Should exercise be prescribed for breast cancer survivors?

Being physically active has many health benefits and it may have profound effect in women who had breast cancer. Living an active life seems to protect women from getting breast cancer; similarly it also seems to stop it from coming back in survivors of cancer. Levels of activity go down in women who have had breast cancer or other cancers.

For many of those who have had breast cancer exercise is extremely difficult to do. Even thinking about activity for many fatigued survivors is a challenge. Yet some evidence seems to suggest that it does not have to be strenuous. It may not be necessary to regularly exercise in the gym or play sport. The normal activity of daily living may have protective benefit. So the key may be to be active in some way, as much as can be tolerated, and light exercise such as daily walks may be beneficial.

Being overweight has been implicated in breast cancer incidence and recurrence. A higher blood insulin level in overweight women has been linked to breast cancer.

However, not everyone who is overweight is at increased risk. It depends on when the extra pounds are put on and where the fat accumulates on the body.

Women who are overweight before breast cancer are more at risk of getting it and if you lose weight the risk goes down. Women who undergo weight reduction surgery are less at risk. The Nurses’ health study found that maintaining weight loss for at least 4 years lower the risk of getting breast cancer by 40%. Not only are you more at risk of getting it if you are overweight, but the prognosis is also worse if you get breast cancer as it is associated with decreased overall survival.

The association between weight and breast cancer is not clear cut. If you are overweight as a child and continue to be as an adult then you seem to be less likely to get it than if you gain weight as an adult especially after the menopause. The amount of hormones in fat has been implicated. If you gain weight before the menopause the fat will contain lower concentrations of estrogen. After the menopause, the fat in breasts is more likely to have higher estrogen levels, which means higher risk of breast cancer.

Also where you put on the weight seems to play a role. If you gain weight in the tummy area then the risk is higher than if the weight is gained in the hips or thighs. The type of fat that accumulates in the tummy tends to be more active and dividing; two factors that may be related to an increased risk of cancers.

Being overweight after breast cancer is an important risk factor for recurrence, especially in terms of reducing the risk of it coming back over many years. This is an important health issue as most women with breast cancers get a cure for their cancer – as many as 80% survivor their breast cancer. This means that prevention of the breast cancer recurring is an extremely important health promotion issues. Women survivors of breast cancer need to remain free of recurrence. And weight reduction is an extremely important aspect of this prevention strategy.

Physical activity reduces the risk of breast cancer and the risk of recurrence over and above the simple benefits of weight reduction. However, it is unclear how much is required. Some evidence suggests that if the cancer doctor prescribes exercise that it is of benefit and reduces the risks of relapse. However, it is unclear whether it is the level of the physical exercise or whether the cancer doctor’s encouragement simply gets the patient to move. A study from the Women’s Health Initiative found that walking briskly for 1-3 hours per day reduced the risk of recurrence by 16%. However there is no evidence that walking for 5 hours per day will reduce the risk more.  So the benefit may not correlate with the amount of exercise done and simply doing some activity may reap a good deal of the benefit and reduce the risk of breast cancer recurrence.

Weight loss is extremely important in breast cancer survivors to prevent the cancer from coming back. Physical activity, or perhaps just moving around during the day, is equally if not more important than just losing the pounds.


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