This document summarizes research on the relationships between obesity, physical activity, and breast cancer risk and prognosis. It finds that obesity is positively associated with breast cancer risk and mortality in postmenopausal women. Physical activity is associated with reduced breast cancer risk and improved survival. Obesity may influence breast cancer through increased estrogen levels, insulin resistance, and inflammation. Weight loss interventions show improvements in relevant biomarkers and health outcomes for breast cancer survivors. The ENERGY trial aims to test if weight loss counseling improves weight and physical functioning in breast cancer survivors.
This document discusses the relationship between obesity and cancer. It notes that cancer causes more deaths worldwide than malaria, tuberculosis, HIV, or childhood diarrhea combined. Obesity is a leading cause of several types of cancer. Randomized controlled trials have shown that intentional weight loss reduces levels of inflammatory markers like CRP that are implicated in cancer development. Understanding the biological mechanisms such as hormones, growth factors, and inflammation linking obesity to cancer can help identify targets for prevention through lifestyle changes and weight management.
This document discusses the relationship between excess body weight, metabolic risk factors, and pancreatic cancer. It summarizes several meta-analyses and prospective cohort studies that found increased risks of pancreatic cancer associated with higher BMI, diabetes, and blood glucose levels. Specifically, a BMI over 30 was associated with a 6-12 times increased risk of pancreatic cancer. Diabetes was also found to double the risk of pancreatic cancer. Multiple biomarkers related to inflammation and glucose metabolism were also found to correlate with higher risks of pancreatic cancer. However, the document notes that the exact mechanisms linking metabolic factors and pancreatic cancer require further study.
This document summarizes a presentation on racial and ethnic differences in obesity given by Professor TH Lam. Some key points:
- Asians generally have higher body fat percentage at a given BMI compared to Caucasians. The same is true for different ethnic groups within Asia.
- Studies show associations between obesity measures like BMI, waist circumference, and body fat percentage with health risks like diabetes and cardiovascular disease. However, more data is needed comparing different ethnic groups using standardized methods.
- Factors like socioeconomic development and differences between populations in different regions/countries may help explain some ethnic/racial differences in obesity and health risks. Considering populations at different stages of obesity epidemics is also important.
1) The document summarizes a presentation on the relationships between obesity, physical activity, and colorectal cancer risk and outcomes.
2) It discusses how increased BMI is an established risk factor for colorectal cancer in a gender- and site-specific manner, and how weight gain, especially in early adulthood, can increase colon cancer risk.
3) It also reviews how measurements of waist circumference and waist-to-hip ratio may be associated with colorectal cancer risk independent of BMI, and how analyses of cancer survival have shown mixed results depending on whether BMI is measured before or after cancer diagnosis.
The document discusses a presentation given by Henry J. Thompson from the Cancer Prevention Laboratory at Colorado State University on the relationship between energy metabolism and cancer processes. It summarizes evidence from animal models on how energy restriction affects carcinogenesis and discusses the cellular and molecular mechanisms linking energy status and cancer. The presentation aims to stimulate discussion on challenges and opportunities in further researching this topic.
This document summarizes evidence from observational studies and randomized clinical trials on the relationship between obesity and cancer risk and prognosis. Key findings include:
1) Observational studies show increased cancer risk and worse survival outcomes with higher adiposity. Randomized trials show improved biomarker outcomes, like reductions in sex hormones and inflammation, with weight loss.
2) A meta-analysis found increased risks of several cancers per 5 kg/m2 increase in BMI.
3) A randomized trial found reductions in estrogens, androgens, insulin, and inflammation with weight loss from diet, exercise, or both among postmenopausal, overweight/obese women.
Ueda2016 diabetes & cancer - mesbah kamelueda2015
Diabetes and certain cancers are linked by shared risk factors like obesity and age. People with diabetes have higher risks of cancers of the liver, pancreas, endometrium, and colon and breast cancers. The biological mechanisms linking the diseases involve insulin and insulin-like growth factors stimulating cancer cell growth. While hyperglycemia is not an independent risk factor, it can worsen cancer outcomes. Metformin may reduce cancer risk compared to other diabetes medications by activating AMPK, an energy sensor that puts cells in energy-saving mode and inhibits cancer cell growth. Further research is still needed to fully understand the diabetes-cancer relationship and its implications for treatment and management.
This document discusses the link between diabetes and cancer. It notes that cancer and diabetes are diagnosed together more frequently than expected by chance. Several risk factors are shared between the two diseases, including age, diet, obesity, and lifestyle factors. The document explores how insulin and IGF-1 may influence cancer development via their effects on cell growth pathways. It reviews evidence on the effects of different diabetes medications, including some studies that found certain insulin analogs may increase cancer risk. Several cohort studies on the cancer risks of insulin glargine are also summarized.
This document discusses the relationship between obesity and cancer. It notes that cancer causes more deaths worldwide than malaria, tuberculosis, HIV, or childhood diarrhea combined. Obesity is a leading cause of several types of cancer. Randomized controlled trials have shown that intentional weight loss reduces levels of inflammatory markers like CRP that are implicated in cancer development. Understanding the biological mechanisms such as hormones, growth factors, and inflammation linking obesity to cancer can help identify targets for prevention through lifestyle changes and weight management.
This document discusses the relationship between excess body weight, metabolic risk factors, and pancreatic cancer. It summarizes several meta-analyses and prospective cohort studies that found increased risks of pancreatic cancer associated with higher BMI, diabetes, and blood glucose levels. Specifically, a BMI over 30 was associated with a 6-12 times increased risk of pancreatic cancer. Diabetes was also found to double the risk of pancreatic cancer. Multiple biomarkers related to inflammation and glucose metabolism were also found to correlate with higher risks of pancreatic cancer. However, the document notes that the exact mechanisms linking metabolic factors and pancreatic cancer require further study.
This document summarizes a presentation on racial and ethnic differences in obesity given by Professor TH Lam. Some key points:
- Asians generally have higher body fat percentage at a given BMI compared to Caucasians. The same is true for different ethnic groups within Asia.
- Studies show associations between obesity measures like BMI, waist circumference, and body fat percentage with health risks like diabetes and cardiovascular disease. However, more data is needed comparing different ethnic groups using standardized methods.
- Factors like socioeconomic development and differences between populations in different regions/countries may help explain some ethnic/racial differences in obesity and health risks. Considering populations at different stages of obesity epidemics is also important.
1) The document summarizes a presentation on the relationships between obesity, physical activity, and colorectal cancer risk and outcomes.
2) It discusses how increased BMI is an established risk factor for colorectal cancer in a gender- and site-specific manner, and how weight gain, especially in early adulthood, can increase colon cancer risk.
3) It also reviews how measurements of waist circumference and waist-to-hip ratio may be associated with colorectal cancer risk independent of BMI, and how analyses of cancer survival have shown mixed results depending on whether BMI is measured before or after cancer diagnosis.
The document discusses a presentation given by Henry J. Thompson from the Cancer Prevention Laboratory at Colorado State University on the relationship between energy metabolism and cancer processes. It summarizes evidence from animal models on how energy restriction affects carcinogenesis and discusses the cellular and molecular mechanisms linking energy status and cancer. The presentation aims to stimulate discussion on challenges and opportunities in further researching this topic.
This document summarizes evidence from observational studies and randomized clinical trials on the relationship between obesity and cancer risk and prognosis. Key findings include:
1) Observational studies show increased cancer risk and worse survival outcomes with higher adiposity. Randomized trials show improved biomarker outcomes, like reductions in sex hormones and inflammation, with weight loss.
2) A meta-analysis found increased risks of several cancers per 5 kg/m2 increase in BMI.
3) A randomized trial found reductions in estrogens, androgens, insulin, and inflammation with weight loss from diet, exercise, or both among postmenopausal, overweight/obese women.
Ueda2016 diabetes & cancer - mesbah kamelueda2015
Diabetes and certain cancers are linked by shared risk factors like obesity and age. People with diabetes have higher risks of cancers of the liver, pancreas, endometrium, and colon and breast cancers. The biological mechanisms linking the diseases involve insulin and insulin-like growth factors stimulating cancer cell growth. While hyperglycemia is not an independent risk factor, it can worsen cancer outcomes. Metformin may reduce cancer risk compared to other diabetes medications by activating AMPK, an energy sensor that puts cells in energy-saving mode and inhibits cancer cell growth. Further research is still needed to fully understand the diabetes-cancer relationship and its implications for treatment and management.
This document discusses the link between diabetes and cancer. It notes that cancer and diabetes are diagnosed together more frequently than expected by chance. Several risk factors are shared between the two diseases, including age, diet, obesity, and lifestyle factors. The document explores how insulin and IGF-1 may influence cancer development via their effects on cell growth pathways. It reviews evidence on the effects of different diabetes medications, including some studies that found certain insulin analogs may increase cancer risk. Several cohort studies on the cancer risks of insulin glargine are also summarized.
This document summarizes a presentation on obesity, physical activity, and colorectal cancer. It discusses 3 key messages: 1) the importance of distinguishing known and unknown factors, 2) how BMI influences cancer risk differently before and after diagnosis, and 3) the "Will Rogers phenomenon" where average risk changes when high-risk groups move. It then reviews evidence that increased BMI, weight gain, waist circumference, and waist-to-hip ratio are associated with higher colorectal cancer risk and mortality. However, these associations may differ depending on cancer type, gender, and whether BMI is measured before or after diagnosis. The document acknowledges collaborators and thanks the audience.
Overweight and obesity are associated with worse cancer outcomes and prognosis. Adipose tissue surrounding tumors, called cancer-associated adipocytes, secrete inflammatory molecules like IL-6 that can promote tumor growth, invasion, and metastasis. In obese conditions, adipose tissue develops a pro-inflammatory state characterized by immune cell infiltration and cytokine expression. This inflamed environment may further enhance cancer-associated adipocytes' effects on tumor progression. Targeting inflammation in adipose tissue, such as with IL-6 blocking antibodies, could potentially improve cancer treatment outcomes, especially in obese patients where adipose tissue inflammation is increased.
This document provides a summary of a presentation on lifestyle medicine and cancer. It discusses how lifestyle factors like smoking, obesity, nutrition, and exercise can impact cancer risk. Obesity is linked to increased risk of several cancers like breast, colon, and prostate cancer. High meat consumption is also associated with greater breast and colon cancer risk. Nutrition plays a role, as diets high in fruits and vegetables are protective while diets high in red meat and processed meat increase cancer risk.
Type 2 diabetes is associated with increased risk of certain cancers like liver, pancreas, endometrium, colorectal, breast and bladder cancers. The relationship is complex with factors like reverse causality, detection bias, shared risk factors between diabetes and cancer, and the effects of antidiabetic medications influencing cancer risk. Metformin appears to have a neutral or protective effect on cancer risk while insulin and sulfonylureas may increase risk, though data is still limited. Further research is needed to fully understand the relationship between diabetes, antidiabetic treatments and cancer.
ueda2012 diabetes and cancer-d.i.daskalovaueda2015
This document discusses the link between diabetes and increased cancer risk. Several factors contribute to this relationship, including aging, obesity, diet, physical activity levels, and chronic inflammation related to insulin resistance and hyperglycemia. The cancer types most strongly associated with diabetes include liver, pancreas, endometrium, colon/rectum, breast, and bladder cancers. The choice of diabetes treatment may also impact cancer risk, with metformin potentially showing a protective effect compared to insulin and sulfonylureas.
Professor Martin Wiseman presented on 'The Continuous Update Project - Breast cancer survivors and prostate cancer' on behalf of WCRF International at the SCPN conference 04/02/2015.
This document summarizes a presentation on weight loss and cancer risk reduction. It discusses how weight gain increases cancer risk, and how modest weight loss through dietary interventions can reduce cancer risk. Clinical trials show intermittent energy restriction may be more effective for weight loss and insulin reduction than daily energy restriction. Weight loss interventions are also discussed after a cancer diagnosis, though randomized trials are still needed. The presentation concludes by discussing targeting overweight individuals for weight loss interventions to reduce cancer risk.
This document discusses cancer prevention and screening. It provides information on lifestyle and environmental factors that can increase cancer risk, such as smoking, obesity, alcohol consumption, certain chemicals and radiation. Maintaining a healthy diet, being physically active, avoiding tobacco and excessive sun exposure can help prevent some cancers. Screening guidelines and key websites for cancer information are also listed. The document emphasizes that prevention through modifying risk factors is the best approach to reducing the cancer burden.
Metastatic Breast Cancer and The Tumor MicroenvironmentAmandaRussell40
This document summarizes research on how the tumor microenvironment influences metastasis at every step of the metastatic cascade. Key points include: (1) the microenvironment can suppress or promote tumorigenesis; (2) the perivascular niche protects disseminated tumor cells and keeps them dormant; (3) targeting the integrin receptors that mediate tumor cell interactions with the vascular niche can sensitize dormant tumor cells to chemotherapy and prevent metastasis without increasing toxicity.
Slides from Alan Jackson's presentation on the Cancer and Nutrition NIHR infrastructure collaboration at Obesity, Physical Activity & Cancer: Life course influences and mechanisms
Addressing your COVID-19 Breast Cancer Concerns bkling
Dr. Anne Moore, medical oncologist and Director of the Breast Cancer Survivorship Program at Weill Cornell and Dr. Leticia Varella, Assistant Professor of Medicine at Weill Cornell Medical College will go over changes in treatment and maintenance care for those with an early stage or metastatic breast cancer diagnosis. They will address your risk level as a cancer patient, provide strategies to minimize risk, discuss how to deal with anxiety, and answer your questions to help you through the COVID-19 pandemic.
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
Sugar-sweetened beverage consumption in relation to diabetes and cardiovascul...My Healthy Waist
By Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public HealthChanning Laboratory, Harvard Medical School and Brigham and Women’s Hospital
Dr. Dustin Deming led us through a discussion on the latest research and treatments for colorectal cancer patients presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
A few of the topics covered include research on immunotherapy and trials studying:
– MSI-H (review of the Anti-PD-1 trial)
– HER2 amplification
– BRAF mutations
For more updates on colorectal cancer research, visit our blog: http://fightcolorectalcancer.org/category/research-treatment/
Report Back from SGO: What’s the Latest in Uterine Cancer?bkling
Dr. Jeannine Villella, Chief of Gynecologic Oncology at Lenox Hill Hospital, provides a comprehensive update from the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer. Dr. Villella breaks down what the research presented at the conference means for you and discusses new developments.
Dr. Jennifer Mueller, gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center, will share research updates on uterine/endometrial cancer and other new developments in treatment and surgery.
This document outlines a project to develop a standardized methodology for conducting systematic reviews of mechanistic cancer studies. The goal is to enable more rigorous synthesis of evidence from animal and cell line studies on how dietary factors may influence cancer risk. An international team of experts will hold workshops to design a comprehensive search strategy, quality assessment criteria, and data extraction methods. These will be tested by reviewing evidence on potential mechanisms linking milk consumption to prostate cancer risk, such as effects on hormone and growth factor levels. The resulting review methodology template will provide guidance for systematically evaluating mechanistic evidence across study types.
This document discusses physical activity and cancer prevention. It begins by outlining the author's conflicts of interest and then reviews the existing evidence on relationships between physical activity and various cancers such as colon, breast, and endometrial cancer. Several studies are summarized that examine the impact of activities like walking, resistance training, and television viewing time on cancer outcomes. Mechanisms by which physical activity may influence cancer risk, such as through effects on obesity, inflammation, and hormones, are also discussed. The document concludes by identifying areas in need of future research.
This document summarizes a presentation on obesity, physical activity, and colorectal cancer. It discusses 3 key messages: 1) the importance of distinguishing known and unknown factors, 2) how BMI influences cancer risk differently before and after diagnosis, and 3) the "Will Rogers phenomenon" where average risk changes when high-risk groups move. It then reviews evidence that increased BMI, weight gain, waist circumference, and waist-to-hip ratio are associated with higher colorectal cancer risk and mortality. However, these associations may differ depending on cancer type, gender, and whether BMI is measured before or after diagnosis. The document acknowledges collaborators and thanks the audience.
Overweight and obesity are associated with worse cancer outcomes and prognosis. Adipose tissue surrounding tumors, called cancer-associated adipocytes, secrete inflammatory molecules like IL-6 that can promote tumor growth, invasion, and metastasis. In obese conditions, adipose tissue develops a pro-inflammatory state characterized by immune cell infiltration and cytokine expression. This inflamed environment may further enhance cancer-associated adipocytes' effects on tumor progression. Targeting inflammation in adipose tissue, such as with IL-6 blocking antibodies, could potentially improve cancer treatment outcomes, especially in obese patients where adipose tissue inflammation is increased.
This document provides a summary of a presentation on lifestyle medicine and cancer. It discusses how lifestyle factors like smoking, obesity, nutrition, and exercise can impact cancer risk. Obesity is linked to increased risk of several cancers like breast, colon, and prostate cancer. High meat consumption is also associated with greater breast and colon cancer risk. Nutrition plays a role, as diets high in fruits and vegetables are protective while diets high in red meat and processed meat increase cancer risk.
Type 2 diabetes is associated with increased risk of certain cancers like liver, pancreas, endometrium, colorectal, breast and bladder cancers. The relationship is complex with factors like reverse causality, detection bias, shared risk factors between diabetes and cancer, and the effects of antidiabetic medications influencing cancer risk. Metformin appears to have a neutral or protective effect on cancer risk while insulin and sulfonylureas may increase risk, though data is still limited. Further research is needed to fully understand the relationship between diabetes, antidiabetic treatments and cancer.
ueda2012 diabetes and cancer-d.i.daskalovaueda2015
This document discusses the link between diabetes and increased cancer risk. Several factors contribute to this relationship, including aging, obesity, diet, physical activity levels, and chronic inflammation related to insulin resistance and hyperglycemia. The cancer types most strongly associated with diabetes include liver, pancreas, endometrium, colon/rectum, breast, and bladder cancers. The choice of diabetes treatment may also impact cancer risk, with metformin potentially showing a protective effect compared to insulin and sulfonylureas.
Professor Martin Wiseman presented on 'The Continuous Update Project - Breast cancer survivors and prostate cancer' on behalf of WCRF International at the SCPN conference 04/02/2015.
This document summarizes a presentation on weight loss and cancer risk reduction. It discusses how weight gain increases cancer risk, and how modest weight loss through dietary interventions can reduce cancer risk. Clinical trials show intermittent energy restriction may be more effective for weight loss and insulin reduction than daily energy restriction. Weight loss interventions are also discussed after a cancer diagnosis, though randomized trials are still needed. The presentation concludes by discussing targeting overweight individuals for weight loss interventions to reduce cancer risk.
This document discusses cancer prevention and screening. It provides information on lifestyle and environmental factors that can increase cancer risk, such as smoking, obesity, alcohol consumption, certain chemicals and radiation. Maintaining a healthy diet, being physically active, avoiding tobacco and excessive sun exposure can help prevent some cancers. Screening guidelines and key websites for cancer information are also listed. The document emphasizes that prevention through modifying risk factors is the best approach to reducing the cancer burden.
Metastatic Breast Cancer and The Tumor MicroenvironmentAmandaRussell40
This document summarizes research on how the tumor microenvironment influences metastasis at every step of the metastatic cascade. Key points include: (1) the microenvironment can suppress or promote tumorigenesis; (2) the perivascular niche protects disseminated tumor cells and keeps them dormant; (3) targeting the integrin receptors that mediate tumor cell interactions with the vascular niche can sensitize dormant tumor cells to chemotherapy and prevent metastasis without increasing toxicity.
Slides from Alan Jackson's presentation on the Cancer and Nutrition NIHR infrastructure collaboration at Obesity, Physical Activity & Cancer: Life course influences and mechanisms
Addressing your COVID-19 Breast Cancer Concerns bkling
Dr. Anne Moore, medical oncologist and Director of the Breast Cancer Survivorship Program at Weill Cornell and Dr. Leticia Varella, Assistant Professor of Medicine at Weill Cornell Medical College will go over changes in treatment and maintenance care for those with an early stage or metastatic breast cancer diagnosis. They will address your risk level as a cancer patient, provide strategies to minimize risk, discuss how to deal with anxiety, and answer your questions to help you through the COVID-19 pandemic.
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
Sugar-sweetened beverage consumption in relation to diabetes and cardiovascul...My Healthy Waist
By Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public HealthChanning Laboratory, Harvard Medical School and Brigham and Women’s Hospital
Dr. Dustin Deming led us through a discussion on the latest research and treatments for colorectal cancer patients presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
A few of the topics covered include research on immunotherapy and trials studying:
– MSI-H (review of the Anti-PD-1 trial)
– HER2 amplification
– BRAF mutations
For more updates on colorectal cancer research, visit our blog: http://fightcolorectalcancer.org/category/research-treatment/
Report Back from SGO: What’s the Latest in Uterine Cancer?bkling
Dr. Jeannine Villella, Chief of Gynecologic Oncology at Lenox Hill Hospital, provides a comprehensive update from the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer. Dr. Villella breaks down what the research presented at the conference means for you and discusses new developments.
Dr. Jennifer Mueller, gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center, will share research updates on uterine/endometrial cancer and other new developments in treatment and surgery.
This document outlines a project to develop a standardized methodology for conducting systematic reviews of mechanistic cancer studies. The goal is to enable more rigorous synthesis of evidence from animal and cell line studies on how dietary factors may influence cancer risk. An international team of experts will hold workshops to design a comprehensive search strategy, quality assessment criteria, and data extraction methods. These will be tested by reviewing evidence on potential mechanisms linking milk consumption to prostate cancer risk, such as effects on hormone and growth factor levels. The resulting review methodology template will provide guidance for systematically evaluating mechanistic evidence across study types.
This document discusses physical activity and cancer prevention. It begins by outlining the author's conflicts of interest and then reviews the existing evidence on relationships between physical activity and various cancers such as colon, breast, and endometrial cancer. Several studies are summarized that examine the impact of activities like walking, resistance training, and television viewing time on cancer outcomes. Mechanisms by which physical activity may influence cancer risk, such as through effects on obesity, inflammation, and hormones, are also discussed. The document concludes by identifying areas in need of future research.
This document summarizes evidence from studies on the mechanisms by which physical activity may impact cancer risk and discusses results from intervention trials measuring relevant biomarkers. It finds that exercise interventions significantly reduce levels of inflammation, oxidative stress, and hormones like leptin, especially with weight loss. Studies in adipose tissue suggest effects on gene expression related to inflammation and sex steroids. While effects on immunity and DNA repair are less clear, more research is needed in cancer patients to understand impacts on prognosis. Future interdisciplinary studies should address multiple dimensions of energy balance and biomarkers.
There are three main points:
1) Many studies show obesity promotes breast cancer development and progression, but mechanisms are still unclear. Increased fat tissue, hormones like estrogen, insulin, and IGF-1 may play roles.
2) Mouse studies show genetic obesity prevents mammary tumors, while diet-induced obesity accelerates tumors depending on degree of obesity. Heavier mice have faster growing, more aggressive tumors and higher leptin levels.
3) Interventions like calorie restriction that reduce leptin and IGF-1 delay tumor development in normal weight rodents, but effects in obese animals require further study. Understanding obesity's effects could lead to new prevention or treatment strategies.
The document discusses the relationship between obesity, adipokines like leptin, and colorectal cancer risk. In vitro studies show that leptin can induce several hallmarks of cancer in colon epithelial cells, including proliferation, angiogenesis, and evasion of apoptosis. A clinical study found that higher BMI, waist circumference, and leptin levels were associated with increased risk of tubular adenomas in men aged 50-65, suggesting obesity-related factors may promote early colorectal tumorigenesis. The authors conclude that for obese individuals with elevated adipokines, the recommended age for first colonoscopy may need to be lowered.
This document discusses the Continuous Update Project (CUP), a systematic review of mechanistic evidence conducted by the World Cancer Research Fund (WCRF). It outlines the CUP methodology, including:
- Conducting systematic literature reviews on cancer mechanisms by exposure
- Developing review protocols through an external expert Mechanisms Protocol Development Group
- Reviewing evidence on cancer hallmarks and emerging hallmarks outlined by Hanahan and Weinberg
- Peer reviewing draft review protocols and reports
- Grading the strength of evidence using predefined criteria to form the basis of recommendations
This document summarizes research on the developmental origins of obesity and cancer risk. It finds that both low and high birth weights are associated with increased risk of diseases like diabetes and cardiovascular disease later in life. Rapid postnatal growth and catch-up growth are also linked to obesity and disease risk. Experimental studies with animal models demonstrate that maternal diet, nutrition during pregnancy and lactation, and post-weaning diets can program offspring's risk of obesity and cancer through metabolic and epigenetic mechanisms.
Physical activity is challenging to measure due to its complex, variable, and error-prone nature. Self-reports provide detailed information but have low accuracy, while objective monitors provide precise measurements but have limitations. Overall, both self-reports and objective monitors are needed to fully understand physical activity patterns and their relationships to health outcomes in large epidemiological studies.
The document discusses obesity's links to cancer from preclinical studies, noting that obesity impacts cancer-related processes like inflammation, growth signaling, and metabolism. It summarizes research in mouse models showing how factors like IGF-1, adipokines, calorie restriction, and mTOR signaling influence tumor growth under different obesity conditions. The presentation concludes by outlining opportunities for translational research to identify targets and strategies for breaking the links between obesity and cancer risk in humans.
1. The document discusses how epigenetic mechanisms can link early life diet to cancer risk later in life.
2. It provides examples of how nutrition and environment during critical periods like prenatal, neonatal, and puberty can cause epigenetic changes that alter gene expression and disease susceptibility long-term.
3. Detecting epigenetic marks like DNA methylation in early life may help predict future disease risk, including some cancers, though more research is still needed.
This document discusses obesity, physical activity, and cancer. It provides the following key points:
- Physical inactivity is linked to increased risk of several cancers and other health issues like cardiovascular disease. Inactivity levels in Europe are high, with over 60% of adults not meeting physical activity guidelines.
- Reducing cancer risks requires increasing physical activity levels to meet guidelines. This could reduce breast and colon cancer burden by 21-25% and cardiovascular disease burden by 27-30%.
- Childhood obesity is increasing across Europe. One-third of European children are overweight or obese, putting them at risk for future health problems.
- Promoting physical activity and healthier diets is important for reducing obesity and
The document summarizes research on factors influencing cancer risk across the lifespan, from fetal development through adulthood. It discusses how characteristics like birth weight, adult height and weight, and physical activity levels impact cancer risk. Early life nutrition is particularly important, as it can program metabolic and hormonal regulation in ways that affect cancer vulnerability later in life. Maintaining the right balance of nutrients, including amino acids like glycine, appears key to supporting health and minimizing cancer risk.
Intermittent Fasting: How it Can Reduce the Risk of Breast Cancer Recurrencebkling
Breast cancer recurrence is the greatest fear for those with breast cancer. While many survivors know that being overweight can contribute to recurrence of their cancer, the thought of dieting and how to go about it can be overwhelming. Dr. Nicholas Webster, Professor of Medicine, Chief of the Division of Endocrinology and Metabolism, and Associate Director for Shared Resources, Moores Cancer Center discusses his study that suggests a path that is easy to follow and produces the type of results that can be a matter of life and death for some breast cancer patients.
This document discusses assessing a patient's diet and using low-calorie diets (LCD) and very low-calorie diets (VLCD) for weight loss and management. It provides information on factors that influence food choices, differences between plant-based and Western diets, strategies for changing diet and lifestyle, and using meal replacements and customizing protein intake as part of a weight loss plan.
Year-by-year trend analysis in modifiable risk factors reductionAbd Alrahman Kfmc
This study analyzed data from over 465,000 cardiac rehabilitation patients to investigate differences in risk factor reduction between younger (18-65 years) and older (>65 years) age groups. Younger patients achieved greater reductions in smoking, physical inactivity, anxiety, depression, and hypertension. Older patients saw better improvements in body mass index and waist circumference. The results suggest cardiac rehabilitation programs may need to be tailored differently for younger and older patients to optimize outcomes.
Menezes, 2012 - An Optimal Method for Measuring Body Fat in Overweight Indivi...Mariana Menezes
This study compared two methods for measuring body fat percentage in overweight individuals - skinfold thickness (SF) and bioelectrical impedance analysis (BIA). 85 overweight or obese adults and elderly patients were evaluated. The percentage of body fat estimated by SF was significantly higher than BIA, but a moderate correlation and strong concordance was observed between the two methods. Both SF and BIA showed significant correlations with BMI and waist circumference, but BIA had stronger correlations. The study concluded that while the methods produced different estimates, they provided similar classifications of individuals. BIA also had better correlation with anthropometric indicators, suggesting it may be a preferable method for measuring body fat in clinical practice.
Landi F. Valutazione del Geriatric Assessment. ASMaD 2015Gianfranco Tammaro
This document discusses the geriatric evaluation of elderly cancer patients. It contains information on several key points of geriatric assessment: determining if a patient will die of cancer or with cancer, if they will live long enough to experience cancer consequences, and if they can tolerate treatment. It highlights that complications are more common in older patients and notes the importance of assessing social support networks. The document advocates for comprehensive geriatric assessment to reduce mortality risk and inform treatment decisions based on a patient's health status, comorbidities, and life expectancy.
Dr. Shyam Kalavalapalli MRCP(London), CCT, MRCP(Diabetes&Endocrinology), FRCP(Edin.)
Director, IDEA CLINICS,
Institute of Diabetes, Endocrinology and Adiposity
040 4004 2000 / 8008166166
International Advisory Board Member, Royal College of Physicians (Edinburgh, UK)
Country Representative for Thyroid Manager, USA
Indian Representative for World Obesity Federation, UK
Breast cancer is one of the most common cancers in women. Several factors can increase a woman's risk of developing breast cancer, including family history, lifestyle factors like obesity and lack of exercise, and hormonal influences. Regular screening through self-exams and mammograms can help detect breast cancer early when it is most treatable. Diet and nutrition also play an important role, as certain foods and dietary patterns may promote inflammation and increase cancer risk, while others provide protective antioxidants.
This document discusses obesity and related topics including:
- Definitions of obesity and measurements like BMI and waist circumference.
- The global scale of obesity and trends over time showing rising rates.
- Common causes of obesity including changes to food environment, diet, and physical activity levels.
- Endocrine factors that can contribute to obesity like hormones that regulate hunger.
- Health complications of obesity such as increased risk of diabetes, cardiovascular disease, and some cancers.
- Approaches to obesity management including diet, exercise, drugs, and bariatric surgery. Evidence is presented on effectiveness of different options.
- The relationship between obesity and diabetes including impact of weight gain from diabetes medications and potential benefits of new incre
Breast cancer recurrence and obesity - YSC2015 - RobinsonPenny Robinson
Moderate to severe obesity is associated with an increased risk of breast cancer recurrence, according to a study that analyzed data from 1,155 women in Australia. The study found that women with a body mass index of 30 to under 40 kg/m2 had a 71% higher risk of breast cancer recurrence compared to normal weight women, after adjusting for other factors like cancer stage at diagnosis. Among the 600 women who had stage 1 breast cancer at diagnosis, those who were moderately to severely obese had over three times the risk of recurrence compared to normal weight women. The results suggest that maintaining a healthy weight may help reduce the risk of the original breast cancer returning after initial treatment.
BC Recurrence and obesity - YSC2015 RobinsonPenny Robinson
These are the slides that Penny Robinson presented at the Young Statisticians Conference in Adelaide on 5 Feb 2015.
Moderate-severe obesity is associated with breast cancer recurrence in women with hormone receptor positive, HER2 negative disease.
The document discusses plans for a new randomized trial in the UK to assess the effects of additional breast cancer screening invitations outside of the standard age range of 50-70. It will involve millions of women being randomized to receive either one extra screening invitation before age 50 or one or more extra invitations after age 70. The main results on breast cancer mortality will not emerge until the 2020s, but the trial aims to help determine the effects of screening at younger or older ages. It also discusses an ongoing collaboration between breast cancer trialists to further review data from past screening trials and help assess the impact of screening on breast cancer mortality rates.
Invited lecture by Dr Sujoy Dasgupta in the Webinar on “PCOS Advocacy” by Endocrinology Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in September, 2020
This study evaluated the relationship between obesity, diet, physical activity and breast cancer risk in Thai women. The study involved 1,130 breast cancer patients and 1,142 healthy controls. It found that obesity (BMI over 25) was associated with a higher risk of breast cancer, especially in postmenopausal women. Underweight BMI in childhood and adolescence showed a decreased risk. Regular physical activity, especially walking, was linked to a lower breast cancer risk. High fruit and vegetable intake reduced risk while high animal fat increased risk in postmenopausal women. The study suggests obesity and diet influence breast cancer risk in Thai women.
Colon cancer is the second and third most common cancer in males and females. Screening programs have led to a reduction in late-stage diagnoses and mortality. Precise identification of prognostic patient groups allows for more targeted adjuvant therapy, improving disease-free and overall survival. Molecular markers of tumor aggressiveness aid in selecting optimal treatment approaches, increasing response rates, progression-free, and overall survival. A multidisciplinary team approach is essential for managing metastatic colon cancer with the goal of surgical cure in organ-limited disease.
Abdominal obesity, intra-abdominal adiposity and related cardiometabolic risk...My Healthy Waist
By Jean-Pierre Després, PhD, FAHA, Scientific Director, International Chair on Cardiometabolic Risk, Professor, Division of Kinesiology, Université Laval, Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada.
Nutrition screening and assessment in critically ill patientsMario Sanchez
- Underfeeding occurs commonly in ICUs according to studies, with mean caloric intake around 56% of targets.
- Several nutrition screening tools are available but may not be optimal for the ICU given limitations like unavailable nutritional history.
- The NUTRIC score was developed to quantify a patient's nutritional risk in the ICU based on factors like age, illness severity, comorbidities, inflammation.
- Higher NUTRIC scores are associated with worse outcomes like mortality and longer ventilation. Patients with higher scores may benefit most from aggressive nutrition interventions while low scores could see potential harm from such interventions.
- Underfeeding occurs commonly in ICUs according to studies, with mean caloric intake around 56% of targets.
- Several nutrition screening tools are available but may not be optimal for the ICU given limitations like unavailable nutritional history.
- The NUTRIC score was developed to quantify a patient's nutritional risk in the ICU based on factors like age, illness severity, comorbidities, inflammation.
- A higher NUTRIC score is associated with worse outcomes like higher mortality and longer ventilation, and these high-risk patients may benefit most from aggressive nutrition therapy.
- The document discusses an integrated approach to cancer prevention and treatment through lifestyle changes.
- It presents a model showing how lifestyle factors like nutrition, exercise, stress, and social support can affect cancer development over many years and influence whether cancer progresses or not.
- Evidence from studies on nutrition, exercise, stress management, and social support suggest that adopting a healthy lifestyle may reduce cancer risk and slow cancer progression. The Prostate Cancer Lifestyle Trial found significant benefits of lifestyle changes for men with early-stage prostate cancer.
A methods document explaining how the NOURISHING database is kept up-to-date with implemented government policies on promoting healthy diets and reducing obesity and non-communicable diseases.
Slides from Alan Jackson's presentation on Policy for Enabling Achievement of Height at Obesity, Physical Activity & Cancer: Life course influences and mechanisms
The document summarizes a randomized controlled trial that compares intermittent energy restriction (IER) to continuous energy restriction (CER) in women receiving chemotherapy for early breast cancer. The trial aims to test if IER is feasible for women on chemotherapy and to compare the two diets' effects on weight changes, body composition, chemotherapy toxicity, and blood biomarkers. Over 470 women were screened for eligibility, with 172 women enrolled and randomly assigned to receive individual counseling and support for either the IER or CER diet during their 4.5-6 months of chemotherapy. Outcomes will be assessed after chemotherapy completion to analyze differences between the diet groups.
To support governments as they develop national food and nutrition plans and targets, we have produced a new policy brief in collaboration with NCD Alliance.
Senior Policy & Public Affairs Manager, Bryony Sinclair's presentation, Curbing global sugar consumption, at the The Sugar Reduction Summit: Sugar, Sweetness & Obesity, 7 December 2015, London, England.
Professor Alan Jackson’s presentation, The Continuous Update Project: Recent Findings on Diet, Nutrition, Physical Activity and Cancer, at the African Organisation for Research & Training in Cancer (AORTIC) conference, 18-22 November 2015, Marrakech, Morocco.
Professor Martin Wiseman’s presentation, The Continuous Update Project: Introduction to the Project, at the African Organisation for Research & Training in Cancer (AORTIC) conference, 18-22 November 2015, Marrakech, Morocco.
Bryony Sinclair discussed a systems approach to policymaking for obesity prevention at American Public Health Association's Annual Meeting, 31 Oct - 4 Nov 2015, Chicago, USA.
Professor Michael Leitzmann presentation on The Continuous Update Project: Recent Findings on Diet, Nutrition, Physical Activity and Cancer at FENS European Nutrition Conference, 20-23 October 2015 Berlin (Germany).
Professor Martin Wiseman presentation on The Continuous Update Project: Introduction to the Project at FENS European Nutrition Conference, 20-23 October 2015 Berlin (Germany).
This document describes the Continuous Update Project, a novel approach developed by the World Cancer Research Fund to systematically review mechanistic evidence on diet, nutrition, physical activity and cancer. The approach involves conducting systematic reviews and meta-analyses of both epidemiological and mechanistic studies to make judgements on causal relationships. It emphasizes reproducibility, predefined criteria, and reviews evidence separately from making judgements. The goal is to help identify causal links between exposures and cancer outcomes.
This document provides various fundraising ideas that individuals and organizations can do to support the World Cancer Research Fund, including hosting events like quiz nights, dress down days at work, banana runs in the park, and golf tournaments. It also suggests challenges people can take on like skydiving, cycling long distances, and running marathons. The final sentences discuss additional ways to fundraise like recycling ink cartridges, payroll donations, selling pin badges, and donating birthdays or proceeds from online shopping.
This document summarizes findings from the Continuous Update Project (CUP) on diet, weight, physical activity and cancer risk. The CUP analyzes global research on cancer prevention and survival. The summary identifies several factors that increase cancer risk, such as being overweight, eating processed meat, drinking alcohol, and smoking. It also identifies factors that decrease cancer risk, such as eating vegetables, fruits, whole grains, and engaging in physical activity. The CUP findings are used to update the World Cancer Research Fund's Cancer Prevention Recommendations.
Operationalising World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations Using an Index Score
ISBNPA 3-6 June 2015
Giota Mitrou PhD MSc
Head of Research Funding & Science External Relations
World Cancer Research Fund International
A coherent approach: effective policy actions for fruits and vegetables throughout the NOURISHING framework.
Bryony Sinclair
Policy and Public Affairs Manager
World Cancer Research Fund International
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Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
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Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
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Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
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Nutritional deficiency Disorder are problems in india.
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- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
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- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
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5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
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1. Energy Balance, Adiposity, Physical
Activity and Breast Cancer
Cheryl L. Rock, PhD, RD
Dept. of Family and Preventive Medicine
Cancer Prevention and Control Program
2. Obesity and Risk and Progression of
Breast Cancer
Breast cancer is the most common cancer
worldwide in women, accounting for 23% of the
total number of new cancers diagnosed
Death rates from breast cancer have been
steadily declining, and there are now an
estimated 2.9 million women in the US alone with
a history of breast cancer
The relationship with BMI and incident breast
cancer is complex: Positively related in
postmenopausal women, but inversely related in
premenopausal women
3. Relative Risk of Breast Cancer Across Quintiles of
BMI in Premenopausal and in Postmenopausal
Women Who Did Not (or Did) Use Hormone Therapy
Pischon et al. Proc Nutr Soc 2008;67:128–145
4. Multivariate Adjusted RR of Breast Cancer by BMI and
Current Hormone Use Among Postmenopausal Women
(N=103,344), EPIC Study
Lahmann et al. Int J Cancer 2004;111:762–771
5. Physical Activity and Breast Cancer
Risk
The majority of epidemiological studies have
found a significant risk reduction among the
most (vs. least) physically active women, with an
average risk reduction of 25-30%, and a dose-
response effect
Evident in both pre- and postmenopausal
women, but greater in magnitude for
postmenopausal women and also in leaner (vs.
obese) women
Stronger risk reduction for recreational, lifetime
or later life and vigorous activity, in non-white
women and women without a family history
Friedenreich et al. Br J Sports Med 2008;42:636–647
6. Case-Control Studies of Physical Activity
and Breast Cancer Risk
Friedenreich et al. Br J Sports Med. 2008;42:636–647
7. Cohort Studies of Physical Activity and Breast Cancer Risk
Friedenreich et al. Br J Sports Med. 2008;42:636–647
8. Obesity and Cancer Progression
and/or Survival
Consistent evidence suggests that obesity is a
negative prognostic factor in breast cancer
Excess adiposity is a major risk factor for breast
cancer recurrence and mortality in both pre- and
postmenopausal women
Higher BMI is a significant independent predictor
of mortality regardless of tumor characteristics
In women who have been diagnosed with breast
cancer, obesity is associated with a 30%
increased risk of breast cancer outcomes
(recurrence, all-cause and breast cancer-specific
mortality)
10. Disease-free Survival of 557 Patients with Breast Cancer
and Negative Nodes According to Obesity at Diagnosis
Non-obese
Disease-free Survival (%)
Obese
Disease-free Months
The number of patients at risk at time 0, at 5 years, and at 10 years is shown for each set of survival
curves. Hazard ratio, 1.93 (95% CI, 1.29 to 2.88: P= 0.001). (Senie et al. Ann Int Med 1992;116:26-32)
11. Meta-Analysis and Pooled Hazard Ratio of the Effect of
Obesity on Breast Cancer-Specific Survival in
Breast Cancer Patients
Protani et al. Breast Cancer Res Treat 2010;123:627–635
12. Meta-Analysis and Pooled Hazard Ratio of the Effect of
Obesity on Overall Survival in Breast Cancer Patients
Protani et al. Breast Cancer Res Treat 2010;123:627–635
13. Physical Activity and Breast Cancer
Prognosis
Consistent evidence from epidemiological studies
suggests that physical activity before or after
breast cancer diagnosis is associated with reduced
all-cause and breast cancer-specific mortality, and
with a dose response effect
Some evidence for effect modification by BMI, but
not consistent, and no differences for pre- and
postmenopausal women or race or ethnicity
Higher level of physical activity appears to be
associated with a 30% decreased risk of mortality
15. Forest Plot of Risk Estimates from Observational Studies
of Physical Activity and Mortality Outcomes in
Breast Cancer Survivors
Indicate hazard ratios (HRs)
95% Confidence intervals (CIs)
Indicates point of unity
Ballard-Barbash et al. J Natl Cancer Inst 2012;104:815-840
16. Obesity: Possible Mechanisms
Several mechanisms have been proposed to explain
the adverse effect of excess adiposity (and physical
activity) on the risk and progression of breast cancer
Circulating reproductive steroid hormones
Insulin and interactions with growth factors
Inflammatory cytokines
17. Reproductive Steroid Hormones
Adipose tissue is an important extragonadal source
of estrogens from precursor adrenal androgens
Endogenous circulating estrogens are 50-100%
higher in postmenopausal obese (vs. normal
weight) women
Obesity is associated with decreased sex-hormone
binding globulin (SHBG)
High circulating estrogen levels are a risk factor for
breast cancer recurrence (Rock et al. CEBP
2008;17:614-620)
18. Adipose Tissue Production of Estrone and
Estradiol from Androstenedione and the Bioavailability of
Estradiol in Postmenopausal Women
Rose & Davis. Maturitas 2010;66:33-38
19. Insulin, Growth Factors, and
Inflammation
Insulin exhibits mitogenic effects that influence both
premalignant and cancerous stages of cell growth, and
insulin and insulin like growth factor (IGF) – I stimulate
mammary cell proliferation in vitro
Insulin also stimulates the synthesis of sex hormone
steroids and inhibits the synthesis of SHBG
Obesity is characterized by chronic mild inflammation,
and weight loss reduces inflammatory factors
Inflammation plays a central role in the insulin
resistance associated with obesity: Cytokines decrease
insulin action by affecting insulin receptor activity
20. 120
r=.54
100
Insulin ųIU/ml
80
60
40
20
0
15 20 25 30 35 40 45 50 55 60
Body Mass Index (kg/m2)
21. Potential Effect of Weight Loss on Proposed Hormonal and
Biological Factors Linking Obesity to Breast Cancer
22. Primary Prevention
In the general population, even a modest degree of
intentional weight loss favorably affects many
breast cancer-relevant risk factors and potential
mediators (Byers & Sedjo. Diabetes Obesity Metab
2011;1312:1063-1072)
Reduced levels of estrogens (30% reduction expected
with 10% weight loss) and increased SHBG
CRP levels decline with similar magnitude after weight
loss
Reductions in TNF-α and IL-6 also observed but of smaller
magnitude
23. Issues Specific to Cancer Survivors
Body image issues related to cancer and cancer
treatments
Enduring psychosocial symptoms, such as
depression and fatigue, affect efforts to make
changes in behaviors
Changes in family dynamics and social support
Increased physical activity is particularly
important, due to effects of treatments on body
composition, and the relationship between lean
body mass and resting energy expenditure
24. Reach Out to ENhancE Wellness in
Older Survivors (RENEW)
• Test the impact of a diet-exercise mailed
material/telephone counseling program on weight loss
and physical functioning in prostate, colorectal and
breast cancer survivors (N=641)
• Study participants: >65 years of age and overweight,
within 5 years of diagnosis, 45% male
Morey et al. JAMA 2009;301:1883-1891
28. Combining Weight Loss Counseling
With Weight Watchers
• Obese breast cancer survivors (N=48) assigned to
individualized weight loss counseling, referral to the
Weight Watchers program, a combination of both, or
control
• Weight change after 12 months of intervention was
0.85 + 6.0 kg (<1% of initial weight) in controls, -2.6 +
5.5 kg (2.7% of initial weight) in the Weight Watchers
only group, -8.0 + 5.5 kg (8.4% of initial weight) in the
individualized counseling only group, and -9.4 + 8.6
kg (9.8% of initial weight) in the combined group
Djuric et al. Obesity Res 2002;10:657-665
29. Weight Loss with Time in Each Study Arm:
Mean and SD of Change in Body Weight
30. Reducing Breast Cancer Recurrence
with Weight Loss: A Vanguard Trial
Exercise and Nutrition to Enhance Recovery and Good
Health for You (ENERGY) Trial (Rock et al. Contemp Clin
Trials 2013;34:282-295)
Randomized controlled study with the primary endpoint of
clinically significant weight loss in 693 overweight or obese
breast cancer survivors, with demonstration of
improvements in quality of life and co-morbidities
Prospective collection of blood and DNA samples to
examine effects on hormones and other factors to explain
the mechanism and probable differential response across
subgroups
Serves as vanguard for a larger cancer outcome study with
sufficient statistical power to assess effects of weight loss
on cancer outcomes in overweight or obese breast cancer
survivors
31. Preliminary Studies
Healthy Weight Management Study, N=85, group-based
cognitive-behavioral weight loss program plus telephone contacts
(Mefferd et al. Breast Cancer Res Treat 2007;1042:145-152)
• Intervention group mean 83.9 kg at baseline, 78.2 kg at 16 wks
(7% of initial weight), and 77.3 kg (8% of initial weight) at 12
mos; reported 7.4 hrs/wk mod + vig activity at 12 months
• Favorable changes in % body fat, waist circumference, SHBG,
bioavailable estradiol, and total and LDL cholesterol
Breast Cancer Survivors Health and Physical Exercise (SHAPE)
Study N=259, group-based behavioral weight loss program (Rock
et al. Clin Breast Cancer 2013)
• Intervention participants lost -4.6 kg (5.5% of initial body
weight) at 6 months and -3.8 kg (4.5% of initial body weight) at
18 months
• Weight loss of >5% associated with favorable changes in
depression, self-esteem, insulin, leptin, and estrogens (in
postmenopausal women)
32. SHAPE Study: Biological Factors by
Follow-up Weight Loss Category*
6-Month Follow-up 18-Month Follow-up
≥5% Weight <5% Weight ≥5% Weight <5% Weight
Loss Loss Loss Loss
(n = 74) (n = 139) P Value (n = 63) (n = 140) P Value
Insulin, µIU/mL
Baseline 16.9 (9.0) 16.3 (8.1) .64 16.9 (7.1) 17.1 (8.3) .08
Follow-up 13.2 (6.1) 19.8 (17.4) <.0001 15.8 (7.3) 23.0 (13.0) <.0001
Leptin, ng/mL
Base 36.4 (18.6) 39.5 (22.4) .32 34.5 (20.3) 40.3 (22.1) .08
Follow-up 20.3 (11.4) 34.5 (18.2) <.0001 20.1 (15.7) 29.8 (14.9) .0001
Sex hormone binding globulin, nmol/L
Baseline 58.9 (35.2) 58.4 (32.6) .92 64.9 (37.9) 55.5 (31.0) .06
Follow-up 71.7 (37.6) 56.3 (33.2) .004 63.9 (29.6) 45.1 (26.6) <.0001
* Values shown are mean (SD). P values represent results of t-tests between weight loss groups.
33. ENERGY Trial
Four sites; UCSD is the Coordinating Center
Subjects: Women aged > 21 years; diagnosed
with breast cancer (Stages I [≥1 cm], II, or III)
between 6 months and 5 years earlier; BMI
between 25 and 45 kg/m2
Intervention: Cognitive-behavioral closed group
sessions, tailored newsletters, individual
participant contacts (by email and/or telephone)
Control: Two individual counseling sessions,
health seminars, monthly contacts
34. ENERGY Trial: Comparability of Study Groups
Control Intervention
(n = 348) (n = 345)
Age, years (mean [SD]) 56.5 (9,5) 56.1 (9.5)
Education, years (mean [SD]) 15.5 (2.4) 15.6 (2.5)
Hispanic (%) 5.8 7.6
Race (%)
White 84.5 83.1
African-American 10.6 10.5
Asian-American 2.0 1.5
American Indian 0.3 0.6
Hawaiian/Pacific Islander 0 0.3
Mixed/Other 2.0 3.8
Missing or refused 0.6 0.3
Postmenopausal at study entry (%) 85.0 85.7
Weight, kg (mean[SD]) 84.7 (13.8) 85.0 (14.3)
Body mass index, kg/m2 (mean [SD]) 31.4 (4.6) 31.6 (4.7)
Years between diagnosis and study entry (mean) 2.83 2.72
Breast cancer stage (%)
I 31.9 32.0
II 51.7 48.6
III 16.4 19.5
35. Measurements and Outcomes
Measurements
• Blood pressure
• Questionnaires: Quality of life, physical activity
• Weight, waist circumference, step test
• Blood sample collection
Outcomes
• Weight loss and weight loss maintenance over a
two-year period (goal is 7% of initial weight)
• Quality of life
• Co-morbidities
• Cancer outcomes in preparation for a larger trial
• Biological samples
36. Transdisciplinary Research in
Energetics and Cancer (TREC)
Cooperative agreement initiative (U54) that explores the
relationship between obesity and cancer, funded by the
National Cancer Institute (Patterson et al. Cancer Causes
Control 2013)
Integrates the study of diet, weight, and physical activity
and their effects on energy balance and cancer
Projects: Biologic and physiologic mechanisms of energy
balance; behavioral, sociocultural, and environmental
influences on diet, physical activity and weight in cancer
survivors and other populations
Across the four centers, two (at UCSD and Univ. of Penn.)
are focused on energy balance and weight loss
interventions in breast cancer prevention and control
37. Considerations
Limitations of observational studies
Confounding: Difficult if not impossible to control for
other influencing factors, clustering of behaviors
Obesity is inextricably linked to behavioral determinants
Measurements are crude: Few if any physical activity
studies used objective measures, and few include full
assessment of all types and doses
Obesity and breast cancer risk and progression
Potential modulators, such as obesity-related
comorbidities
Energy restriction versus reduced adiposity
Manage metabolic changes associated with obesity
rather than focus on weight loss?
38. Weight Loss Interventions for Breast
Cancer Survivors
This target population is motivated and able to make
modifications in diet and physical activity to promote
weight loss
Individualized counseling (in person or telephone),
group sessions, and mailed material can promote
weight loss
More intensive interventions produce greater weight
loss
Evidence suggests that proposed biological
mediators are favorably affected
39. ENERGY Research Team
ENERGY Trial investigators (in alphabetical order):
Tim Byers, MD, MPH, Graham Colditz, MD, DrPH
(Data Management and Analysis), Wendy Demark-
Wahnefried, PhD, RD, Patricia Ganz, MD, Bilgé
Pakiz, EdD, Barbara Parker, MD, Cheryl Rock, PhD,
RD (PI of Parent Grant and Coordinating Center),
Rebecca Sedjo, PhD, Kathleen Wolin, ScD, Holly
Wyatt, MD
NCI: Catherine Alfano, PhD (program officer) and
Julia Rowland, PhD, Office of Cancer Survivorship;
also Robert Croyle, PhD, Division of Cancer Control
and Population Sciences