ASCO 2019: Impact of Diet & Exercise on Breast Cancer Risk

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Rebecca Seago‑Coyle:

Hey, everyone.  I'm here with Dr. Jennifer Ligibel from the Dana‑Farber Institute.  She's a medical oncologist in breast cancer. 

Thanks so much for joining us today.  Can you tell us a little bit why you're here at ASCO? 

Dr. Ligibel:

Sure.  So I'm a medical oncologist.  I take care of women with breast cancer, and I also do research looking at how diet and exercise impact breast cancer risk and outcomes.  ASCO is definitely the biggest meeting of the year for new research in breast and other cancers.  It's also a really great place to learn about ongoing studies, learn about things that have been recently completed and also hear a lot of great educational talks on topics. 

Rebecca Seago‑Coyle:

Has there been anything, late‑breaking news in the exercise and diet topics for breast cancer patients that you've learned here this weekend? 

Dr. Ligibel:

Not really.  I mean, I think that there is another update of a trial that was started a long time ago a called the Women's Health Initiative.  That was a trial that looked at whether eating a low‑fat diet could lower a woman's risk of developing breast cancer.  Unfortunately the study didn't show that this low‑fat diet reduced the risk of getting breast cancer in the first place, but they have followed women who did develop breast cancer in the study over long periods of time, and there is some suggestion that women who ultimately developed breast cancer who had been on that diet might do better over time. 

So I think it's not necessarily clear how to translate that into should people be eating a particular diet.  It was a study that was started a long time ago when we thought all fat was bad, which fortunately now I think we have a little bit better understanding of diet, but it does provide yet another piece of evidence that lifestyle factors, weight, diet, exercise, are really important for cancer prevention and control. 

Rebecca Seago‑Coyle:

So I also understand you're a breast cancer researcher too, and you're working on a Be Well study.  Can you talk a little bit about that? 

Dr. Ligibel:

Sure.  So the Breast Cancer Weight Loss or Be Well study is a trial that will look at whether a weight loss program reduces the risk of recurrence in women who are overweight or obese when they're diagnosed with breast cancer.  We know that obesity is a risk factor for an increased risk of recurrence and breast cancer‑related mortality in women who are diagnosed with early‑stage breast cancer, but what we don't know is if you could help women lose weight and whether that will actually lower their risk of having the cancer come back.  And so that's what the study is designed to do. 

It's a big study.  It will enroll more than 3,000 women from across the United States and Canada.  We're looking for women who have stage III and II breast cancer with either hormonally driven breast cancer or triple‑negative disease, and we've enrolled so far about 2100 women over the last two and a half years.   

Rebecca Seago‑Coyle:

And is that‑‑you said that you're covering many cities in the US and Canada, but is that available‑‑how does someone access that trial?   

Dr. Ligibel:

So the study is open through the National Cancer Institute's Cooperative Group Program, and so we have more than 1,000 cancer clinics across the United States and Canada that are participating.  And so patients are enrolled through their doctors' offices, and they receive all of their care through their doctor, but then we deliver either a health education program or health education plus a weight loss program through our center at Dana‑Farber. 

Rebecca Seago‑Coyle:

As I mentioned to you earlier, I am a breast cancer survivor myself, and I also love to exercise.  What do you tell your patients that are coming to you who have been newly diagnosed? 

Dr. Ligibel:

I think that although we don't have concrete evidence yet that exercise or weight loss or changes in diet will actually lower the risk of recurrence—we're studying that—but we do have a lot of other information that shows that these types of programs help people feel better, help them recover from their cancer treatment more quickly, help prevent them from becoming debilitated and fatigued. 

So I tell people it's really important to stay active all through treatment.  We used to tell people you should rest.  Lay on the couch, eat ice cream.  We don't tell people those things anymore because we know that if you don't exercise for all the months that you're having your therapy it's really hard to get back to where you were before you were diagnosed.  You lose muscle pretty quickly, and there's some pretty dramatic changes that can happen during chemotherapy, losing muscle, gaining fat, even if people don't actually gain weight. 

So I tell people no matter where you are in your cancer trajectory you should be active.  We really focus a lot more on diet and weight changes after treatment is finished.  It can be hard to be trying to make a lot of changes in your diet when you're also dealing with chemotherapy and things like that, but really try to think about staying active throughout the whole trajectory and then focus a lot more on weight loss if that needs to be a goal after treatment's finished. 

Rebecca Seago‑Coyle:

That's great advice, and very important.  Just to share a little bit more, when I was diagnosed I was in the best health of my life and someone gave me the analogy of you have a savings account and now you're going to draw on that savings account, but it's important to continue to be active.  

Dr. Ligibel:

It is.  

Rebecca Seago‑Coyle:

Now I'm working on building that savings account back up.   

You know, we're talking here at ASCO.  You know the theme is saying caring for every patient, learning from every patient.  How do you feel like you—how do you feel like you live that theme in your clinic and in your research?  

Dr. Ligibel:

From a research perspective we designed Be Well to be a completely telephone and web‑based program that's very flexible.  So if people have internet they can access the web pieces.  If they don't it's a telephone‑based intervention.  And we did this on purpose so that the study wasn't only available to people who lived right next to a big cancer center.  We really wanted this program to be able to enroll people who lived in rural areas, people who live in places where there aren't a lot of clinical trials.   

That's been great.  We have patients now from 49 of the 50 states.  About half of our patients come from community practices.  We enroll patients in some places where there aren't any other clinical trials.  This is it.  And so I think that's been really exciting to be able to really try to enroll every patient and not have this be restricted to people who live in areas that have a lot of resources.   

Rebecca Seago‑Coyle:

Well, thank you so much for the research that you're doing and what you're trying to educate patients on the diet and exercise.  It's amazing, so thank you so much for your time today. 

And as we say at Patient Power, knowledge can be the best medicine.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.