Recommendations for a lifestyle which could prevent breast cancer and its relapse: physical activity and dietetic aspects

Molecular Mechanisms of Exercise on Cancer: A Bibliometrics Study and Visualization Analysis via CiteSpace

Objective: To analyze the research hot spots and frontiers of molecular mechanisms of exercise on cancer via CiteSpace.

Method: Related publications in the Web of Science Core Collection Science Citation Index Expanded were retrieved from inception to November 27th, 2021. Then we used CiteSpace to generate network maps and identify top authors, institutions, countries, keywords, co-cited authors, journals, references and research trends.

Results: A total of 1,130 related publications were retrieved. The most productive author and journal were Lee W Jones and PLOS ONE. Hanahan D and Warburg O were the most cited authors. Fudan University and Shanghai Jiao Tong University were the leading institutions, while China was the leading country. Top-cited authors and references generally focused on the epidemiology and hallmarks of cancer. Top five keywords with both high frequency and high betweenness centrality were breast cancer, aerobic glycolysis, oxidative stress, gene expression, skeletal muscle. Keyword “warburg effect” ranked first with the highest citation burst, while “inflammation”, “hepatocellular carcinoma”, “epithelial mesenchymal transition”, and “adipose tissue” were emerging research foci.

Conclusion: This study analyzed the research hot spots and frontiers of molecular mechanisms of exercise on cancer via CiteSpace. Based on the results, altered metabolism (aerobic glycolysis, insulin resistance, myokines), oxidative stress, gene expression and apoptosis were hot-research mechanisms of exercise on cancer. Emerging research foci of mechanisms were generally around inflammation, epithelial mesenchymal transition and adipokines. In addition, future studies could carry in-depth research of interactions between different mechanisms and try to elucidate the recommended doses and intensities of exercise for cancer, especially in breast, colorectal, prostate cancer and hepatocellular carcinoma.

Roles and molecular mechanisms of physical exercise in cancer prevention and treatment

Exercise can enhance motivation to change lifestyle behaviors, improve aerobic fitness, improve physical function, control fatigue, and enhance quality of life. Studies have demonstrated the benefits to be gained from physical exercise, highlighting the importance of popularizing the concept of physical exercise for individuals and making professional exercise-treatment programs available to patients with cancer. However, the correlation between physical exercise and carcinogenesis is easily overlooked, and exercise interventions are not routinely provided to patients with cancer, especially those with advanced cancer. In this article, we present a literature review of the effects of exercise on cancer development and progression and give recent evidence for the type of exercise best suited for different types of cancer and in different disease stages. Moreover, the molecular mechanisms about regulating metabolism and systemic immune function in cancer are summarized and discussed. In conclusion, physical exercise should be considered as an important intervention for preventing and treating cancer and its complications.

Lifestyle change experiences among breast cancer survivors participating in a pilot intervention: A narrative thematic analysis

PURPOSE

Healthy lifestyle adoption among breast cancer (BC) survivors remains a poorly understood process. This study aimed to qualitatively examine the unique change trajectories of BC survivors who partook in a pilot version of the Healthy Lifestyle Modification After Breast Cancer (HLM-ABC) intervention.

METHODS

A sample of four BC survivors were studied intensively through longitudinal interviews conducted at four time points with each participant: (1) pre-treatment, (2) mid-way treatment, (3) post-treatment, and (4) three-months following their participation in the HLM-ABC. A multiple-case study, narrative analysis was applied to 15 interviews, resulting in individual narratives as well as shared 'thematic intersections' elucidating cross-participant experiences.

RESULTS

The findings showed that participants offered unique styles of authorship, characterized by diverse struggles, victories, and motivational insights, organized around the following intersecting themes: (1)Weight management prescription as a motivator or deterrent, (2) 'Time for me' is time away from my family, and (3) Patterns of opposition to lifestyle change. These women's rich, storied accounts suggest experiences of personal growth and imply that existential concerns can be both motivating and deterring in relation to health behavior change.

CONCLUSION

This research provides a comprehensive and nuanced grasp of healthy lifestyle modification in the survivorship stage of BC.

Knowledge and Perceptions of Common Breast Cancer Risk Factors in Northern Saudi Arabia

Background: Breast cancer is the second leading cause of cancer death in women around the world. The degree of adoption of a preventive lifestyle offers valuable information for planning appropriate intervention programs for improving women’s health. The objective of the present study was to assess the levels of breast cancer related knowledge among a Northern Saudi population. Methodology: In this cross sectional study, data were obtained from 566 Saudi volunteers living in the city of Hail, the Kingdom of Saudi Arabia (KSA). Results: With regard to breast cancer risk factors, 427/566 (75.4%) of participants answered in the affirmative to whether breast cancer could be inherited. For early puberty and late menopause, 209/566 (37%) were in agreement with increased risk, for low and delayed child birth, 261/566 (46%), and for overweight and obesity, 210/566(37%). For the question of whether natural breast feeding can reduce the risk of breast cancer, only 35/566 (6.2%) said yes. Conclusion: There is a general lack of knowledge regarding several BC risk factors among the northern Saudi community which necessitates urgent implementation of educational programs.

Exploring breast cancer preventive lifestyle and social support of Iranian women: a study protocol for a mixed-methods approach

BACKGROUND

It is widely accepted that a healthy lifestyle may decrease the probability of developing cancer. This study aimed to describe a study protocol that makes it possible to explore preventive health lifestyles of Iranian women and their received social support for the purpose of developing cultural strategies to increase breast cancer prevention.

METHODS

A mixed-methods study will be accomplished in two sequential parts. First, a cross-sectional study will be conducted in which 2,250 Iranian women are recruited by using a random multistage cluster sampling of 20 health care centers. Structured face-to-face interviews will be conducted to obtain information on the participants' health lifestyle and perceived social support. Data will be analyzed using both multivariate regression and structural equation modeling techniques. Then, a qualitative study will be conducted among employed women using a purposive sampling design. Data will be collected by means of focus groups and semi-structured interviews and will be analyzed using a conventional content analysis approach. The results of the quantitative and qualitative study will be used to develop breast cancer preventive strategies.

DISCUSSION

Researchers need to acquire knowledge regarding the lifestyle and perceived social support of Iranian women that will foster culturally competent approaches to promote healthy lifestyles to develop breast cancer preventive strategies. Examining breast cancer preventive lifestyles provides valuable information for designing applicable intervention programs for improving women's health.

Physical Activity Modifies the Association between Dietary Protein and Lean Mass of Postmenopausal Women

BACKGROUND

Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women.

OBJECTIVE

Our aim was to evaluate whether the association between dietary protein and lean mass differs by physical activity level, amino acid composition, and body mass index categories.

DESIGN

We performed a cross-sectional analysis of a prospective cohort.

PARTICIPANTS/SETTING

Participants were postmenopausal women from the Women's Health Initiative with body composition measurements by dual-energy x-ray absorptiometry (n=8,298).

MAIN OUTCOME MEASURES

Our study measured percent lean mass, percent fat mass, and lean body mass index.

STATISTICAL ANALYSES PERFORMED

Linear regression models adjusted for scanner serial number, age, calibrated energy intake, race/ethnicity, neighborhood socioeconomic status, and recreational physical activity were used to determine the relationship between protein intake and body composition measures. Likelihood ratio tests and stratified analysis were used to investigate physical activity and body mass index as potential effect modifiers.

RESULTS

Biomarker-calibrated protein intake was positively associated with percent lean mass; women in the highest protein quintile had 6.3 percentage points higher lean mass than the lowest quintile (P<0.001). This difference rose to 8.5 percentage points for physically active women in the highest protein quintile (Pinteraction=0.023). Percent fat mass and lean body mass index were both inversely related to protein intake (both P<0.001). Physical activity further reduced percent fat mass (Pinteraction=0.022) and lean body mass index (Pinteraction=0.011). Leucine intake was associated with lean mass, as were branched chain amino acids combined (both P<0.001), but not independent of total protein. All associations were observed for normal-weight, overweight, and obese women.

CONCLUSIONS

Protein consumption up to 2.02 g/kg body weight daily is positively associated with lean mass in postmenopausal women. Importantly, those that also engage in physical activity have the highest lean mass across body mass index categories.

Development and psychometric testing of a new instrument to measure factors influencing women's breast cancer prevention behaviors (ASSISTS)

BACKGROUND

Breast cancer preventive behaviors have an extreme effect on women's health. Despite the benefits of preventive behaviors regarding breast cancer, they have not been implemented as routine care for healthy women. To assess this health issue, a reliable and valid scale is needed. The aim of the present study is to develop and examine the psychometric properties of a new scale, called the ASSISTS, in order to identify factors that affect women's breast cancer prevention behaviors.

METHODS

A multi-phase instrument development method was performed to develop the questionnaire from February 2012 to September 2014. The item pool was generated based on secondary analyses of previous qualitative data. Then, content and face validity were applied to provide a pre-final version of the scale. The scale validation was conducted with a sample of women recruited from health centers affiliated with Tehran University of Medical Sciences. The construct validity (both exploratory and confirmatory), convergent validity, discriminate validity, internal consistency reliability and test-retest analysis of the questionnaire were tested.

RESULTS

Fifty-eight items were initially extracted from the secondary analysis of previous qualitative data. After content validity, this was reduced to 49 items. The exploratory factor analysis revealed seven factors (Attitude, supportive systems, self-efficacy, information seeking, stress management, stimulant and self-care) containing 33 items that jointly accounted for 60.62 % of the observed variance. The confirmatory factor analysis showed a model with appropriate fitness for the data. The Cronbach's alpha coefficient for the subscales ranged from 0.68 to 0.85, and the Intraclass Correlation Coefficient (ICC) ranged from 0.71 to 0.98; which is well above the acceptable thresholds.

CONCLUSION

The findings showed that the designed questionnaire was a valid and reliable instrument for assessing factors affecting women's breast cancer prevention behaviors that can be used both in practice and in future studies.

Correlation of Physical Activities and Breast Cancer Characteristics: A Prospective Analysis with Special Focus on Triple Negative Breast Cancer

OBJECTIVE

Several studies have demonstrated that daily physical activity (PA) prevents the development of breast cancer. Our objective was to examine the relationship between PA and clinical and biological tumor characteristics in breast cancer patients in order to determine the impact of energy expenditure (EE) on tumor prognosis.

METHODS

We pooled data from two prospective studies, including a total of 121 breast cancer patients. The measure of PA was done using the self-completion Population Physical Activity Questionnaire, which was answered by each patient.

RESULTS

Ten patients harbored triple negative (TN) tumors. The mean body mass index (BMI) in the general population and in patients with TN tumors was 24.3 and 25.6, respectively. The mean daily EE (DEE) was 10,266 kJ×24 h(-1) in the general population and 11,212 kJ×24 h(-1) in patients with TN tumors. In the whole population, there was an inverse statistical correlation between BMI and DEE, rest, low PA, and high PA (p=0.0002, p=0.003, p<0001, and p=0.03, respectively). There was a positive correlation between negative estrogen receptor status and intensive PA (p=0.041) and DEE (p=0.007). For TN tumors, there was no significant correlation between BMI and categories of EE.

CONCLUSIONS

Lifestyle (weight regulation, PA) should be adapted and personalized according to biological, clinical, and epidemiological characteristics of the tumors.

Health Promoting Life-Style Behaviors and Systemic Inflamma-tion in African American and Caucasian Women Prior to Chemo-therapy for Breast Cancer

BACKGROUND

Racial disparities in breast cancer outcomes persist, with differential adverse outcomes in African American women. Although research has ex-amined possible genetic differences, there has been little research on potentially modifiable characteristics such as health promoting behaviors. The purpose of this article is to describe the characteristics and to compare the differences by race in lifestyle factors and inflammatory biomarkers in African American and Caucasian women with breast cancer.

METHODS

This is a baseline descriptive analysis from an ongoing randomized controlled trial that includes 124 women diagnosed with early stage breast cancer prior to chemotherapy. Data sources included medical records, self-re-port questionnaires and a blood sample for measures of inflammation. The sta-tistical analysis included descriptive statistics and ANOVA models to determine differences between the two groups.

RESULTS

Overall, both groups had low levels of health promoting behaviors. African Americans had a significantly higher body mass index. Caucasian women consumed more alcohol. Levels of C-reactive protein and MIP-1β were significantly higher in African Americans.

CONCLUSION

Potentially modifiable factors such as nutrition, physical activity and levels of inflammation warrant further attention.

The beneficial effect of enhanced physical activity on the welfare of breast cancer survivors

SUMMARY 

Healthcare providers caring for breast cancer survivors can positively impact patients' quality of life by counseling them about lifestyle modifications such as physical activity and exercise. Based on a literature review of current available evidence, this article serves as a guide to primary care providers regarding the beneficial role of lifestyle modification and physical activity. Specific survivorship issues and beneficial impacts of physical activity that will be discussed in this article include the management of arthralgias, cancer related fatigue, lymphedema, pain, mental health conditions, weight management and reducing breast cancer recurrence. The timing and intensity of physical activity needs to be individualized based on patient symptoms, comorbidities and personal preferences. The goals of physical activity options for breast cancer survivors are to aid in the management of treatment-related side effects, improve fitness and maintain a healthy lifestyle.

Development and preliminary testing of an instrument to measure healthiness of lifestyle among breast cancer survivors

Monitoring lifestyle to maintain health is an important issue for breast cancer survivors. No multidimensional instrument has previously been available specifically for assessing overall healthiness of lifestyle among breast cancer survivors. This study aims (i) to establish the Healthy Lifestyle Instrument for Breast Cancer Survivors (HLI-BCS) and (ii) to examine the reliability and validity of the established scale. A quantitative cross-sectional design was used. This project was conducted in four phases. In phase I, using the Health-Promoting Lifestyle Profile as the core concept, we created 50 preliminary measurement items. In phase II, we invited 10 breast cancer survivors and five professional experts to conduct a content validity assessment. In phases III and IV, a total of 220 breast cancer survivors were enrolled to assess the construct validity and the internal consistency and reliability. The final HLI-BCS contains 20 items across five domains: dietary habits, environment and physiology, health responsibility and stress management, social and interpersonal relations and spiritual growth. Through the information presented in the HLI-BCS, breast cancer survivors can assess their lifestyles on multiple dimensions and subsequently adjust their lifestyles to enhance their recovery and quality of life.

Breast cancer-preventive behaviors: exploring Iranian women's experiences

Background

Breast cancer-preventive behaviors are critical for community and women’s health. Although many studies have addressed women’s knowledge and attitudes toward breast cancer, little information is available about their experiences of breast cancer preventive behaviors. This study aimed to explore the experiences of Iranian women regarding preventive behaviors.

Methods

This was a qualitative study. A sample of Iranian women aged 30 years and over was selected purposefully. Data collected through focus group and semi-structured audiotaped interviews and were analyzed by conventional content analysis.

Results

The following five main themes emerged from the analysis: attitude toward breast cancer and preventive behaviors, stress management, healthy lifestyle, perceived social support and individual/environmental barriers. The findings showed that women were highly motivated to preventive behaviors of breast cancer but faced considerable challenges.

Conclusions

The findings indicated that increased awareness, positive attitudes, stronger motivational factors, and fewer barriers toward preventive behaviors are most important parameters that might encourage women to practice breast cancer-preventive behaviors.

Complications of thoracic radiotherapy

The issue of toxicity is a primary concern for chest irradiation, because it is a dose-limiting toxicity and because in some circumstances it can alleviate the survival benefit of radiation therapy. Potential acute and delayed side effects can compromise the patients' prognosis and generate significant morbidity. Here we review on chest complications of radiation therapy, with focus on cardiac and pulmonary radio-induced side effects. Most radiographic changes associated with thoracic irradiation are asymptomatic. However, chest irradiation generated by treatment of breast cancer, bronchopulmonary malignancies, or mediastinal lymphoma has been associated with a risk of acute radiation pneumonitis and late lung fibrosis. An increasing number of clinical studies suggest that some dosimetric factors (e.g. V20, V30, mean lung dose) should be considered for limiting the risk of lung toxicity. Improvements in radiation techniques as well as changes in indications, volumes and prescribed doses of radiation therapy should help to better spare lungs from irradiation and thus decreasing the risk of subsequent toxicity. Numerous other contributing factors should also be considered, such as chemotherapeutic agents, smoking, tumor topography, or intrinsic sensitivity. Cardiac toxicity is another clinically relevant issue in patients receiving radiation therapy for breast cancer or for lymphoma. This life threatening toxicity should be analyzed in the light of dosimetric factors (including low doses) but also associated systemic agents which almost carry a potential for additive toxicity toward myocardium or coronaries. A long-term follow-up of patients as well as an increasing knowledge of the underlying biological pathways involved in cardiac toxicity should help designing effective preventing strategies.

Healthy lifestyle changes during the period before and after cancer diagnosis among breast cancer survivors

AIMS

The purpose of the present study was to investigate healthy lifestyle changes during the period before and after breast cancer diagnosis in Taiwan.

MATERIALS AND METHOD

Lifestyle changes during the period before and after cancer diagnosis were assessed by convenience sampling with a structured questionnaire for breast cancer survivors.

RESULTS

A total of 235 breast cancer survivors completed the healthy lifestyle scale. The mean values before and after breast cancer diagnosis of the participants were 3.27 and 3.73. The final five dimensions for the period before breast cancer diagnosis were: had not experienced stress; had exercised; had maintained sleep quality; had maintained body weight; and had maintained relationships. The final five dimensions for the period after breast cancer diagnosis were: sleep quality; had not experienced stress; relationship; had exercised; and had maintained body weight. A paired-t test was applied to examine the differences before and after cancer diagnosis, revealing that the total average scores of the participants on the healthy lifestyle scale clearly differed statistically (t= -17.20, p<0.01); and the nine dimensions before and after testing also demonstrate a marked statistical difference (p<0.01).

CONCLUSIONS

These findings are helpful in understanding the healthy lifestyle changes during the period before and after cancer diagnosis among breast cancer survivors. It is expected that these results can offer references of self-care for this group of patients.

Breast cancer survivors' efforts to renew and preserve their health in Taiwan

AIMS

This study was designed to describe the personal life experiences of breast cancer survivors regarding their efforts to recover and preserve their health in Taiwan.

METHOD

The study utilized a qualitative research method, wherein purposive sampling, one-on-one, face-to-face, in-depth semi-structured interviews were conducted. The data were then analyzed using content analysis. Data were saturated after interviewing 15 cancer survivors.

RESULTS

Three common themes emerged: introspection on the cause of the cancer, realization of a harmonized lifestyle, and reflecting on the strong will to survive.

CONCLUSIONS

These findings are helpful in understanding the relationship between breast cancer survival and individual efforts to restore and preserve health.

[Establishment of a pilot study of awareness retraining in physical activity in two selected populations of patients with breast cancer]

The purpose of this study is to measure the impact of an educational program to raise awareness of the increased spending energy in two different population of patients with breast cancer by using the questionnaire POPAQ (Population Physical Activity Questionnaire). This is a prospective study including two groups of 15 consecutive breast cancer patients (≤ 50 years Group 1 and Group 2 > 50 and < 70 years) followed in the department of radiotherapy at the Institute of Cancer of the Loire from January to July 2011. A questionnaire of physical activity assessment was used at two different times before the diagnosis/treatment of breast cancer (t0) and at 6 months (t6) to measure the impact of the awareness method. Comparison of different measures of daily energy expenditure (t0) between groups 1 and 2 was statistically significant (1,1803 and 9434 kJ/24 h, respectively, p = 0.0005). Daily energy expenditure of professional activity was statistically different between the two groups (1437 and 457 kJ/24 h, in groups 1 and 2, respectively; p = 0.003). Between t0 and t6, we observed a significant decrease in total energy consumption in group 1 (1,1803 to 1,0876 kJ/24 h) while there was no significant change between the group 2, except energy expended at rest (basal metabolism). There were differences in daily energy expenditure based on age may influence behavioral patterns deal with energy expenditure in physical activities. Tomorrow's challenges are to provide re-entrainment programs tailored to targeted populations.