Re: Beyond Treatment: Lifestyle Choices After Breast Cancer.........

[Guest guest]

HI<

Just a comment on this--

Having been aware of information similar to the article, I have been

aware for years of fats, weight control, exercise, etc.

I am not overweight--exercise and walk every single day and probably

have walked for recreation all my life--eat a low fat diet--have no

specific heredity of bc--

Still I have breast cancer-

I jokingly said maybe it is because I have cooked with a microwave

oven for as long as they have existed (probably 30+ years)--but who

knows??

Carol

> Beyond treatment: lifestyle choices after breast cancer to enhance

> quality of life and survival

> Volume 14, Issue 1, Pages 11-13 (January 2004)

> Kroenke CH, Holmes MD

>

http://www.journals.elsevierhealth.com/periodicals/whi/article/PIIS104

> 9386703001178/fulltext

>

> Almost 2 million women in the United States are living with a

breast

> cancer diagnosis (Aziz, 2002). Recent advances in treatment give

new

> hope for a long and healthy life (Goss et al., 2003). However,

length

> of survival after a breast cancer diagnosis varies greatly, even

> after accounting for disease stage and treatment (, Lippman,

> Morrow, & Osborne, 2000). This suggests that other factors may also

> be important.

>

> People commonly change diet and lifestyle after a cancer diagnosis

in

> an effort to maintain health and prevent recurrence (Maskarinec,

> , Shumay, & Kakai, 2001) However, there are few definitive

data

> about nonclinical factors that influence breast cancer outcomes. We

> will review epidemiologic findings for several lifestyle factors

and

> outcomes after breast cancer, and indicate current knowledge gaps.

We

> have focused on lifestyle factors after diagnosis, which is what

the

> woman facing a breast cancer diagnosis can change.

>

> The predominant hypothesis has been that a diet high in fruit,

> vegetables, and fiber and low in fat may benefit survival (Rock &

> Demark-Wahnefried, 2002). There are trials currently underway to

> examine these dietary patterns on the risk for recurrence and

> survival after diagnosis of early-stage breast cancer. The Women's

> Healthy Eating and Living (WHEL) Study includes 3,000 women where

the

> intervention is to consume five vegetable servings (including 16

> ounces of vegetable juice), three fruit servings, 30 g of dietary

> fiber per day, and a very low fat diet (15% to 20% of energy). The

> Women's Intervention Nutrition Study (WINS), with 2,500

> postmenopausal women, will evaluate the impact of a reduction in

> dietary fat intake to =15% energy on survival. Results are due in

> several years.

>

> The hypothesis that a low-fat diet could improve breast cancer

> survival has been based mostly on international comparisons.

Japanese

> women have better survival rates than Western women, even after

> accounting for disease stage ( et al., 1991; Le Marchand,

1991)

> However, other factors could account for international differences

> and observational studies have not strongly supported the low-fat

> hypothesis.

>

> In 1999, we reported on diet after breast cancer diagnosis and risk

> of death from any cause among nearly 2,000 women followed for up to

> 18 years (Holmes et al., 1999). We found no linear association

> between higher fat intake and increased mortality (p = .40), but a

> slightly elevated risk of death for the highest versus the lowest

> quintile of intake (relative risk [RR], 1.34, 95% confidence

interval

> [CI]: 0.97–1.85), and an unexpected decreased risk of death with

> higher protein intake (RR = 0.65, CI: 0.47–0.88, p-value for linear

> trend < .001), and poultry intake (RR = 0.70, CI: 0.50–0.97 for

>0.4

> servings per day versus =0.1 serving per day; p-trend = .02), but

no

> association with red meat. We also found a borderline decreased

risk

> of death with increased vegetable intake (RR = 0.81, CI 0.59–1.11

for

> >4.2 servings per day versus =2.1 servings per day; p-trend = .07).

> Results for death specifically from breast cancer were similar.

>

> Two recent reports lend support to these findings. Goodwin and

> colleagues (2003) described a U-shaped relationship between intake

of

> several nutrients (including carbohydrates, alcohol, and

> polyunsaturated fat) and survival among 477 women with early-stage

> breast cancer. However, the curves for fat and protein intake

showed

> little evidence of increased hazard with higher intake, suggesting

a

> level of intake above which prognostic effects are constant. In

fact,

> there was a borderline statistically significant association

between

> increased protein intake and decreased risk of death, when intake

was

> modeled linearly (p = .07) (Goodwin et al., 2003). In addition,

Nagle

> and colleagues (2003) reported on diet and survival among 609 women

> with ovarian cancer. They found a lower risk of death with higher

> vegetable intake (highest versus lowest tertile; RR = 0.75, CI:

0.57–

> 0.99; p-trend .01), and similarly with vitamin E (RR = 0.76, CI:

0.58–

> 1.01; p-trend = .04), and a near-significant similar association

with

> protein (p = .09) (Nagle et al., 2003).

>

> Physical activity has been associated with a 12–60% decreased risk

of

> contracting breast cancer in most epidemiologic studies (Gammon,

> , & Britton, 1998). Physical activity after a breast cancer

> diagnosis has also been strongly linked to an improved quality of

> life (Pinto & Maruyama, 1999), suggesting an indirect link with

> survival (Chang et al., 1998; Kramer et al., 2000) However, one

study

> found no association between physical activity after diagnosis and

> survival among 412 women with breast cancer (Rohan, Fu, & Hiller,

> 1995).

>

> The most plausible mechanism is a decrease in estrogen levels

induced

> by exercise. Physically active women have both greater menstrual

> irregularities and lower serum estrogen Levels (Gammon et al.,

1998).

> Lowered estrogen levels among physically active women with breast

> cancer could potentially improve survival, although little research

> has addressed this question (Holmberg et al., 2001).

>

> Although physical activity and diet may have direct effects on

> survival, they may also influence survival through their effects on

> body weight. Among postmenopausal women, being overweight is a risk

> factor for developing breast cancer (Chlebowski, Aiello, &

McTiernan,

> 2002). Additionally, heavy women have twice the risk of recurrence

> over 5 years and a 60% increased risk of death over 10 years,

> compared with normal-weight or thinner women (Goodwin & Boyd,

1990).

> Overweight postmenopausal women have been observed to have higher

> estrogen and androgen concentrations compared with lighter women

> (Chlebowski et al., 2002; McTiernan et al., 2003).

>

> Weight gain after diagnosis may also have adverse effects on

> survival, although few studies have explored this question

> (Chlebowski et al., 2002). In the largest such study, (n = 545),

> Camoriano and colleagues (1990) found an elevated risk of relapse

(RR

> = 1.5, p = .17) and death (RR = 1.6, p = .04) among premenopausal

> women who gained more than the median weight by 5 years post-

> diagnosis. They found a weaker but nonsignificant association in

> postmenopausal women (Camoriano, 1990).

>

> Up to 60% or more of women may gain weight after breast cancer

> diagnosis, which is related to receipt of chemotherapy and

treatment-

> related menopause. Because of the potentially adverse effect on

> survival, it may be important for clinicians and women to manage

> weight gain associated with treatment.

>

> Reducing fat intake has not been shown to affect weight in breast

> cancer survivors (Rock et al., 2001). However, a prudent diet

> including fruits, vegetables, whole grains, and legumes may

increase

> survival (Rock & Demark-Wahnefried, 2002) and help to control

> appetite and caloric intake (Pereira & Ludwig, 2001). There is

> evidence to suggest that a diet high in fiber and low in refined

> carbohydrates may help women maintain weight (Liu et al., 2003).

> Maintaining higher levels of vigorous physical activity has been

> shown to limit weight gain among women undergoing breast cancer

> therapy (Goodwin et al., 1998).

>

> More speculatively, psychosocial factors may influence outcomes

after

> breast cancer, although this may depend on disease stage. In 1989,

> Spiegel and co-workers reported a doubling in survival among women

> with metastatic breast cancer who had participated in a social

> support intervention (Spiegel, 1989). More recently, Goodwin and

> colleagues (2001) tried to duplicate the methods of Spiegel. In

> contrast with Spiegel's study, they found no evidence that social

> support improves survival among patients with metastatic disease.

> However, the support intervention did improve quality of life and

> reduce pain (Goodwin, 2001).

>

> Several observational studies of women with early-stage breast

cancer

> have found a modest increase in mortality risk among women with low

> levels of social connection (Maunsell, Brisson, & Deschenes, 1995;

> Reynolds et al., 1994). Low levels of social networks have also

been

> related to higher mortality in the general population (Berkman &

> Syme, 1979). There have been no trials examining whether social

> connection or support influences early-stage breast cancer survival.

>

> The epidemiologic findings with regard to lifestyle factors and

> breast cancer outcomes are only suggestive at this time. However,

> adoption of healthy practices including high levels of physical

> activity, a prudent diet, maintaining normal weight, and

maintaining

> social connection are unlikely to be harmful. They are likely to

> reduce the risk of other illnesses such as cardiovascular disease.

> Even if ultimately found not to directly influence breast cancer

> survival, they may influence overall survival as well as improve

> quality of life.

>

> References

> et al., 1991. DS, Bulbrook RD, Chaudary MA, Hayward JL,

> Yoshida M, Miura S, et al. Recurrence and survival rates in British

> and Japanese women with breast cancer. Breast Cancer Research &

> Treatment. 1991;18(Suppl 1):S131-S134

> Aziz, 2002. Aziz, N. (2002). Presented at Long term cancer

> survivorship—Research initiative: RFA 97-018. Rockville, MD:

National

> Cancer Institute. September 12, 2002

> Berkman and Syme, 1979. Berkman LF, Syme SL. Social networks, host

> resistance, and mortality: A nine-year follow-up study of Alameda

> County residents. American Journal of Epidemiology. 1979;109(2):186-

> 204 MEDLINE

> Camoriano et al., 1990. Camoriano JK, Loprinzi CL, Ingle JN,

Therneau

> TM, Krook JE, Veeder MH. Weight change in women treated with

adjuvant

> therapy or observed following mastectomy for node-positive breast

> cancer. Journal of Clinical Oncology. 1990;8(8):1327-1334 MEDLINE

> Chang et al., 1998. Chang VT, Thaler HT, Polyak TA, Kornblith AB,

> Lepore JM, Portenoy RK. Quality of life and survival: The role of

> multidimensional symptom assessment. Cancer. 1998;83(1):173-179

> MEDLINE

> Chlebowski et al., 2002. Chlebowski RT, Aiello E, McTiernan A.

Weight

> loss in breast cancer patient management. Journal of Clinical

> Oncology. 2002;20(4):1128-1143 MEDLINE

> Gammon et al., 1998. Gammon MD, EM, Britton JA. Recreational

and

> occupational physical activities and risk of breast cancer. Journal

> of the National Cancer Institute. 1998;90:100-117 MEDLINE

> Goodwin et al., 1998. Goodwin P, Esplen MJ, K, Winocur J,

> Pritchard K, Brazel S, et al. Multidisciplinary weight management

in

> locoregional breast cancer: Results of a phase II study. Breast

> Cancer Research and Treatment. 1998;48(1):53-64 MEDLINE

> Goodwin and Boyd, 1990. Goodwin PJ, Boyd NF. Body size and breast

> cancer prognosis: A critical review of the evidence. Breast Cancer

> Research and Treatment. 1990;16(3):205-214 MEDLINE

> Goodwin et al., 2003. Goodwin PJ, Ennis M, Pritchard KI, Koo J,

> Trudeau ME, Hood N. Diet and breast cancer: Evidence that extremes

in

> diet are associated with poor survival. Journal of Clinical

Oncology.

> 2003;21(13):2500-2507 MEDLINE

> Goodwin et al., 2001. Goodwin PJ, Leszcz M, Ennis M, Koopmans J,

> L, Guther H, et al. The effect of group psychosocial

support

> on survival in metastatic breast cancer. Comment The New England

> Journal of Medicine. 2001;345(24):1719-1726

> Goss et al., 2003. Goss PE, Ingle JN, o S, NJ, Muss

HB,

> Piccart MJ, et al. A randomized trial of letrozole in

postmenopausal

> women after five years of tamoxifen therapy for early-stage breast

> cancer. The New England Journal of Medicine. 2003;349(19):1793-1802

> et al., 2000. JR, Lippman ME, Morrow M, Osborne CK.

> Diseases of the breast. (2nd ed) Philadelphia: Lippincott ,

> and Wilkins 2000

> Holmberg et al., 2001. Holmberg L, Norden T, Lindgren A, Wide L,

> Degerman M, Adami HO. Pre-operative oestradiol levels—Relation to

> survival in breast cancer. European Journal of Surgical Oncology.

> 2001;27(2):152-156 MEDLINE

> Holmes et al., 1999. Holmes MD, Stampfer MJ, Colditz GA, Rosner B,

> Hunter DJ, Willett WC. Dietary factors and the survival of women

with

> breast carcinoma. [see comments] Cancer. 1999;86(5):826-835erratum

> 2707–2708 MEDLINE

> Kramer et al., 2000. Kramer JA, Curran D, Piccart M, de Haes JC,

> Bruning P, Klijn J, et al. Identification and interpretation of

> clinical and quality of life prognostic factors for survival and

> response to treatment in first-line chemotherapy in advanced breast

> cancer. European Journal of Cancer. 2000;36(12):1498-1506 PDF (126

> KB) | MEDLINE

> Le Marchand, 1991. Le Marchand L. Ethnic variation in breast cancer

> survival: A review. Breast Cancer Research & Treatment. 1991;18

(Suppl

> 1):S119-S126

> Liu et al., 2003. Liu S, Willett WC, Manson JE, Hu FB, Rosner B,

> Colditz G. Relation between changes in intakes of dietary fiber and

> grain products and changes in weight and development of obesity

among

> middle-aged women. American Journal of Clinical Nutrition. 2003;78

> (5):920-927 MEDLINE

> Maskarinec et al., 2001. Maskarinec G, S, Shumay DM, Kakai

H.

> Dietary changes among cancer survivors. European Journal of Cancer

> Care (Engl). 2001;10(1):12-20

> Maunsell et al., 1995. Maunsell E, Brisson J, Deschenes L. Social

> support and survival among women with breast cancer. Cancer. 1995;76

> (4):631-637 MEDLINE

> McTiernan et al., 2003. McTiernan A, Rajan KB, Tworoger SS, Irwin

M,

> Bernstein L, Baumgartner R, et al. Adiposity and sex hormones in

> postmenopausal breast cancer survivors. Journal of Clinical

Oncology.

> 2003;21(10):1961-1966 MEDLINE

> Nagle et al., 2003. Nagle CM, Purdie DM, Webb PM, Green A, Harvey

PW,

> Bain CJ. Dietary influences on survival after ovarian cancer.

> International Journal of Cancer. 2003;106(2):264-269 MEDLINE

> Pereira and Ludwig, 2001. Pereira MA, Ludwig DS. Dietary fiber and

> body-weight regulation. Observations and mechanisms. Pediatric

> Clinics of North America. 2001;48(4):969-980 MEDLINE

> Pinto and Maruyama, 1999. Pinto BM, Maruyama NC. Exercise in the

> rehabilitation of breast cancer survivors. Psychooncology. 1999;8

> (3):191-206 MEDLINE

> Reynolds et al., 1994. Reynolds P, Boyd PT, Blacklow RS,

JS,

> Greenberg RS, Austin DF, et al. The relationship between social

ties

> and survival among black and white breast cancer patients. National

> Cancer Institute Black/White Cancer Survival Study Group. Cancer

> Epidemiology, Biomarkers, & Prevention. 1994;3(3):253-259

> Rock and Demark-Wahnefried, 2002. Rock CL, Demark-Wahnefried W.

> Nutrition and survival after the diagnosis of breast cancer: A

review

> of the evidence. Journal of Clinical Oncology. 2002;20(15):3302-

3316

> MEDLINE

> Rock et al., 2001. Rock CL, Thomson C, Caan BJ, Flatt SW, Newman V,

> Ritenbaugh C, et al. Reduction in fat intake is not associated with

> weight loss in most women after breast cancer diagnosis: Evidence

> from a randomized controlled trial. Cancer. 2001;91(1):25-34 MEDLINE

> Rohan et al., 1995. Rohan TE, Fu W, Hiller JE. Physical activity

and

> survival from breast cancer. European Journal of Cancer Prevention.

> 1995;4(5):419-424 MEDLINE

> Spiegel et al., 1989. Spiegel D, Bloom JR, Kraemer HC, Gottheil E.

> Effect of psychosocial treatment on survival of patients with

> metastatic breast cancer. Lancet. 1989;2(8668):888-891 MEDLINE

> Vitae:

> Dr. Holmes is an assistant professor of medicine at Harvard medical

> School. Her research interests include lifestyle factors (diet,

> weight change, physical activity, and psychosocial factors)

affecting

> quality of life and survival after a cancer diagnosis, as well as

the

> association between diet and breast cancer risk. Other research

> interests include diet and lifestyle influences on endogenous

levels

> of steroid hormones and insulin-like growth factor and ethnic

> differences in obesity and other lifestyle factors affecting

chronic

> disease risk. She co-edited a book on nutrition for cancer

survivors

> soon to be published by the American Cancer society.Vitae: Dr.

> Kroenke is an instructor at the Harvard Medical School. Her

research

> focuses on quality of life and survival after breast cancer, as

well

> as the influence of diet and psychosocial factors on chronic

disease

> outcomes.

> © 2004 The 's Institute of Women's Health

>

======================================================================

> =====================

> Breast Cancer News is brought to you by BREAST CANCER OPTIONS, part

> of the Mid Hudson Options Project, a grassroots Breast Cancer

Health

> Advocacy, Support and Activist Group. The information is intended

for

> educational purposes only, in order to help you make informed

health

> choices and may not have been touched upon by your doctors. We are

> not doctors and we do not recommend any particular treatments. We

are

> sending this information to advise you of the complete scientific

> overview that is currently available, although we may not

necessarily

> endorse it. http://www.breastcanceroptions.org

[Guest guest]

HI<

Just a comment on this--

Having been aware of information similar to the article, I have been

aware for years of fats, weight control, exercise, etc.

I am not overweight--exercise and walk every single day and probably

have walked for recreation all my life--eat a low fat diet--have no

specific heredity of bc--

Still I have breast cancer-

I jokingly said maybe it is because I have cooked with a microwave

oven for as long as they have existed (probably 30+ years)--but who

knows??

Carol

> Beyond treatment: lifestyle choices after breast cancer to enhance

> quality of life and survival

> Volume 14, Issue 1, Pages 11-13 (January 2004)

> Kroenke CH, Holmes MD

>

http://www.journals.elsevierhealth.com/periodicals/whi/article/PIIS104

> 9386703001178/fulltext

>

> Almost 2 million women in the United States are living with a

breast

> cancer diagnosis (Aziz, 2002). Recent advances in treatment give

new

> hope for a long and healthy life (Goss et al., 2003). However,

length

> of survival after a breast cancer diagnosis varies greatly, even

> after accounting for disease stage and treatment (, Lippman,

> Morrow, & Osborne, 2000). This suggests that other factors may also

> be important.

>

> People commonly change diet and lifestyle after a cancer diagnosis

in

> an effort to maintain health and prevent recurrence (Maskarinec,

> , Shumay, & Kakai, 2001) However, there are few definitive

data

> about nonclinical factors that influence breast cancer outcomes. We

> will review epidemiologic findings for several lifestyle factors

and

> outcomes after breast cancer, and indicate current knowledge gaps.

We

> have focused on lifestyle factors after diagnosis, which is what

the

> woman facing a breast cancer diagnosis can change.

>

> The predominant hypothesis has been that a diet high in fruit,

> vegetables, and fiber and low in fat may benefit survival (Rock &

> Demark-Wahnefried, 2002). There are trials currently underway to

> examine these dietary patterns on the risk for recurrence and

> survival after diagnosis of early-stage breast cancer. The Women's

> Healthy Eating and Living (WHEL) Study includes 3,000 women where

the

> intervention is to consume five vegetable servings (including 16

> ounces of vegetable juice), three fruit servings, 30 g of dietary

> fiber per day, and a very low fat diet (15% to 20% of energy). The

> Women's Intervention Nutrition Study (WINS), with 2,500

> postmenopausal women, will evaluate the impact of a reduction in

> dietary fat intake to =15% energy on survival. Results are due in

> several years.

>

> The hypothesis that a low-fat diet could improve breast cancer

> survival has been based mostly on international comparisons.

Japanese

> women have better survival rates than Western women, even after

> accounting for disease stage ( et al., 1991; Le Marchand,

1991)

> However, other factors could account for international differences

> and observational studies have not strongly supported the low-fat

> hypothesis.

>

> In 1999, we reported on diet after breast cancer diagnosis and risk

> of death from any cause among nearly 2,000 women followed for up to

> 18 years (Holmes et al., 1999). We found no linear association

> between higher fat intake and increased mortality (p = .40), but a

> slightly elevated risk of death for the highest versus the lowest

> quintile of intake (relative risk [RR], 1.34, 95% confidence

interval

> [CI]: 0.97–1.85), and an unexpected decreased risk of death with

> higher protein intake (RR = 0.65, CI: 0.47–0.88, p-value for linear

> trend < .001), and poultry intake (RR = 0.70, CI: 0.50–0.97 for

>0.4

> servings per day versus =0.1 serving per day; p-trend = .02), but

no

> association with red meat. We also found a borderline decreased

risk

> of death with increased vegetable intake (RR = 0.81, CI 0.59–1.11

for

> >4.2 servings per day versus =2.1 servings per day; p-trend = .07).

> Results for death specifically from breast cancer were similar.

>

> Two recent reports lend support to these findings. Goodwin and

> colleagues (2003) described a U-shaped relationship between intake

of

> several nutrients (including carbohydrates, alcohol, and

> polyunsaturated fat) and survival among 477 women with early-stage

> breast cancer. However, the curves for fat and protein intake

showed

> little evidence of increased hazard with higher intake, suggesting

a

> level of intake above which prognostic effects are constant. In

fact,

> there was a borderline statistically significant association

between

> increased protein intake and decreased risk of death, when intake

was

> modeled linearly (p = .07) (Goodwin et al., 2003). In addition,

Nagle

> and colleagues (2003) reported on diet and survival among 609 women

> with ovarian cancer. They found a lower risk of death with higher

> vegetable intake (highest versus lowest tertile; RR = 0.75, CI:

0.57–

> 0.99; p-trend .01), and similarly with vitamin E (RR = 0.76, CI:

0.58–

> 1.01; p-trend = .04), and a near-significant similar association

with

> protein (p = .09) (Nagle et al., 2003).

>

> Physical activity has been associated with a 12–60% decreased risk

of

> contracting breast cancer in most epidemiologic studies (Gammon,

> , & Britton, 1998). Physical activity after a breast cancer

> diagnosis has also been strongly linked to an improved quality of

> life (Pinto & Maruyama, 1999), suggesting an indirect link with

> survival (Chang et al., 1998; Kramer et al., 2000) However, one

study

> found no association between physical activity after diagnosis and

> survival among 412 women with breast cancer (Rohan, Fu, & Hiller,

> 1995).

>

> The most plausible mechanism is a decrease in estrogen levels

induced

> by exercise. Physically active women have both greater menstrual

> irregularities and lower serum estrogen Levels (Gammon et al.,

1998).

> Lowered estrogen levels among physically active women with breast

> cancer could potentially improve survival, although little research

> has addressed this question (Holmberg et al., 2001).

>

> Although physical activity and diet may have direct effects on

> survival, they may also influence survival through their effects on

> body weight. Among postmenopausal women, being overweight is a risk

> factor for developing breast cancer (Chlebowski, Aiello, &

McTiernan,

> 2002). Additionally, heavy women have twice the risk of recurrence

> over 5 years and a 60% increased risk of death over 10 years,

> compared with normal-weight or thinner women (Goodwin & Boyd,

1990).

> Overweight postmenopausal women have been observed to have higher

> estrogen and androgen concentrations compared with lighter women

> (Chlebowski et al., 2002; McTiernan et al., 2003).

>

> Weight gain after diagnosis may also have adverse effects on

> survival, although few studies have explored this question

> (Chlebowski et al., 2002). In the largest such study, (n = 545),

> Camoriano and colleagues (1990) found an elevated risk of relapse

(RR

> = 1.5, p = .17) and death (RR = 1.6, p = .04) among premenopausal

> women who gained more than the median weight by 5 years post-

> diagnosis. They found a weaker but nonsignificant association in

> postmenopausal women (Camoriano, 1990).

>

> Up to 60% or more of women may gain weight after breast cancer

> diagnosis, which is related to receipt of chemotherapy and

treatment-

> related menopause. Because of the potentially adverse effect on

> survival, it may be important for clinicians and women to manage

> weight gain associated with treatment.

>

> Reducing fat intake has not been shown to affect weight in breast

> cancer survivors (Rock et al., 2001). However, a prudent diet

> including fruits, vegetables, whole grains, and legumes may

increase

> survival (Rock & Demark-Wahnefried, 2002) and help to control

> appetite and caloric intake (Pereira & Ludwig, 2001). There is

> evidence to suggest that a diet high in fiber and low in refined

> carbohydrates may help women maintain weight (Liu et al., 2003).

> Maintaining higher levels of vigorous physical activity has been

> shown to limit weight gain among women undergoing breast cancer

> therapy (Goodwin et al., 1998).

>

> More speculatively, psychosocial factors may influence outcomes

after

> breast cancer, although this may depend on disease stage. In 1989,

> Spiegel and co-workers reported a doubling in survival among women

> with metastatic breast cancer who had participated in a social

> support intervention (Spiegel, 1989). More recently, Goodwin and

> colleagues (2001) tried to duplicate the methods of Spiegel. In

> contrast with Spiegel's study, they found no evidence that social

> support improves survival among patients with metastatic disease.

> However, the support intervention did improve quality of life and

> reduce pain (Goodwin, 2001).

>

> Several observational studies of women with early-stage breast

cancer

> have found a modest increase in mortality risk among women with low

> levels of social connection (Maunsell, Brisson, & Deschenes, 1995;

> Reynolds et al., 1994). Low levels of social networks have also

been

> related to higher mortality in the general population (Berkman &

> Syme, 1979). There have been no trials examining whether social

> connection or support influences early-stage breast cancer survival.

>

> The epidemiologic findings with regard to lifestyle factors and

> breast cancer outcomes are only suggestive at this time. However,

> adoption of healthy practices including high levels of physical

> activity, a prudent diet, maintaining normal weight, and

maintaining

> social connection are unlikely to be harmful. They are likely to

> reduce the risk of other illnesses such as cardiovascular disease.

> Even if ultimately found not to directly influence breast cancer

> survival, they may influence overall survival as well as improve

> quality of life.

>

> References

> et al., 1991. DS, Bulbrook RD, Chaudary MA, Hayward JL,

> Yoshida M, Miura S, et al. Recurrence and survival rates in British

> and Japanese women with breast cancer. Breast Cancer Research &

> Treatment. 1991;18(Suppl 1):S131-S134

> Aziz, 2002. Aziz, N. (2002). Presented at Long term cancer

> survivorship—Research initiative: RFA 97-018. Rockville, MD:

National

> Cancer Institute. September 12, 2002

> Berkman and Syme, 1979. Berkman LF, Syme SL. Social networks, host

> resistance, and mortality: A nine-year follow-up study of Alameda

> County residents. American Journal of Epidemiology. 1979;109(2):186-

> 204 MEDLINE

> Camoriano et al., 1990. Camoriano JK, Loprinzi CL, Ingle JN,

Therneau

> TM, Krook JE, Veeder MH. Weight change in women treated with

adjuvant

> therapy or observed following mastectomy for node-positive breast

> cancer. Journal of Clinical Oncology. 1990;8(8):1327-1334 MEDLINE

> Chang et al., 1998. Chang VT, Thaler HT, Polyak TA, Kornblith AB,

> Lepore JM, Portenoy RK. Quality of life and survival: The role of

> multidimensional symptom assessment. Cancer. 1998;83(1):173-179

> MEDLINE

> Chlebowski et al., 2002. Chlebowski RT, Aiello E, McTiernan A.

Weight

> loss in breast cancer patient management. Journal of Clinical

> Oncology. 2002;20(4):1128-1143 MEDLINE

> Gammon et al., 1998. Gammon MD, EM, Britton JA. Recreational

and

> occupational physical activities and risk of breast cancer. Journal

> of the National Cancer Institute. 1998;90:100-117 MEDLINE

> Goodwin et al., 1998. Goodwin P, Esplen MJ, K, Winocur J,

> Pritchard K, Brazel S, et al. Multidisciplinary weight management

in

> locoregional breast cancer: Results of a phase II study. Breast

> Cancer Research and Treatment. 1998;48(1):53-64 MEDLINE

> Goodwin and Boyd, 1990. Goodwin PJ, Boyd NF. Body size and breast

> cancer prognosis: A critical review of the evidence. Breast Cancer

> Research and Treatment. 1990;16(3):205-214 MEDLINE

> Goodwin et al., 2003. Goodwin PJ, Ennis M, Pritchard KI, Koo J,

> Trudeau ME, Hood N. Diet and breast cancer: Evidence that extremes

in

> diet are associated with poor survival. Journal of Clinical

Oncology.

> 2003;21(13):2500-2507 MEDLINE

> Goodwin et al., 2001. Goodwin PJ, Leszcz M, Ennis M, Koopmans J,

> L, Guther H, et al. The effect of group psychosocial

support

> on survival in metastatic breast cancer. Comment The New England

> Journal of Medicine. 2001;345(24):1719-1726

> Goss et al., 2003. Goss PE, Ingle JN, o S, NJ, Muss

HB,

> Piccart MJ, et al. A randomized trial of letrozole in

postmenopausal

> women after five years of tamoxifen therapy for early-stage breast

> cancer. The New England Journal of Medicine. 2003;349(19):1793-1802

> et al., 2000. JR, Lippman ME, Morrow M, Osborne CK.

> Diseases of the breast. (2nd ed) Philadelphia: Lippincott ,

> and Wilkins 2000

> Holmberg et al., 2001. Holmberg L, Norden T, Lindgren A, Wide L,

> Degerman M, Adami HO. Pre-operative oestradiol levels—Relation to

> survival in breast cancer. European Journal of Surgical Oncology.

> 2001;27(2):152-156 MEDLINE

> Holmes et al., 1999. Holmes MD, Stampfer MJ, Colditz GA, Rosner B,

> Hunter DJ, Willett WC. Dietary factors and the survival of women

with

> breast carcinoma. [see comments] Cancer. 1999;86(5):826-835erratum

> 2707–2708 MEDLINE

> Kramer et al., 2000. Kramer JA, Curran D, Piccart M, de Haes JC,

> Bruning P, Klijn J, et al. Identification and interpretation of

> clinical and quality of life prognostic factors for survival and

> response to treatment in first-line chemotherapy in advanced breast

> cancer. European Journal of Cancer. 2000;36(12):1498-1506 PDF (126

> KB) | MEDLINE

> Le Marchand, 1991. Le Marchand L. Ethnic variation in breast cancer

> survival: A review. Breast Cancer Research & Treatment. 1991;18

(Suppl

> 1):S119-S126

> Liu et al., 2003. Liu S, Willett WC, Manson JE, Hu FB, Rosner B,

> Colditz G. Relation between changes in intakes of dietary fiber and

> grain products and changes in weight and development of obesity

among

> middle-aged women. American Journal of Clinical Nutrition. 2003;78

> (5):920-927 MEDLINE

> Maskarinec et al., 2001. Maskarinec G, S, Shumay DM, Kakai

H.

> Dietary changes among cancer survivors. European Journal of Cancer

> Care (Engl). 2001;10(1):12-20

> Maunsell et al., 1995. Maunsell E, Brisson J, Deschenes L. Social

> support and survival among women with breast cancer. Cancer. 1995;76

> (4):631-637 MEDLINE

> McTiernan et al., 2003. McTiernan A, Rajan KB, Tworoger SS, Irwin

M,

> Bernstein L, Baumgartner R, et al. Adiposity and sex hormones in

> postmenopausal breast cancer survivors. Journal of Clinical

Oncology.

> 2003;21(10):1961-1966 MEDLINE

> Nagle et al., 2003. Nagle CM, Purdie DM, Webb PM, Green A, Harvey

PW,

> Bain CJ. Dietary influences on survival after ovarian cancer.

> International Journal of Cancer. 2003;106(2):264-269 MEDLINE

> Pereira and Ludwig, 2001. Pereira MA, Ludwig DS. Dietary fiber and

> body-weight regulation. Observations and mechanisms. Pediatric

> Clinics of North America. 2001;48(4):969-980 MEDLINE

> Pinto and Maruyama, 1999. Pinto BM, Maruyama NC. Exercise in the

> rehabilitation of breast cancer survivors. Psychooncology. 1999;8

> (3):191-206 MEDLINE

> Reynolds et al., 1994. Reynolds P, Boyd PT, Blacklow RS,

JS,

> Greenberg RS, Austin DF, et al. The relationship between social

ties

> and survival among black and white breast cancer patients. National

> Cancer Institute Black/White Cancer Survival Study Group. Cancer

> Epidemiology, Biomarkers, & Prevention. 1994;3(3):253-259

> Rock and Demark-Wahnefried, 2002. Rock CL, Demark-Wahnefried W.

> Nutrition and survival after the diagnosis of breast cancer: A

review

> of the evidence. Journal of Clinical Oncology. 2002;20(15):3302-

3316

> MEDLINE

> Rock et al., 2001. Rock CL, Thomson C, Caan BJ, Flatt SW, Newman V,

> Ritenbaugh C, et al. Reduction in fat intake is not associated with

> weight loss in most women after breast cancer diagnosis: Evidence

> from a randomized controlled trial. Cancer. 2001;91(1):25-34 MEDLINE

> Rohan et al., 1995. Rohan TE, Fu W, Hiller JE. Physical activity

and

> survival from breast cancer. European Journal of Cancer Prevention.

> 1995;4(5):419-424 MEDLINE

> Spiegel et al., 1989. Spiegel D, Bloom JR, Kraemer HC, Gottheil E.

> Effect of psychosocial treatment on survival of patients with

> metastatic breast cancer. Lancet. 1989;2(8668):888-891 MEDLINE

> Vitae:

> Dr. Holmes is an assistant professor of medicine at Harvard medical

> School. Her research interests include lifestyle factors (diet,

> weight change, physical activity, and psychosocial factors)

affecting

> quality of life and survival after a cancer diagnosis, as well as

the

> association between diet and breast cancer risk. Other research

> interests include diet and lifestyle influences on endogenous

levels

> of steroid hormones and insulin-like growth factor and ethnic

> differences in obesity and other lifestyle factors affecting

chronic

> disease risk. She co-edited a book on nutrition for cancer

survivors

> soon to be published by the American Cancer society.Vitae: Dr.

> Kroenke is an instructor at the Harvard Medical School. Her

research

> focuses on quality of life and survival after breast cancer, as

well

> as the influence of diet and psychosocial factors on chronic

disease

> outcomes.

> © 2004 The 's Institute of Women's Health

>

======================================================================

> =====================

> Breast Cancer News is brought to you by BREAST CANCER OPTIONS, part

> of the Mid Hudson Options Project, a grassroots Breast Cancer

Health

> Advocacy, Support and Activist Group. The information is intended

for

> educational purposes only, in order to help you make informed

health

> choices and may not have been touched upon by your doctors. We are

> not doctors and we do not recommend any particular treatments. We

are

> sending this information to advise you of the complete scientific

> overview that is currently available, although we may not

necessarily

> endorse it. http://www.breastcanceroptions.org

[Guest guest]

Hi Toni,

ONLY TWO MORE TREATMENTS TO GO!!!

Saw doctor today and he gave me a referral for a new oncologist--

wants me to have an appt before I see him again, which will be about

3 weeks from end of treatment.

Do not know if I will start medication right away--I return to work

in 2 weeks and seem these days to only be able to handle one set of

changes at a time.

I use hydrocortisone cream on the affected area of my breast. Rash

has subsided a whole lot since week--hardly itches at all. I have

never felt the need to go without my bra, either.

There are actually two other options that, like Arimidex, have been

in use for a while in treating recurrent breast cancer. They have

found Femara and Aromasin to be effective as a preventative

medication. They all increase osteoporosis, from what I understand.

I intend also to ask new doctor--what if I cannot tolerate any of

them??? A real possiblity, with the long, long list of other

medications of all types that I have had very strong reactions to---

I think the key to good treatment is a doctor who listens to you, and

feeling comfortable with the course of treatment he prescribes. I

did not with first oncologist and hope that is different with this

new one.

Writing and posting helps a lot too--I already know that!

Carol

In breastcancer2 , " Toni Graf " <tagraf@c...> wrote:

> Thank you for your comments. I read this report and almost passed

out.

> There is bc in the family and I am overweight. My diet is very

good, I just

> eat too much and snack inbetween. Also exercise is not on the top

of my

> list, but it is just recent that I do not work or have children

around me to

> keep me moving.

>

> Now I won't panic (altho in panic mode until the diagnosis on

Thursday).

> You always feel what did I do to have this happen and how can I fix

it. I

> have to keep reminding myself, it is the luck of the draw, the way

my body

> is. I have made changes already to diet and am walking daily,

started

> yesterday again after the mammotone biopsy recovery (mental

inertia).

>

> I am so glad your radiation is almost over. I took my mother-in-

law for her

> six weeks and of course my sister. I know the effects can be

minimal to a

> little nasty. Am I ready? NO. But am bending my mind to it. Do

you have

> anthing to put on the rash to stop the itching?

>

> When I talk to the surgeon this Thursday, I do want the sentinal

node

> biopsied. I bleed alot during the mammotome and am afraid

that " stuff " has

> been dislodged and floating around who knows where. I hope he has

answers.

>

> Yes we are in the military and at present I am being seen at Walter

.

> My husband is in the medical field and is adament about leaving the

military

> medicine and searching civilian possibilities. Our neice is a

social worker

> at a hospital in northern Virginia and I am going to contact her

today about

> researching my alternatives. If she doesn't have the capabilities,

> hopefully she can steer me to who does. I have told very few

people about

> my problem as to not worry anyone until it is time to worry. My

neice does

> not know but I think it is time to be selfish and use her

expertise. Her

> mom has worked as a hospice nurse for over 10 years and I will also

be using

> her to help me research protocols with oncology.

>

> Yesterday was a good day, the biopsied area didn't pulse anymore

and altho

> the bandages have not fallen off yet, there is no bruising which I

expected.

> So I will busy myself with cleaning the kitchen after my husband

cooked all

> weekend(he is so messy when he cooks, but the food tastes

wonderful). He

> has been trying so hard to do everything he can think of. Friday

eve tho he

> had a total meltdown. This effects everyone.

>

> Our daughter with her twins and older child, her girlfriend and her

baby,

> will travel here Thurday nite from South Carolina for an extended

weekend.

> I tried telling her no but she would not have any of it. I do fear

I will

> be an emotional mess and yet all the activity should take my mind

off

> things.

>

> Did your radiologist give you any idea as to any prevention

(besides this

> article)? I hope you find an oncologist that works for you. Don't

forget

> the new drug arimidex. It is not supposed to have the side effects

> tamoxifin has. You do have to be aware of osterporosis tho. I do

think you

> need to take one or the other, and I am not a fan of tamoxifin at

all.

>

> Does your grandson live close so you can enjoy him often? I hope

so.

>

> Thanks again for listening to me, you have helped me so so much.

>

> Re: Beyond Treatment: Lifestyle Choices

After

> Breast Cancer.........

>

>

> HI<

>

> Just a comment on this--

>

> Having been aware of information similar to the article, I have

been

> aware for years of fats, weight control, exercise, etc.

>

> I am not overweight--exercise and walk every single day and

probably

> have walked for recreation all my life--eat a low fat diet--have

no

> specific heredity of bc--

>

> Still I have breast cancer-

>

> I jokingly said maybe it is because I have cooked with a microwave

> oven for as long as they have existed (probably 30+ years)--but

who

> knows??

>

> Carol

>

>

> > Beyond treatment: lifestyle choices after breast cancer to

enhance

> > quality of life and survival

> > Volume 14, Issue 1, Pages 11-13 (January 2004)

> > Kroenke CH, Holmes MD

> >

>

http://www.journals.elsevierhealth.com/periodicals/whi/article/PIIS104

> > 9386703001178/fulltext

> >

> > Almost 2 million women in the United States are living with a

> breast

> > cancer diagnosis (Aziz, 2002). Recent advances in treatment give

> new

> > hope for a long and healthy life (Goss et al., 2003). However,

> length

> > of survival after a breast cancer diagnosis varies greatly, even

> > after accounting for disease stage and treatment (,

Lippman,

> > Morrow, & Osborne, 2000). This suggests that other factors may

also

> > be important.

> >

> > People commonly change diet and lifestyle after a cancer

diagnosis

> in

> > an effort to maintain health and prevent recurrence (Maskarinec,

> > , Shumay, & Kakai, 2001) However, there are few definitive

> data

> > about nonclinical factors that influence breast cancer

outcomes. We

> > will review epidemiologic findings for several lifestyle factors

> and

> > outcomes after breast cancer, and indicate current knowledge

gaps.

> We

> > have focused on lifestyle factors after diagnosis, which is what

> the

> > woman facing a breast cancer diagnosis can change.

> >

> > The predominant hypothesis has been that a diet high in fruit,

> > vegetables, and fiber and low in fat may benefit survival (Rock

&

> > Demark-Wahnefried, 2002). There are trials currently underway to

> > examine these dietary patterns on the risk for recurrence and

> > survival after diagnosis of early-stage breast cancer. The

Women's

> > Healthy Eating and Living (WHEL) Study includes 3,000 women

where

> the

> > intervention is to consume five vegetable servings (including 16

> > ounces of vegetable juice), three fruit servings, 30 g of

dietary

> > fiber per day, and a very low fat diet (15% to 20% of energy).

The

> > Women's Intervention Nutrition Study (WINS), with 2,500

> > postmenopausal women, will evaluate the impact of a reduction in

> > dietary fat intake to =15% energy on survival. Results are due

in

> > several years.

> >

> > The hypothesis that a low-fat diet could improve breast cancer

> > survival has been based mostly on international comparisons.

> Japanese

> > women have better survival rates than Western women, even after

> > accounting for disease stage ( et al., 1991; Le Marchand,

> 1991)

> > However, other factors could account for international

differences

> > and observational studies have not strongly supported the low-

fat

> > hypothesis.

> >

> > In 1999, we reported on diet after breast cancer diagnosis and

risk

> > of death from any cause among nearly 2,000 women followed for

up to

> > 18 years (Holmes et al., 1999). We found no linear association

> > between higher fat intake and increased mortality (p = .40),

but a

> > slightly elevated risk of death for the highest versus the

lowest

> > quintile of intake (relative risk [RR], 1.34, 95% confidence

> interval

> > [CI]: 0.97–1.85), and an unexpected decreased risk of death with

> > higher protein intake (RR = 0.65, CI: 0.47–0.88, p-value for

linear

> > trend < .001), and poultry intake (RR = 0.70, CI: 0.50–0.97 for

> >0.4

> > servings per day versus =0.1 serving per day; p-trend = .02),

but

> no

> > association with red meat. We also found a borderline decreased

> risk

> > of death with increased vegetable intake (RR = 0.81, CI 0.59–

1.11

> for

> > >4.2 servings per day versus =2.1 servings per day; p-trend

= .07).

> > Results for death specifically from breast cancer were similar.

> >

> > Two recent reports lend support to these findings. Goodwin and

> > colleagues (2003) described a U-shaped relationship between

intake

> of

> > several nutrients (including carbohydrates, alcohol, and

> > polyunsaturated fat) and survival among 477 women with early-

stage

> > breast cancer. However, the curves for fat and protein intake

> showed

> > little evidence of increased hazard with higher intake,

suggesting

> a

> > level of intake above which prognostic effects are constant. In

> fact,

> > there was a borderline statistically significant association

> between

> > increased protein intake and decreased risk of death, when

intake

> was

> > modeled linearly (p = .07) (Goodwin et al., 2003). In addition,

> Nagle

> > and colleagues (2003) reported on diet and survival among 609

women

> > with ovarian cancer. They found a lower risk of death with

higher

> > vegetable intake (highest versus lowest tertile; RR = 0.75, CI:

> 0.57–

> > 0.99; p-trend .01), and similarly with vitamin E (RR = 0.76, CI:

> 0.58–

> > 1.01; p-trend = .04), and a near-significant similar association

> with

> > protein (p = .09) (Nagle et al., 2003).

> >

> > Physical activity has been associated with a 12–60% decreased

risk

> of

> > contracting breast cancer in most epidemiologic studies (Gammon,

> > , & Britton, 1998). Physical activity after a breast cancer

> > diagnosis has also been strongly linked to an improved quality

of

> > life (Pinto & Maruyama, 1999), suggesting an indirect link with

> > survival (Chang et al., 1998; Kramer et al., 2000) However, one

> study

> > found no association between physical activity after diagnosis

and

> > survival among 412 women with breast cancer (Rohan, Fu, &

Hiller,

> > 1995).

> >

> > The most plausible mechanism is a decrease in estrogen levels

> induced

> > by exercise. Physically active women have both greater menstrual

> > irregularities and lower serum estrogen Levels (Gammon et al.,

> 1998).

> > Lowered estrogen levels among physically active women with

breast

> > cancer could potentially improve survival, although little

research

> > has addressed this question (Holmberg et al., 2001).

> >

> > Although physical activity and diet may have direct effects on

> > survival, they may also influence survival through their

effects on

> > body weight. Among postmenopausal women, being overweight is a

risk

> > factor for developing breast cancer (Chlebowski, Aiello, &

> McTiernan,

> > 2002). Additionally, heavy women have twice the risk of

recurrence

> > over 5 years and a 60% increased risk of death over 10 years,

> > compared with normal-weight or thinner women (Goodwin & Boyd,

> 1990).

> > Overweight postmenopausal women have been observed to have

higher

> > estrogen and androgen concentrations compared with lighter women

> > (Chlebowski et al., 2002; McTiernan et al., 2003).

> >

> > Weight gain after diagnosis may also have adverse effects on

> > survival, although few studies have explored this question

> > (Chlebowski et al., 2002). In the largest such study, (n = 545),

> > Camoriano and colleagues (1990) found an elevated risk of

relapse

> (RR

> > = 1.5, p = .17) and death (RR = 1.6, p = .04) among

premenopausal

> > women who gained more than the median weight by 5 years post-

> > diagnosis. They found a weaker but nonsignificant association in

> > postmenopausal women (Camoriano, 1990).

> >

> > Up to 60% or more of women may gain weight after breast cancer

> > diagnosis, which is related to receipt of chemotherapy and

> treatment-

> > related menopause. Because of the potentially adverse effect on

> > survival, it may be important for clinicians and women to manage

> > weight gain associated with treatment.

> >

> > Reducing fat intake has not been shown to affect weight in

breast

> > cancer survivors (Rock et al., 2001). However, a prudent diet

> > including fruits, vegetables, whole grains, and legumes may

> increase

> > survival (Rock & Demark-Wahnefried, 2002) and help to control

> > appetite and caloric intake (Pereira & Ludwig, 2001). There is

> > evidence to suggest that a diet high in fiber and low in refined

> > carbohydrates may help women maintain weight (Liu et al., 2003).

> > Maintaining higher levels of vigorous physical activity has been

> > shown to limit weight gain among women undergoing breast cancer

> > therapy (Goodwin et al., 1998).

> >

> > More speculatively, psychosocial factors may influence outcomes

> after

> > breast cancer, although this may depend on disease stage. In

1989,

> > Spiegel and co-workers reported a doubling in survival among

women

> > with metastatic breast cancer who had participated in a social

> > support intervention (Spiegel, 1989). More recently, Goodwin and

> > colleagues (2001) tried to duplicate the methods of Spiegel. In

> > contrast with Spiegel's study, they found no evidence that

social

> > support improves survival among patients with metastatic

disease.

> > However, the support intervention did improve quality of life

and

> > reduce pain (Goodwin, 2001).

> >

> > Several observational studies of women with early-stage breast

> cancer

> > have found a modest increase in mortality risk among women with

low

> > levels of social connection (Maunsell, Brisson, & Deschenes,

1995;

> > Reynolds et al., 1994). Low levels of social networks have also

> been

> > related to higher mortality in the general population (Berkman &

> > Syme, 1979). There have been no trials examining whether social

> > connection or support influences early-stage breast cancer

survival.

> >

> > The epidemiologic findings with regard to lifestyle factors and

> > breast cancer outcomes are only suggestive at this time.

However,

> > adoption of healthy practices including high levels of physical

> > activity, a prudent diet, maintaining normal weight, and

> maintaining

> > social connection are unlikely to be harmful. They are likely to

> > reduce the risk of other illnesses such as cardiovascular

disease.

> > Even if ultimately found not to directly influence breast cancer

> > survival, they may influence overall survival as well as improve

> > quality of life.

> >

> > References

> > et al., 1991. DS, Bulbrook RD, Chaudary MA, Hayward

JL,

> > Yoshida M, Miura S, et al. Recurrence and survival rates in

British

> > and Japanese women with breast cancer. Breast Cancer Research &

> > Treatment. 1991;18(Suppl 1):S131-S134

> > Aziz, 2002. Aziz, N. (2002). Presented at Long term cancer

> > survivorship—Research initiative: RFA 97-018. Rockville, MD:

> National

> > Cancer Institute. September 12, 2002

> > Berkman and Syme, 1979. Berkman LF, Syme SL. Social networks,

host

> > resistance, and mortality: A nine-year follow-up study of

Alameda

> > County residents. American Journal of Epidemiology. 1979;109

(2):186-

> > 204 MEDLINE

> > Camoriano et al., 1990. Camoriano JK, Loprinzi CL, Ingle JN,

> Therneau

> > TM, Krook JE, Veeder MH. Weight change in women treated with

> adjuvant

> > therapy or observed following mastectomy for node-positive

breast

> > cancer. Journal of Clinical Oncology. 1990;8(8):1327-1334

MEDLINE

> > Chang et al., 1998. Chang VT, Thaler HT, Polyak TA, Kornblith

AB,

> > Lepore JM, Portenoy RK. Quality of life and survival: The role

of

> > multidimensional symptom assessment. Cancer. 1998;83(1):173-179

> > MEDLINE

> > Chlebowski et al., 2002. Chlebowski RT, Aiello E, McTiernan A.

> Weight

> > loss in breast cancer patient management. Journal of Clinical

> > Oncology. 2002;20(4):1128-1143 MEDLINE

> > Gammon et al., 1998. Gammon MD, EM, Britton JA.

Recreational

> and

> > occupational physical activities and risk of breast cancer.

Journal

> > of the National Cancer Institute. 1998;90:100-117 MEDLINE

> > Goodwin et al., 1998. Goodwin P, Esplen MJ, K, Winocur J,

> > Pritchard K, Brazel S, et al. Multidisciplinary weight

management

> in

> > locoregional breast cancer: Results of a phase II study. Breast

> > Cancer Research and Treatment. 1998;48(1):53-64 MEDLINE

> > Goodwin and Boyd, 1990. Goodwin PJ, Boyd NF. Body size and

breast

> > cancer prognosis: A critical review of the evidence. Breast

Cancer

> > Research and Treatment. 1990;16(3):205-214 MEDLINE

> > Goodwin et al., 2003. Goodwin PJ, Ennis M, Pritchard KI, Koo J,

> > Trudeau ME, Hood N. Diet and breast cancer: Evidence that

extremes

> in

> > diet are associated with poor survival. Journal of Clinical

> Oncology.

> > 2003;21(13):2500-2507 MEDLINE

> > Goodwin et al., 2001. Goodwin PJ, Leszcz M, Ennis M, Koopmans J,

> > L, Guther H, et al. The effect of group psychosocial

> support

> > on survival in metastatic breast cancer. Comment The New England

> > Journal of Medicine. 2001;345(24):1719-1726

> > Goss et al., 2003. Goss PE, Ingle JN, o S, NJ, Muss

> HB,

> > Piccart MJ, et al. A randomized trial of letrozole in

> postmenopausal

> > women after five years of tamoxifen therapy for early-stage

breast

> > cancer. The New England Journal of Medicine. 2003;349(19):1793-

1802

> > et al., 2000. JR, Lippman ME, Morrow M, Osborne

CK.

> > Diseases of the breast. (2nd ed) Philadelphia: Lippincott

,

> > and Wilkins 2000

> > Holmberg et al., 2001. Holmberg L, Norden T, Lindgren A, Wide L,

> > Degerman M, Adami HO. Pre-operative oestradiol levels—Relation

to

> > survival in breast cancer. European Journal of Surgical

Oncology.

> > 2001;27(2):152-156 MEDLINE

> > Holmes et al., 1999. Holmes MD, Stampfer MJ, Colditz GA, Rosner

B,

> > Hunter DJ, Willett WC. Dietary factors and the survival of women

> with

> > breast carcinoma. [see comments] Cancer. 1999;86(5):826-

835erratum

> > 2707–2708 MEDLINE

> > Kramer et al., 2000. Kramer JA, Curran D, Piccart M, de Haes JC,

> > Bruning P, Klijn J, et al. Identification and interpretation of

> > clinical and quality of life prognostic factors for survival and

> > response to treatment in first-line chemotherapy in advanced

breast

> > cancer. European Journal of Cancer. 2000;36(12):1498-1506 PDF

(126

> > KB) | MEDLINE

> > Le Marchand, 1991. Le Marchand L. Ethnic variation in breast

cancer

> > survival: A review. Breast Cancer Research & Treatment. 1991;18

> (Suppl

> > 1):S119-S126

> > Liu et al., 2003. Liu S, Willett WC, Manson JE, Hu FB, Rosner B,

> > Colditz G. Relation between changes in intakes of dietary fiber

and

> > grain products and changes in weight and development of obesity

> among

> > middle-aged women. American Journal of Clinical Nutrition.

2003;78

> > (5):920-927 MEDLINE

> > Maskarinec et al., 2001. Maskarinec G, S, Shumay DM,

Kakai

> H.

> > Dietary changes among cancer survivors. European Journal of

Cancer

> > Care (Engl). 2001;10(1):12-20

> > Maunsell et al., 1995. Maunsell E, Brisson J, Deschenes L.

Social

> > support and survival among women with breast cancer. Cancer.

1995;76

> > (4):631-637 MEDLINE

> > McTiernan et al., 2003. McTiernan A, Rajan KB, Tworoger SS,

Irwin

> M,

> > Bernstein L, Baumgartner R, et al. Adiposity and sex hormones in

> > postmenopausal breast cancer survivors. Journal of Clinical

> Oncology.

> > 2003;21(10):1961-1966 MEDLINE

> > Nagle et al., 2003. Nagle CM, Purdie DM, Webb PM, Green A,

Harvey

> PW,

> > Bain CJ. Dietary influences on survival after ovarian cancer.

> > International Journal of Cancer. 2003;106(2):264-269 MEDLINE

> > Pereira and Ludwig, 2001. Pereira MA, Ludwig DS. Dietary fiber

and

> > body-weight regulation. Observations and mechanisms. Pediatric

> > Clinics of North America. 2001;48(4):969-980 MEDLINE

> > Pinto and Maruyama, 1999. Pinto BM, Maruyama NC. Exercise in the

> > rehabilitation of breast cancer survivors. Psychooncology.

1999;8

> > (3):191-206 MEDLINE

> > Reynolds et al., 1994. Reynolds P, Boyd PT, Blacklow RS,

> JS,

> > Greenberg RS, Austin DF, et al. The relationship between social

> ties

> > and survival among black and white breast cancer patients.

National

> > Cancer Institute Black/White Cancer Survival Study Group. Cancer

> > Epidemiology, Biomarkers, & Prevention. 1994;3(3):253-259

> > Rock and Demark-Wahnefried, 2002. Rock CL, Demark-Wahnefried W.

> > Nutrition and survival after the diagnosis of breast cancer: A

> review

> > of the evidence. Journal of Clinical Oncology. 2002;20(15):3302-

> 3316

> > MEDLINE

> > Rock et al., 2001. Rock CL, Thomson C, Caan BJ, Flatt SW,

Newman V,

> > Ritenbaugh C, et al. Reduction in fat intake is not associated

with

> > weight loss in most women after breast cancer diagnosis:

Evidence

> > from a randomized controlled trial. Cancer. 2001;91(1):25-34

MEDLINE

> > Rohan et al., 1995. Rohan TE, Fu W, Hiller JE. Physical activity

> and

> > survival from breast cancer. European Journal of Cancer

Prevention.

> > 1995;4(5):419-424 MEDLINE

> > Spiegel et al., 1989. Spiegel D, Bloom JR, Kraemer HC, Gottheil

E.

> > Effect of psychosocial treatment on survival of patients with

> > metastatic breast cancer. Lancet. 1989;2(8668):888-891 MEDLINE

> > Vitae:

> > Dr. Holmes is an assistant professor of medicine at Harvard

medical

> > School. Her research interests include lifestyle factors (diet,

> > weight change, physical activity, and psychosocial factors)

> affecting

> > quality of life and survival after a cancer diagnosis, as well

as

> the

> > association between diet and breast cancer risk. Other research

> > interests include diet and lifestyle influences on endogenous

> levels

> > of steroid hormones and insulin-like growth factor and ethnic

> > differences in obesity and other lifestyle factors affecting

> chronic

> > disease risk. She co-edited a book on nutrition for cancer

> survivors

> > soon to be published by the American Cancer society.Vitae: Dr.

> > Kroenke is an instructor at the Harvard Medical School. Her

> research

> > focuses on quality of life and survival after breast cancer, as

> well

> > as the influence of diet and psychosocial factors on chronic

> disease

> > outcomes.

> > © 2004 The 's Institute of Women's Health

> >

>

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> > =====================

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> > of the Mid Hudson Options Project, a grassroots Breast Cancer

> Health

> > Advocacy, Support and Activist Group. The information is

intended

> for

> > educational purposes only, in order to help you make informed

> health

> > choices and may not have been touched upon by your doctors. We

are

> > not doctors and we do not recommend any particular treatments.

We

> are

> > sending this information to advise you of the complete

scientific

> > overview that is currently available, although we may not

> necessarily

> > endorse it. http://www.breastcanceroptions.org

>

>

>