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Home Support Diet Diet and Breast Cancer

Diet and Breast Cancer

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A healthy lifestyle is essential to boost immunity and fight various diseases and is especially important for patients on breast cancer therapy, who are prone to various infections and therapy side-effects. Diet and exercise are major components of healthy living. Both diet and Physical Activity (PA) have each been shown to modify circulating gonadal/female sex hormone concentrations which play a key role in breast cancer progression and treatment.  Various studies have shown advantage of a nutritious diet in fighting breast cancer.

Breast cancer survivors who consume a healthy diet and are physically active may increase their years of survival after diagnosis. Specifically, those who reported eating a minimum of 5 Vegetable Fruit (VF) servings daily and performing weekly PA equivalent to 30 minutes of walking at a moderate pace for 6 days a week had a higher 10-year survival rate than those who did not adhere to these lifestyle practices. The improved survival rate was observed in women who were obese as well as those who were not obese. Adhering to these two health behaviors reduced the probability of death by 50%, whereas this effect was not seen if breast cancer survivors were adherent to only PA or VF dietary pattern (1). Epidemiologic studies have linked diets high in vegetables and fruit with an increased likelihood of survival after the diagnosis of breast cancer (2).

Excessive dieting behavior is strongly discouraged (2).

EFFECT OF BMI ON BREAST CANCER:
Epidemiologic studies have identified obesity as an important negative prognostic factor (2). Women categorized as low Body Mass Index (BMI < 20) had twice the mortality/death rate (15.6% versus 7.1%) as women with BMI 20 to 24.99 or categorized as overweight (BMI = 25 to 29.99). Women categorized as obese (BMI = 30) had a higher mortality rate than normal-weight participants. Mortality seemed to decrease with increasing intake to 5 Vegetable Fruit (VF) servings /day (1).

EFFECT OF PHYSICAL ACTIVITY:
Physical activity appeared to be associated with a 30% decreased risk of mortality (3).

EFFECT OF HEALTHY LIFESTYLE ON SPECIFIC BREAST CANCER SUBTYPES:
Studies have shown the benefit of healthy lifestyle on specific breast cancer subtypes. There was no survival advantage for healthy lifestyle in estrogen receptor–negative, progesterone receptor–negative (ER-, PR-) group, a borderline advantage for ER-negative, PR-positive group (ER-/PR+), and significant advantages for ER-positive, PR-negative(ER+/PR-) and ER-positive, PR-positive groups (ER+/PR+) (1).
There is a strong protective association of high VF/high PA with improved survivorship. The survival advantage for the high VF/high PA lifestyle was present in women who had ER-positive tumors, but not in those who were ER-negative, suggesting that the mechanism for action for this effect might be reproductive gonadal hormones (1).

EFFECT OF VARIOUS NUTRIENTS ON BREAST CANCER:
FAT: Food pattern characterized by high-fat food choices was significantly associated with increased risk of breast cancer (5, 3). Total fat intake was also significantly inversely associated with survival i.e. higher the total fat intake-lower the survival chances (2).

FIBER: Studies that examined relationships between recurrence or survival and intakes of high-fiber foods (e.g., vegetables, fruit, cereal-grain products), found that intakes of these foods were inversely associated with progressive disease i.e. higher the fiber intake-lesser the chances of a progressive disease (2). Fiber has a protective effect on breast cancer (3). Dietary fiber can play a role in preventing breast cancer through non-estrogen pathways among postmenopausal women (4).

POMEGRANATE FRUIT PEEL EXTRACTS (PPE): PPE has important antioxidant and apoptotic (programmed cell death) effects (3). Studies demonstrated that Pomegranate Fruit Extracts enhance the Tamoxifen action (a commonly used anti-hormonal therapy in breast cancer) in both sensitive and Tamoxifen-resistant cells through the inhibition of cell viability by inducing cell-death machinery. Collectively, the results showed that pomegranate combined with Tamoxifen may represent a novel and a powerful approach to enhance and sensitize Tamoxifen action (7).

BLUE BERRIES: Dietary phytochemicals are known to exhibit a variety of anti-carcinogenic properties. A study investigated the chemo-preventive activity of blueberry extract in triple-negative breast cancer cell lines in vitro and in vivo. Treatment with blueberry decreased aggressive intracellular pathways like, phosphatidylinositol 3-kinase (PI3K)/AKT. Tumor weight and proliferation (Ki-67 expression) were decreased in blueberry-treated mice, where apoptosis was increased compared with controls (6).
In a study the extracts of rosehips, blueberries, black currant, black chokeberries, apple, sea buckthorn, plum, lingonberries, cherries, and raspberries decreased the proliferation of breast cancer cells and the effect was proportional to concentration (12).

ISOFLAVONES:  Isoflavones may protect against breast cancer by acting as estrogen agonists or antagonists. Isoflavones protect against all tumor subtypes of breast cancer have biological plausibility, being supported by evidence from experimental studies. Foods that contain high amounts of isoflavones include soy, peanuts, chick peas, alfalfa, fava beans, and kudzu (10).

BLACK TEA: Studies suggest that black tea consumption may be positively associated with risk of ER+/PR+ tumors (8).

CARBOHYDRATES:  Women with higher glycemic load diets were more prone to develop breast cancer because of elevated insulin and insulin growth factor levels. These factors have potent positive effects on the development and spread of breast cancer cells. Patients with diets rich in high glycemic index foods (that cause a rapid surge in blood sugar, e.g., potatoes, bread) had a 44% greater risk for developing ER+ PR- tumors than patients with diets rich in low glycemic index food (that cause a gradual increase in blood sugar, e.g., high-fiber cereals, beans).Women in the highest category of “glycemic load” had an 81% greater risk for ER+PR- tumors (9).

RED MEAT:  Higher red meat intake may be a risk factor for ER+/PR+ breast cancer among premenopausal women (11).


CONCLUSION:
Diet is thus an important aspect in dealing with breast cancer. One should be aware of the foods to be consumed and not consumed while on treatment or at high risk of breast cancer. Finally, an effort to make and eat fresh healthy food is strongly recommended to fight the leading cause of cancer death in women i.e. Breast Cancer.


DR. JIGISHA P THAKKAR
VISITING RESEARCH ASSOCIATE, UNIVERSITY OF ILLINOIS AT CHICAGO.


REFERENCES:
1)  Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol. 2007 Jun 10;25(17):2335-7. PMID:17557947
2) Can lifestyle modification increase survival in women diagnosed with breast cancer? J Nutr. 2002 Nov;132(11 Suppl):3504S-3507S. PMID: 12421877
3)  The Antioxidant Potency of Punica granatum L. Fruit Peel Reduces Cell Proliferation and Induces Apoptosis on Breast Cancer. J Med Food. 2011 Aug 23. PMID: 21861726
4) Dietary fiber intake and risk of breast cancer in postmenopausal women: the National Institutes of Health-AARP Diet and Health Study. Am J Clin Nutr. 2009 Sep;90(3):664-71. PMID:19625685
5)  Identification of a dietary pattern characterized by high-fat food choices associated with increased risk of breast cancer: the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Br J Nutr. 2008 Nov;100(5):942-6. PMID: 18377685
6)  Blueberry phytochemicals inhibit growth and metastatic potential of MDA-MB-231 breast cancer cells through modulation of the phosphatidylinositol 3-kinase pathway. Cancer Res. 2010 May 1;70(9):3594-605. PMID: 20388778
7)  Pomegranate sensitizes Tamoxifen action in ER-a positive breast cancer cells. J Cell Commun Signal. 2011 Jun 27.  PMID: 21706446
8) Coffee and black tea consumption and risk of breast cancer by estrogen and progesterone receptor status in a Swedish cohort.  Cancer Causes Control. 2009 Dec;20(10):2039-44. PMID: 19597749
9) Glycemic load, glycemic index and breast cancer risk in a prospective cohort of Swedish women Int J Cancer. 2009 Jul 1;125(1):153-7. PMID: 19319984
10) Dietary intake of isoflavones and breast cancer risk by estrogen and progesterone receptor status.  Breast Cancer Res Treat. 2009 Dec;118(3):553-63. PMID: 19252980
11)  Is red meat intake a risk factor for breast cancer among premenopausal women? Breast Cancer Res Treat. 2009 Sep;117(1):1-8. PMID: 19543971
12)  Inhibition of cancer cell proliferation in vitro by fruit and berry extracts and correlations with antioxidant levels. J Agric Food Chem. 2004 Dec 1;52(24):7264-71. PMID: 15563205.