent vs. continuous energy restriction

Background

  • ~ 60% of women overweight / obese
  • Wt loss >5% difficult to achieve (50%) & maintain (20% over 5 years)
  • Animal studies show intermittent restriction is superior to continuous

restriction for breast cancer prevention

Questions

  • Is intermittent energy restriction acceptable & easier to adhere to

than daily (continuous) restriction ?

  • Does intermittent restriction have greater beneficial effects on breast

cancer risk markers compared to continuous restriction ?

slide9
CER

7 days

~1500 kcal / day Mediterranean diet

IER

2 days ~550kcal:

2 pints semi-skimmed milk

1 portion fruit

4 portions vegetable

2 pints low-calorie drinks

Multi-vitamin & mineral

5 days

~1900 kcal/day Mediterranean diet

main findings
Main findings
  • IER is as effective as CER for weight loss but is not more acceptable or easy to adhere to
  • 2. IER appears to have better effects on insulin sensitivity
our prevention research11
Our Prevention Research
  • Epidemiology: assessing risk/ protective factors from population studies ( Iowa Women’s Health Study)
  • Designing and testing optimum diets to prevent cancer (randomised trials) Intermittent energy restriction
  • How does diet weight control reduce risk ? Small mechanistic studies ( gene expression in breast tissue)
  • Qualitative research to understand behavioural & psychosocial factors which influence adherence to diet and exercise recommendations amongst high risk women
slide12

After diagnosis of breast cancer

  • 60% of patients overweight / obese at diagnosis
  • Obesity linked to breast cancer & overall mortality (RR ~1.5-2.5)
  • Obesity in early breast cancer patients linked to:

~50% more non cancer deaths ~60% more other cancers

  • 75% of patients gain weight after diagnosis
  • Weight gain worsens prognosis in 4/6 cohort studies

Goodwin PJ. Energy balance and cancer prognosis: Breast Cancer In: McTiernan A. Cancer prevention & management through exercise &weight control. 2006.Dignam et al JNCI 2003 95:19 1467

Irwin et al J Clin Oncol. 2005 Feb 1;23(4):774-82.

b ahead study b reast a ctivity and h ealthy e ating a fter d iagnosis
B - AHEAD StudyBreast – Activity and Healthy Eating After Diagnosis
  • Weight control amongst early breast cancer patients
  • Randomised comparison of 3 diet & exercise programmes:

-Supervised

-Home based

-Leaflet only

  • Recruiting 480 pt from UHSM, Christie, Oldham, N Manchester Stepping Hill August 2008 – Oct 2011
developments which may arise from work
Developments which may arise from work
  • Acceptable effective energy restriction interventions could:

-Prevent the 25% of breast cancer cases attributable to excess calories.

-Prevent 25% of relapse amongst early breast cancer patients

2.Defining mechanism of cancer prevention with energy restriction could lead to :

-Energy restriction mimetic agents for cancer prevention

- Predictive test of breast cancer risk using genetic variation in key enzymes up / down regulated with ER

slide15

Collaborators

Prof Anthony Howell

Prof Gareth Evans

Prof Nigel Bundred

Dr Sue Astley/ Alan Hufton

Dr Penny Hopwood

Dr Rob Clarke /Dr Kai Ren Ong

Dr Andrew Wardley

Prof Kinta Beaver

Dr Jack Cuzick Wolfson Institute London

Dr Alan Flyvbjerg & Jan Frystk Aarhus Denmark

Dr Susan Jebb HNR MRC Cambridge

Prof Mark Mattson NIHR Institute of Ageing

Baltimore

Dr Alison Wearden University of Manchester

Dr Gaynor Parfitt University of Exeter