Lifestyle Factors and Breast Cancer
To mark “Breast Cancer Awareness Month” 2014, on October 30th, The Epworth Breast Service, conducted an evening session, “Lifestyle Factors and Breast Cancer” held in the new fifth floor Epworth Medical library, which boasts impressive views over Richmond and East Melbourne. The session, organized by our Breast Care Nurse, Trish Calder, was very well attended by clinicians, allied health professionals and also many of our breast cancer patients who have completed the Epworth Breast Cancer Rehabilitation Programme, established in 2013. Speakers included specialist breast surgeon, Jane O’Brien, medical oncologist, Rick de Boer, Catherine Carracher, Epworth Rehabilitation and our new team member Dr Bridie O’Donnell, who is coordinating our long term breast cancer surveillence programme.
Bridie, who teaches motivational interviewing and health enhancement at Deakin University Medical School, gave an inspirational talk on capturing “teachable moments”; described as naturally occurring life transitions or health events that have the potential to motivate individuals to spontaneously adopt risk-reducing or health-protective behaviours. Both the diagnosis of cancer and the transition to cancer survivor are potential “teachable moments” for consideration of behavioural and lifestyle interventions, and Dr Peter Larkins, Epworth sports medicine physician, added invited comments reinforcing the value and importance of exercise in this context.
Breast cancer survival rates continue to improve in Australia, with a five year overall survival of around 90%, but we continue to hear the most common concern for women following treatment for breast cancer is uncertainty about the future, and fear of a recurrence. Lifestyle factors have been linked to the risk of developing many common malignancies, including breast cancer, and, increasingly, to prognosis. Observational evidence has shown a relationship between so-called energy balance factors (ie diet, physical activity, and body weight) and risk of cancer recurrence. Interventional work has shown that individuals who make favourable changes in these lifestyle factors after cancer diagnosis feel better, experience less fatigue, and may decrease risk of cancer recurrence. Other lifestyle behaviours, such as smoking and alcohol consumption, also have important health consequences for cancer survivors.
The impact of lifestyle factors on both the risk of developing breast cancer and also the risk of recurrence is currently a hot topic. On the first of October 2014 the American Society of Clinical Oncology (ASCO) published it’s first ever position statement on the relationship between cancer and obesity. It clearly states that cancer clinicians must integrate obesity education and management into cancer care, and it strongly urges clinicians to address this problem openly with their patients from the time of diagnosis and routinely during all follow-up visits. The position statement may be downloaded on http://jco.ascopubs.org/content/32/31/3568
The evidence suggests lifestyle factors such as moderate levels of physical activity can reduce the risk of recurrence of breast cancer by 24% and reduce the risk of death by more than one third compared with inactive women. This means for women who feel well enough, undertaking as little as 3 hours of physical activity such as brisk walking or cycling each week could help them stay healthy.
Despite this, one in four women who have had breast cancer are not aware that lifestyle changes may significantly reduce the risk of breast cancer recurrence, according to a survey conducted by Cancer Australia and BCNA of women in Australia diagnosed with breast cancer. Additionally, the survey results showed that almost half of women who were aware of these lifestyle actions were not given information about this by any of their health professionals, so there is certainly plenty of room for improvement in this area, and ensuring all members of the health care team are educated about the importance of reinforcing lifestyle modification measures is a vital first step in the right direction.