Abstract
Breast cancer (BC) represents the most common cancer in women, while overweight and obesity are the second preventable cause of cancer. Weight gain and fat accumulation are common after BC diagnosis; moreover, weight gain during the treatment decreases the survival rate and increases the risk of recurrence in breast cancer survivors (BCS). To reduce the risk of second primary cancer or BC recurrence, and all-cause mortality in BCS, multiple interventions have been investigated to obtain reduction in weight, BMI and/or waist circumference. The aim of this narrative review is to analyze evidence on BCS for their risk of recurrence or mortality related to increased weight or fat deposition, and the effects of interventions with healthy dietary patterns to achieve a proper weight and to reduce fat-related risk. The primary focus was on dietary patterns instead of single nutrients and supplements, as the purpose was to investigate on secondary prevention in women free from disease at the end of their cancer treatment. In addition, BC relation with insulin resistance, dietary carbohydrate, and glycemic index/glycemic load is discussed. In conclusion, obesity and overweight, low rates of physical activity, and hormone receptor-status are associated with poorer BC-treatment outcomes. To date, there is a lack of evidence to suggest which dietary pattern is the best approach for weight management in BCS. In the future, multimodal lifestyle interventions with dietary, physical activity and psychological support after BC diagnosis should be studied with the aim of reducing the risk of BC recurrence or mortality.
Highlights
Breast cancer (BC) represents the most common cancer in women, while overweight or obesity are the second preventable cause of cancer, related to 33% of postmenopausal breast cancers that could be prevented by lifestyle modification [1].Excessive body fat deposition and weight gain promote a pro-oxidative microenvironment with chronic low-grade systemic inflammation, posing breast cancer survivors (BCS) at high risk of second primary cancer or BC recurrence, and all-cause mortality [2]
There is a lack of evidence to suggest which dietary pattern is the best approach for weight management in BCS
Among 61 selected papers, only 32 address a specific dietary pattern implemented in BCS not undergoing chemotherapy or any active treatment other than hormonal or immune therapy, aimed at the prevention of recurrence
Summary
Breast cancer (BC) represents the most common cancer in women, while overweight or obesity are the second preventable cause of cancer, related to 33% of postmenopausal breast cancers that could be prevented by lifestyle modification [1]. Excessive body fat deposition and weight gain promote a pro-oxidative microenvironment with chronic low-grade systemic inflammation, posing breast cancer survivors (BCS) at high risk of second primary cancer or BC recurrence, and all-cause mortality [2]. The third expert report on “Diet, nutrition, physical activity and breast cancer” of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) [dietandcancerreport.org] for preventing cancer generally recommends maintaining a healthy lifestyle by being physically active and eating a healthy diet for proper weight management [1]. All women after a BC diagnosis undergo treatments for such a life-changing diagnosis and should be counselled to prevent excessive fat mass deposition, that is often a common event [3]
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