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Obesity and Breast Cancer: Not Only a Risk Factor of the Disease

Current Treatment Options in Oncology volume 16, Article number: 22 (2015) Cite this article

Opinion statement

Obesity not only is an independent risk factor of postmenopausal breast cancer (BC), and in particular estrogen receptor-positive/progesterone receptor-positive BC, it is also a prognostic factor of the disease. Substantial evidence has shown that obesity, as measured by body mass index (BMI) is linked to BC outcomes. All-cause and BC-specific mortality risk increase for each BMI unit increase in pre- and postmenopausal BC survivors is estimated to range from 8 to 29 %, depending on when BMI is ascertained. The positive associations in pre- and postmenopausal BC and in hormone receptor-positive and hormone receptor-negative BC are not significantly different. Furthermore, the negative impact of abdominal obesity on BC survival highlights the need of using fat distribution (waist circumference, waist-hip-ratio) as well as general obesity (BMI) to evaluate prognosis in the clinical setting. More research is needed to elucidate possible differential associations in pre- and postmenopausal BC that are defined by hormone receptor and/or human epidermal growth factor receptor (HER), and in advanced tumors; for which the data are limited and less clear. Current evidence on treatment toxicity supports the guidelines from the American Society for Clinical Oncology, which recommends the use of full weight-based chemotherapy to treat obese cancer patients. Several studies have shown that lifestyle interventions are feasible and safe; more research is needed on specific diets for health maintenance and weight loss in BC survivors. Being physically active (≥150 min/week of moderate intensity activity) helps manage body weight (normal BMI 18.5–24.9 kg/m2), improves survival, and has secondary health benefits. Oncologists should recommend their patients to be physically active and control body weight when the conditions of the patient allow it.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. GLOBOCAN. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. 2012. Available at http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed 3 Nov 2014.

  2. American Cancer Society. Cancer treatment and survivorship facts & figures 2014–2015. Atlanta: American Cancer Society; 2014.

    Google Scholar 

  3. Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491–7.

    PubMed  Article  Google Scholar 

  4. McCormack VA, Boffetta P. Today’s lifestyles, tomorrow’s cancers: trends in lifestyle risk factors for cancer in low- and middle-income countries. Ann Oncol. 2011;22:2349–57.

    CAS  PubMed  Article  Google Scholar 

  5. World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007.

    Google Scholar 

  6. Demark-Wahnefried W, Rimer BK, Winer EP. Weight gain in women diagnosed with breast cancer. J Am Diet Assoc. 1997;97:519–26.

    CAS  PubMed  Article  Google Scholar 

  7. Vance V, Mourtzakis M, McCargar L, et al. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12:282–94.

    CAS  PubMed  Article  Google Scholar 

  8. Sheean PM, Hoskins K, Stolley M. Body composition changes in females treated for breast cancer: a review of the evidence. Breast Cancer Res Treat. 2012;135:663–80.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  9. Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. J Clin Oncol. 2002;20:1128–43.

    PubMed  Article  Google Scholar 

  10. Niraula S, Ocana A, Ennis M, et al. Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat. 2012;134:769–81.

    CAS  PubMed  Article  Google Scholar 

  11. Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123:627–35.

    PubMed  Article  Google Scholar 

  12. Druesne-Pecollo N, Touvier M, Barrandon E, et al. Excess body weight and second primary cancer risk after breast cancer: a systematic review and meta-analysis of prospective studies. Breast Cancer Res Treat. 2012;135:647–54.

    PubMed  Article  Google Scholar 

  13. Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008;27:32.

    PubMed Central  PubMed  Article  Google Scholar 

  14. Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg. 1999;177:184–7.

    CAS  PubMed  Article  Google Scholar 

  15. Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120:104–10.

    CAS  PubMed  Article  Google Scholar 

  16. Rose DP, Komninou D, Stephenson GD. Obesity, adipocytokines, and insulin resistance in breast cancer. Obes Rev. 2004;5:153–65.

    CAS  PubMed  Article  Google Scholar 

  17. Hursting SD, Berger NA. Energy balance, host-related factors, and cancer progression. J Clin Oncol. 2010;28:4058–65.

    PubMed Central  PubMed  Article  Google Scholar 

  18. Cleary MP, Grossmann ME. Minireview: obesity and breast cancer: the estrogen connection. Endocrinology. 2009;150:2537–42.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  19. Goodwin PJ, Ennis M, Pritchard KI, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol. 2002;20:42–51.

    CAS  PubMed  Article  Google Scholar 

  20. van Kruijsdijk RC, van der Wall E, Visseren FL. Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev. 2009;18:2569–78.

    PubMed  Article  Google Scholar 

  21. Cui Y, Whiteman MK, Flaws JA, et al. Body mass and stage of breast cancer at diagnosis. Int J Cancer. 2002;98:279–83.

    CAS  PubMed  Article  Google Scholar 

  22. Kaidar-Person O, Bar-Sela G, Person B. The two major epidemics of the twenty-first century: obesity and cancer. Obes Surg. 2011;21:1792–7.

    PubMed  Article  Google Scholar 

  23. Griggs JJ, Sorbero ME, Lyman GH. Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med. 2005;165:1267–73.

    PubMed  Article  Google Scholar 

  24. Makari-Judson G, Braun B, Jerry DJ, et al. Weight gain following breast cancer diagnosis: implication and proposed mechanisms. World J Clin Oncol. 2014;5:272–82.

    PubMed Central  PubMed  Article  Google Scholar 

  25. Niravath P. Aromatase inhibitor-induced arthralgia: a review. Ann Oncol. 2013;24:1443–9.

    CAS  PubMed  Article  Google Scholar 

  26. Ligibel JA, Alfano CM, Courneya KS, et al. American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol. 2014;32:3568–74. In recognition of the significance of obesity in cancer prognosis, ASCO has released this position statement to feature the multipronged initiative to combat obesity.

    PubMed  Article  Google Scholar 

  27. American Society of Clinical Oncology. Obesity and cancer. A guide for Oncology Providers. 2014. Available at http://www.asco.org/sites/www.asco.org/files/obesity_provider_guide_final.pdf. Access 3 Nov 2014. This is one of the tools provided by ASCO to help oncology providers address obesity with their patients. Strategies to promote weight loss and/or prevention of weight gain in cancer survivors are provided.

  28. World Health Organization. Global database on body mass index. BMI classification. 2014. Available at http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed 3 Nov 2014.

  29. Chan DS, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25:1901–14. This systematic review provided supporting evidence that higher BMI is consistently associated with lower survival in BC survivors before and after cancer diagnosis.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  30. Kwan ML, John EM, Caan BJ, et al. Obesity and mortality after breast cancer by race/ethnicity: The California Breast Cancer Survivorship Consortium. Am J Epidemiol. 2014;179:95–111.

    PubMed Central  PubMed  Article  Google Scholar 

  31. Pan H, Gray RG, Early Breast Cancer Trialists’ Collaborative Group. Effect of obesity in premenopausal ER+ early breast cancer: EBCTCG data on 80,000 patients in 70 trials. J Clin Oncol. 2014;32:5s (suppl; abstr 503).

    Article  Google Scholar 

  32. Copson ER, Cutress RI, Maishman T, et al. Obesity and the outcome of young breast cancer patients in the UK: the POSH study. Ann Oncol. 2015;26:101–12.

    CAS  PubMed  Article  Google Scholar 

  33. Wolff AC, Hammond ME, Hicks DG, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31:3997–4013.

    PubMed  Article  Google Scholar 

  34. Van Mieghem T, Leunen K, Pochet N, et al. Body mass index and HER-2 overexpression in breast cancer patients over 50 years of age. Breast Cancer Res Treat. 2007;106:127–33.

    CAS  PubMed  Article  Google Scholar 

  35. Cancer Progress.Net. Progress Against Breast Cancer. 2014. Available at http://www.cancerprogress.net/sites/cancerprogress.net/files/category-downloads/progress_against_breast_cancer_timeline.pdf. Accessed 3 Nov 2014.

  36. Sparano JA, Wang M, Zhao F, et al. Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer. 2012;118:5937–46.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  37. Robinson PJ, Bell RJ, Davis SR. Obesity is associated with a poorer prognosis in women with hormone receptor positive breast cancer. Maturitas. 2014;79:279–86.

    CAS  PubMed  Article  Google Scholar 

  38. Crozier JA, Moreno-Aspitia A, Ballman KV, et al. Effect of body mass index on tumor characteristics and disease-free survival in patients from the HER2-positive adjuvant trastuzumab trial N9831. Cancer. 2013;119:2447–54.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  39. Jiralerspong S, Kim ES, Dong W, et al. Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients. Ann Oncol. 2013;24:2506–14.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  40. Mazzarella L, Disalvatore D, Bagnardi V, et al. Obesity increases the incidence of distant metastases in oestrogen receptor-negative human epidermal growth factor receptor 2-positive breast cancer patients. Eur J Cancer. 2013;49:3588–97.

    CAS  PubMed  Article  Google Scholar 

  41. Adamo V, Ricciardi GR, Adamo B, et al. The risk of toxicities from trastuzumab, alone or in combination, in an elderly breast cancer population. Oncology. 2014;86:16–21.

    CAS  PubMed  Article  Google Scholar 

  42. Yu AF, Yadav NU, Lung BY, et al. Trastuzumab interruption and treatment-induced cardiotoxicity in early HER2-positive breast cancer. Breast Cancer Res Treat. 2015;149:489–95.

    CAS  PubMed  Article  Google Scholar 

  43. Cleator S, Heller W, Coombes RC. Triple-negative breast cancer: therapeutic options. Lancet Oncol. 2007;8:235–44.

    PubMed  Article  Google Scholar 

  44. Sturtz LA, Melley J, Mamula K, et al. Outcome disparities in African American women with triple negative breast cancer: a comparison of epidemiological and molecular factors between African American and Caucasian women with triple negative breast cancer. BMC Cancer. 2014;14:62.

    PubMed Central  PubMed  Article  Google Scholar 

  45. Schmitz KH, Neuhouser ML, Agurs-Collins T, et al. Impact of obesity on cancer survivorship and the potential relevance of race and ethnicity. J Natl Cancer Inst. 2013;105:1344–54.

    PubMed Central  PubMed  Article  Google Scholar 

  46. Gluz O, Liedtke C, Gottschalk N, et al. Triple-negative breast cancer—current status and future directions. Ann Oncol. 2009;20:1913–27.

    CAS  PubMed  Article  Google Scholar 

  47. Swisher AK, Abraham J, Bonner D, et al. Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Support Care Cancer. 2015. doi:10.1007/s00520-015-2667-z.

    PubMed  Google Scholar 

  48. Ademuyiwa FO, Groman A, O’Connor T, et al. Impact of body mass index on clinical outcomes in triple-negative breast cancer. Cancer. 2011;117:4132–40.

    PubMed  Article  Google Scholar 

  49. Christiansen N, Chen L, Gilmore J, et al. Association between African American race and outcomes in patients with nonmetastatic triple-negative breast cancer: a retrospective analysis by using results from the Georgia Cancer Specialist Database. Clin Breast Cancer. 2012;12:270–5.

    PubMed  Article  Google Scholar 

  50. Dawood S, Lei X, Litton JK, et al. Impact of body mass index on survival outcome among women with early stage triple-negative breast cancer. Clin Breast Cancer. 2012;12:364–72.

    PubMed  Article  Google Scholar 

  51. Mowad R, Chu QD, Li BD, et al. Does obesity have an effect on outcomes in triple-negative breast cancer? J Surg Res. 2013;184:253–9.

    PubMed  Article  Google Scholar 

  52. Tait S, Pacheco JM, Gao F, et al. Body mass index, diabetes, and triple-negative breast cancer prognosis. Breast Cancer Res Treat. 2014;146:189–97.

    CAS  PubMed  Article  Google Scholar 

  53. Perez CA, Zumsteg ZS, Gupta G, et al. Black race as a prognostic factor in triple-negative breast cancer patients treated with breast-conserving therapy: a large, single-institution retrospective analysis. Breast Cancer Res Treat. 2013;139:497–506.

    CAS  PubMed  Article  Google Scholar 

  54. Turkoz FP, Solak M, Petekkaya I, et al. The prognostic impact of obesity on molecular subtypes of breast cancer in premenopausal women. J BUON. 2013;18:335–41.

    CAS  PubMed  Google Scholar 

  55. Gennari A, Nanni O, Puntoni M, et al. Body mass index and prognosis of metastatic breast cancer patients receiving first-line chemotherapy. Cancer Epidemiol Biomarkers Prev. 2013;22:1862–7.

    PubMed  Article  Google Scholar 

  56. Jung SY, Rosenzweig M, Sereika SM, et al. Factors associated with mortality after breast cancer metastasis. Cancer Causes Control. 2012;23:103–12.

    PubMed  Article  Google Scholar 

  57. von Drygalski A, Tran TB, Messer K, et al. Obesity is an independent predictor of poor survival in metastatic breast cancer: retrospective analysis of a patient cohort whose treatment included high-dose chemotherapy and autologous stem cell support. Int J Breast Cancer. 2011;2011:523276. doi:10.4061/2011/523276.

    Google Scholar 

  58. World Health Organization. Waist circumference and waist-hip ratio: report of a WHO Expert Consultation. Geneva; 2008.

  59. World Cancer Research Fund International. Continuous Update Project Report: diet, nutrition, physical activity, and breast cancer survivors; 2014. This report published by WCRF contains lifestyle recommendations to BC survivors, based on evidence of body fatness and physical activity along with other dietary factors and survival in women with BC.

  60. George SM, Bernstein L, Smith AW, et al. Central adiposity after breast cancer diagnosis is related to mortality in the Health, Eating, Activity, and Lifestyle study. Breast Cancer Res Treat. 2014;146:647–55. Results from the HEAL study support the role of body fat distribution in BC survival. The association may be mediated by insulin resistance and inflammation.

    PubMed  Article  Google Scholar 

  61. Thompson AM, Moulder-Thompson SL. Neoadjuvant treatment of breast cancer. Ann Oncol. 2012;23 Suppl 10:x231–6.

    PubMed  Article  Google Scholar 

  62. Fontanella C, Lederer B, Gade S, et al. Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials. Breast Cancer Res Treat. 2015;150:127–39. Results from this pooled analysis of 8,872 BC patients in 8 neoadjuvant trials show that higher BMI was associated with lower pCR and a detrimental impact on survival; chemotherapy compliance and dosage may partly explain the results.

    CAS  PubMed  Article  Google Scholar 

  63. Budman DR, Berry DA, Cirrincione CT, et al. Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B. J Natl Cancer Inst. 1998;90:1205–11.

    CAS  PubMed  Article  Google Scholar 

  64. Hourdequin KC, Schpero WL, McKenna DR, et al. Toxic effect of chemotherapy dosing using actual body weight in obese versus normal-weight patients: a systematic review and meta-analysis. Ann Oncol. 2013;24:2952–62. This systematic review supports the use of full weight-based chemotherapy doses in obese patients with solid tumors, based on the findings of 12 relevant studies that showed similar or lower rates of toxic effects, and similar survival outcomes compared with normal weight patients.

    CAS  PubMed  Article  Google Scholar 

  65. Carroll JP, Protani MM, Nguyen L, et al. Toxicity and tolerability of adjuvant breast cancer chemotherapy in obese women. Med Oncol. 2014;31:881. doi:10.1007/s12032-014-0881-z.

    PubMed  Article  Google Scholar 

  66. Griggs JJ, Mangu PB, Anderson H, et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2012;30:1553–61.

    PubMed  Article  Google Scholar 

  67. Burstein HJ, Temin S, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline focused update. J Clin Oncol. 2014;32:2255–69.

    PubMed  Article  Google Scholar 

  68. Pfeiler G, Stoger H, Dubsky P, et al. Efficacy of tamoxifen +/- aminoglutethimide in normal weight and overweight postmenopausal patients with hormone receptor-positive breast cancer: an analysis of 1509 patients of the ABCSG-06 trial. Br J Cancer. 2013;108:1408–14.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  69. Fabian CJ. The what, why and how of aromatase inhibitors: hormonal agents for treatment and prevention of breast cancer. Int J Clin Pract. 2007;61:2051–63.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  70. Sestak I, Distler W, Forbes JF, et al. Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol. 2010;28:3411–5.

    CAS  PubMed  Article  Google Scholar 

  71. Goodwin PJ, Pritchard KI. Obesity and hormone therapy in breast cancer: an unfinished puzzle. J Clin Oncol. 2010;28:3405–7.

    CAS  PubMed  Article  Google Scholar 

  72. Ioannides SJ, Barlow PL, Elwood JM, et al. Effect of obesity on aromatase inhibitor efficacy in postmenopausal, hormone receptor-positive breast cancer: a systematic review. Breast Cancer Res Treat. 2014;147:237–48.

    CAS  PubMed  Article  Google Scholar 

  73. Dixon JM, Renshaw L, Young O, et al. Letrozole suppresses plasma estradiol and estrone sulphate more completely than anastrozole in postmenopausal women with breast cancer. J Clin Oncol. 2008;26:1671–6.

    CAS  PubMed  Article  Google Scholar 

  74. Folkerd EJ, Dixon JM, Renshaw L, et al. Suppression of plasma estrogen levels by letrozole and anastrozole is related to body mass index in patients with breast cancer. J Clin Oncol. 2012;30:2977–80.

    CAS  PubMed  Article  Google Scholar 

  75. Ewertz M, Gray KP, Regan MM, et al. Obesity and risk of recurrence or death after adjuvant endocrine therapy with letrozole or tamoxifen in the breast international group 1-98 trial. J Clin Oncol. 2012;30:3967–75.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  76. O’Shaughnessy J. A decade of letrozole: FACE. Breast Cancer Res Treat. 2007;105 Suppl 1:67–74.

    PubMed Central  PubMed  Article  Google Scholar 

  77. Goodwin PJ. Obesity and endocrine therapy: host factors and breast cancer outcome. Breast. 2013;22 Suppl 2:S44–7. This article is a concise review of the RCTs that evaluated the impact of BMI in the aromatase inhibitor (AI) efficacy in BC patients and concluded that the findings do not support the use of BMI as a predictor of AI vs. tamoxifen benefit in the adjuvant setting in postmenopausal BC.

    PubMed  Article  Google Scholar 

  78. Burstein HJ, Prestrud AA, Seidenfeld J, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol. 2010;28:3784–96.

    PubMed  Article  Google Scholar 

  79. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790–7.

    CAS  PubMed  Article  Google Scholar 

  80. Gandini S, Puntoni M, Heckman-Stoddard BM, et al. Metformin and cancer risk and mortality: a systematic review and meta-analysis taking into account biases and confounders. Cancer Prev Res (Phila). 2014;7:867–85.

    CAS  Article  Google Scholar 

  81. Goodwin PJ, Stambolic V, Lemieux J, et al. Evaluation of metformin in early breast cancer: a modification of the traditional paradigm for clinical testing of anti-cancer agents. Breast Cancer Res Treat. 2011;126:215–20.

    CAS  PubMed  Article  Google Scholar 

  82. Yin M, Zhou J, Gorak EJ, et al. Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: a systematic review and meta-analysis. Oncologist. 2013;18:1248–55.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  83. Goodwin PJ, Parulekar WR, Gelmon KA, et al. Effect of metformin versus placebo on weight and metabolic factors in initial patients enrolled onto NCIC CTG MA.32, a multicenter adjuvant randomized controlled trial in early-stage breast cancer (BC). J Clin Oncol. 2013;31. NCIC CTG MA.32 published promising preliminary results that showed non-diabetics early-stage BC patients using metformin had improved body weight and obesity-related biomarkers compared with placebo.

  84. Chlebowski RT, Blackburn GL, Thomson CA, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst. 2006;98:1767–76.

    PubMed  Article  Google Scholar 

  85. Pierce JP, Natarajan L, Caan BJ, et al. Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA. 2007;298:289–98.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  86. Demark-Wahnefried W, Campbell KL, Hayes SC. Weight management and its role in breast cancer rehabilitation. Cancer. 2012;118:2277–87.

    PubMed  Article  Google Scholar 

  87. Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 2014;25:1293–311.

    CAS  PubMed  Article  Google Scholar 

  88. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:243–74. This report published by the ACS summarizes the findings on the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer and contains useful lifestyle recommendations for cancer survivors.

    PubMed  Article  Google Scholar 

  89. Courneya KS, Segal RJ, McKenzie DC, et al. Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Med Sci Sports Exerc. 2014;46:1744–51. START is the first aerobic or resistance exercise intervention to publish results on BC survival endpoints, which showed promising results of improved survival compared with patients who received usual care during adjuvant treatment.

    CAS  PubMed  Article  Google Scholar 

  90. Reeves MM, Terranova CO, Eakin EG, et al. Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev. 2014;15:749–68. In this systematic review, BC survivors in 8 out of the 14 intervention trials attained significant weight loss and health benefits with no adverse effects, which provided supporting evidence of the feasibility and beneficial effects of weight loss through diet and/or exercise.

    CAS  PubMed  Article  Google Scholar 

  91. Goodwin PJ, Segal RJ, Vallis M, et al. Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol. 2014;32:2231–9. The LISA trial is the latest weight loss intervention trial to publish results and showed that significant weight loss could be achieved in BC survivors through simple lifestyle modification strategies that were delivered through telephone counselling.

    PubMed  Article  Google Scholar 

  92. Travier N, Fonseca-Nunes A, Javierre C, et al. Effect of a diet and physical activity intervention on body weight and nutritional patterns in overweight and obese breast cancer survivors. Med Oncol. 2014;31:783.

    CAS  PubMed  Article  Google Scholar 

  93. Caan BJ, Kwan ML, Shu XO, et al. Weight change and survival after breast cancer in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev. 2012;21:1260–71.

    PubMed Central  PubMed  Article  Google Scholar 

  94. Rack B, Andergassen U, Neugebauer J, et al. The German SUCCESS C Study—the first European lifestyle study on breast cancer. Breast Care (Basel). 2010;5:395–400.

    Article  Google Scholar 

  95. Villarini A, Pasanisi P, Traina A, et al. Lifestyle and breast cancer recurrences: the DIANA-5 trial. Tumori. 2012;98:1–18.

    CAS  PubMed  Google Scholar 

Other references

  1. Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30–67.

    PubMed  Article  Google Scholar 

  2. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–26.

    PubMed  Article  Google Scholar 

  3. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008. Available at http://www.health.gov/paguidelines/pdf/paguide.pdf. Accessed 3 Nov 2014.

  4. World Cancer Research Fund International. Our cancer prevention recommendations. 2014. Available at http://www.wcrf.org/int/research-we-fund/our-cancer-prevention-recommendations. Accessed 3 Nov 2014.

  5. National Comprehensive Cancer Network. NCCN Guidelines for Treatment of Cancer by Site. Breast Cancer. 2014. Available at http://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf. Accessed 3 Nov 2014.

Download references

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Doris S.M. Chan and Teresa Norat declare that they have no conflict of interest.

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  1. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, Paddington, London, W2 1PG, UK

    Doris S. M. Chan M.Sc. & Teresa Norat Ph.D.

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Chan, D.S.M., Norat, T. Obesity and Breast Cancer: Not Only a Risk Factor of the Disease. Curr. Treat. Options in Oncol. 16, 22 (2015). https://doi.org/10.1007/s11864-015-0341-9

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Keywords

  • General obesity
  • Abdominal obesity
  • Breast cancer prognosis
  • Lifestyle modifications