Abstract
BackgroundMechanisms influencing breast cancer (BC) development and recurrence include hyperglycemia, hyperinsulinemia, high insulin-like growth factor-1, high circulating estrogen, inflammation and impaired cellular differentiation/apoptosis. A lifestyle program that targets all the above mechanisms may be warranted. Low glycemic index (GI) foods produce lower post-prandial glucose and insulin responses and have been associated with lower BC risk. Moderate physical activity post-diagnosis reduces BC recurrence and mortality, partly explained by reduced insulin and estrogen levels. Vitamin D increases cell differentiation/apoptosis and high serum vitamin D levels improve BC survival. Yet no trial has evaluated the combined effect of a low GI diet, moderate physical activity and vitamin D supplementation on BC recurrence in the context of a Mediterranean lifestyle setting.MethodsWomen (30-74 yr) who had undergone surgery for primary histologically confirmed BC (stages I-III) within the previous 12 months, in cancer centres in Italy, will be randomized to follow, for a maximum of 33 months, either a high intensity treatment (HIT) composed of low GI diet + exercise + vitamin D (60 ng/mL serum concentration) or a lower intensity treatment (LITE) with general advice to follow a healthy diet and exercise pattern + vitamin D to avoid insufficiency. Both interventions are on a background of a Mediterranean diet. Considering a 20% recurrence rate within 3 years for BC cases and a predicted rate of 10% in the HIT group, with power of 80% and two-sided alpha of 0.05, the subject number required will be 506 (n = 253 in each arm). Clinic visits will be scheduled every 3 months. Dietary and exercise counselling and vitamin D supplements will be given at each clinic visit when blood samples, anthropometric measures and 7-day food records will be collected.DiscussionDEDiCa study aims to reduce BC recurrence in women with BC using a lifestyle approach with additional vitamin D and to investigate possible cardio-metabolic benefits as well as epigenetic modifications according to lifestyle changes. Given the supporting evidence and safety of the components of our intervention we believe it is feasible and urgent to test it in cancer patients.Trial registrationMay 11, 2016; NCT02786875. EudraCT Number2015-005147-14
Highlights
Mechanisms influencing breast cancer (BC) development and recurrence include hyperglycemia, hyperinsulinemia, high insulin-like growth factor-1, high circulating estrogen, inflammation and impaired cellular differentiation/apoptosis
The purpose of this study is to reduce BC recurrence and increase disease-free survival through a lifestyle program that includes a low glycemic index diet, physical activity and vitamin D supplementation in women with BC living in a Mediterranean country
It is expected that the higher intensity program of low glycemic index (GI) diet, exercise and vitamin D will reduce BC recurrence by 50% compared to the lower intensity program
Summary
Mechanisms influencing breast cancer (BC) development and recurrence include hyperglycemia, hyperinsulinemia, high insulin-like growth factor-1, high circulating estrogen, inflammation and impaired cellular differentiation/apoptosis. Low GI foods lower the glycemic and insulinemic potential of the diet and have been shown to reduce the risk of several cancers diabetesrelated cancers including BC [15,16,17,18] and some evidence suggests they correlate with lower recurrence [19]. Physical activity after BC diagnosis has been shown to reduce the risk of BC mortality by 40–50% when it is of moderate intensity such as 30 minutes of brisk walking per day [32,33,34,35] an effect possibly modulated partly by insulin economy improvements in reduced insulin, insulin-like growth factors and estrogen levels [36]
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