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Nutrition News

The Role of Nutrition in Breast Cancer Survivors


With improvements in early cancer detection and more effective cancer treatments, there are an increasing number of cancer survivors now more than ever. In the area of breast cancer, the number of survivors in the US has gone from 3 million in 1971 to 11.7 million in 2007 (1). Recently, study in the Journal of the National Cancer Institute found that about 1 in 5 breast cancer survivors that completed adjuvant therapy had a recurrence within 10 years of their treatment (2). What role, if any, does nutrition have in risk of recurrence?
Though research in the area of nutrition and survivorship is in its early stage, progress is being made. Here are some of the most recent findings.
In a study by Pierce, et al., breast cancer survivors who were diagnosed and treated for early stage breast cancer showed a 50% reduction in mortality (in both obese and nonobese women) with a diet containing 5 or more serving of fruits and vegetables per day as well as an exercise regimen of 30 minutes of walking 6 days per week (3).
Weight control, along with diet and exercise, was important in reducing the risk of recurrent breast cancer, in a review by Demark-Wahnefried.  Recommending a healthy body weight through a plant-based diet appears to be optimal.  Such a diet contains a large amount of nutrient-dense, low-energy foods. An emphasis on exercise should also be advisable to preserve or possibly increase bone and lean body mass (4).
The possible benefits of consuming a multivitamin were assessed in women with early-stage breast cancer. The study showed a mild protection for those treated with radiation alone and for those treated with radiation and chemotherapy. The research also revealed the women who had better overall survival were those who took a multivitamin consistently before and after their diagnosis, who consumed more fruits and vegetables, and were more physically active(5).
Numerous studies and trials are on the horizon in the area of nutrition and breast cancer survivorship. Much knowledge is to be gained. In a review by Tramm, evidence of the role of diet in breast cancer recurrence is still widely inconclusive (6). For now, the best evidenced based guidelines in nutrition for breast cancer survivors is summarized in the American Cancer Society (ACS) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations (website listed below) . A summary of these are cited below.


1. Maintain a healthy weight (BMI 18.5-24.9) achieved through diet and exercise.
2. Be active and stay active with at least 30 minutes of moderate to vigorous activity each day. For example, brisk walking, stair climbing, bicycling, swimming laps, gardening.
3. Consume a healthy diet comprised of more plant based foods such as fruits, vegetables, beans, peas, nuts, seeds, whole grains. Eat at least 5 servings of fruits and vegetable a day in a variety of colors. Limit consumption of both red meat (less than 18 oz per week) and processed meats.
4. Limit alcohol consumption to no more than 1 serving per day for females and 2 servings per day for males (7).

 

 

Summary Article


With improvements in early cancer detection and more effective cancer treatments, there are an increasing number of cancer survivors. Research is increasing in the area of nutrition and cancer survivorship. At present, the best evidenced based guidelines in nutrition for breast cancer survivors is summarized in the American Cancer Society (ACS) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations. In summary,
1. Maintain a healthy weight, i.e., BMI 18.5-24.9, via diet and exercise.

2. Be active and stay active with at least 30 minutes of moderate to vigorous activity every day.  Such activity may include brisk walking, stair climbing, bicycling, swimming laps, and gardening.

3. Consume a healthy diet comprised of more plant based foods such as fruits, vegetables, beans, peas, nuts, seeds, whole grains. Eat at least 5 servings of fruits and vegetable a day in a variety of colors. Limit consumption of both red meat (less than 18 oz per week) and processed meats.

4. Limit alcohol consumption to no more than 1 serving per day for females and 2 servings per day for males (7).

 

Recipes


From Survivorship: Nutrition Guidelines for Cancer Survivors by MD Anderson Cancer Center

Baked Squash Casserole (8 servings)
2 yellow squash, sliced
2 zucchini, sliced
2 fresh tomatoes, sliced
1 large onion, sliced
1 green bell pepper, cut into strips
Parmesan cheese, grated
Olive oil spray
Salt and pepper

1. Preheat oven to 350 degrees.
2. Spray bottom of 9” by 13” pan with olive oil.
3. Layer on bottom of the pan: yellow squash, 1 tomato, ½ onion, ½ green pepper.
4. Lightly sprinkle with salt and pepper.
5. Sprinkle with Parmesan cheese.
6. Layer zucchini, 1 tomato, ½ onion and ½ green pepper.
7. Lightly sprinkle with salt and pepper.
8. Top with Parmesan cheese.
9. Bake one hour.

Reduced-Fat Banana Pudding (8 servings)
1 large box fat-free instant vanilla pudding (fat-free, sugar-free may be used, if desired)
1 cup vanilla flavored low-fat soy milk
1 container fat-free whipped topping
2-3 sliced bananas
½-¾ box reduced-fat vanilla wafers

1. Beat together pudding and soy milk until thick.
2. Fold in whipped topping, and refrigerate for five minutes.
3. In large serving bowl, layer twice as follows: vanilla wafers, bananas and pudding mix. Top with vanilla wafers.
4. Refrigerate until ready to serve.

 

Events:  
National Cancer Survivors Day is June 5, 2011. www.ncsdf.org

Web Resources:
American Cancer Society:  www.acscsn.org
American Institute for Cancer Research:  www.aicr.org  
Cancer.Net:  www.cancer.net/patient/survivorship
National Cancer Institute:  www.cancer.gov/cancertopics/coping/survivorship
The University of Texas MD Anderson Cancer Survivorship:  www.mdanderson.org/topics/survivorship  

Book Resources:
Anticancer:  A New Way of Life by David Servan-Schreiber, 2008.
Eating Well Through Cancer: Easy Recipes & Recommendations During and After Treatment by Holly Clegg, 2006.
Food, Nutrition, Physical Activity, and the Prevention of Cancer:  A Global Perspective by the World Cancer Research Fund and the American Institute for Cancer Research, 2007.
The New American Plate Cookbook by the American Institute for Cancer Research, 2005.
The Survivor’s Handbook: Eating Right for Cancer Survival by Neal Barnard, 2006.


References:


1. Frieden T, Jaffe H, Stephens J, Thacker S, Zaza S. Cancer Survivors—United States, 2007. Morbidity and Mortality Weekly Report 2011 March 11; 60(9): 269-272.
2. Brewster A, Hortobagyi G, Broglio K, Kau S, Santa-Maria C, Arun B, Buzdar A, Booser D, Valero V, Bondy M, Esteva F. Residual Risk of Breast Cancer Recurrence 5 Years After Adjuvant Therapy. Journal of the National Cancer Institute 2008; 100(16):1179-1183.
3. Pierce J, Stefanick M, Flatt S, Natarajan L, Sternfeld B, Madlensky L, Al-Delaimy W, Thomson C, Kealey S, Hajek R, Parker B, Newman V, Caan B, Rock C. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. Journal of Clinical Oncology 2007; 25(17):2345-2351.
4. Demark-Wahnefried W. Nutrition-related issues for the breast cancer survivor. Seminars in Oncology 2003 Dec; 30(6):789-798.
5. Kwan M, Greenlee H, Lee V, Castill A, Gunderson E, Habel L, Kushi L, Sweeney C. Tam E, Caan B. Multivitamin Use and Breast Cancer Outcomes in women with Early-Stage Breast Cancer: the Life After Cancer Epidemiology Study. Breast Cancer Research and Treatment 2011; 10.1007/x10549-011-1557-4.
6. Tramm R, McCarthy A, Yates. Dietary Modification for Women after Breast Cancer Treatment: a Narrative Review. European Journal of Cancer Care 2011 March; 20(3):294-304.
7. Robien K, Demark-Wahnefried W, Rock C. Evidence-Based Nutrition Guidelines for Cancer Survivors: Current Guidelines, Knowledge Gaps, and Future Research Direction. Journal of the American Dietetic Association 2011; 111(3):368-374.


© 2014 The University of Texas MD Anderson Cancer Center