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Schmitz KH, Williams NI, Kontos D, Domchek S, Morales KH, Hwang WT, Grant LL, DiGiovanni L, Salvatore D, Fenderson D, Schnall M, Galantino ML, Stopfer J, Kurzer MS, Wu S, Adelman J, Brown JC, Good J. Dose-response effects of aerobic exercise on estrogen among women at high risk for breast cancer: a randomized controlled trial. Breast Cancer Res Treat 2015; 154:309-18. [PMID: 26510851 PMCID: PMC6196733 DOI: 10.1007/s10549-015-3604-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Medical and surgical interventions for elevated breast cancer risk (e.g., BRCA1/2 mutation, family history) focus on reducing estrogen exposure. Women at elevated risk may be interested in less aggressive approaches to risk reduction. For example, exercise might reduce estrogen, yet has fewer serious side effects and less negative impact than surgery or hormonal medications. Randomized controlled trial. Increased risk defined by risk prediction models or BRCA mutation status. Eligibility: Age 18-50, eumenorrheic, non-smokers, and body mass index (BMI) between 21 and 50 kg/m(2). 139 were randomized. Treadmill exercise: 150 or 300 min/week, five menstrual cycles. Control group maintained exercise <75 min/week. PRIMARY OUTCOME Area under curve (AUC) for urinary estrogen. Secondary measures: urinary progesterone, quantitative digitized breast dynamic contrast-enhanced magnetic resonance imaging background parenchymal enhancement. Mean age 34 years, mean BMI 26.8 kg/m(2). A linear dose-response relationship was observed such that every 100 min of exercise is associated with 3.6 % lower follicular phase estrogen AUC (linear trend test, p = 0.03). No changes in luteal phase estrogen or progesterone levels. There was also a dose-response effect noted: for every 100 min of exercise, there was a 9.7 % decrease in background parenchymal enhancement as measured by imaging (linear trend test, p = 0.009). Linear dose-response effect observed to reduce follicular phase estrogen exposure measured via urine and hormone sensitive breast tissue as measured by imaging. Future research should explore maintenance of effects and extent to which findings are repeatable in lower risk women. Given the high benefit to risk ratio, clinicians can inform young women at increased risk that exercise may blunt estrogen exposure while considering whether to try other preventive therapies.
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Affiliation(s)
- Kathryn H Schmitz
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA.
| | - Nancy I Williams
- Department of Kinesiology, Pennsylvania State University, State College, USA
| | - Despina Kontos
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Susan Domchek
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Knashawn H Morales
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Wei-Ting Hwang
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Lorita L Grant
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Laura DiGiovanni
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Domenick Salvatore
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Desire' Fenderson
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Mitchell Schnall
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Mary Lou Galantino
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Jill Stopfer
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Mindy S Kurzer
- Department of Nutrition, University of Minnesota, Minneapolis, USA
| | - Shandong Wu
- Department of Radiology, University of Pittsburgh, Pittsburgh, USA
| | - Jessica Adelman
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Justin C Brown
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
| | - Jerene Good
- Perelman School of Medicine, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104-6021, USA
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To C, Kim EH, Royce DB, Williams CR, Collins RM, Risingsong R, Sporn MB, Liby KT. The PARP inhibitors, veliparib and olaparib, are effective chemopreventive agents for delaying mammary tumor development in BRCA1-deficient mice. Cancer Prev Res (Phila) 2014; 7:698-707. [PMID: 24817481 DOI: 10.1158/1940-6207.capr-14-0047] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Poly-ADP ribose polymerase (PARP) inhibitors are effective for the treatment of BRCA-deficient tumors. Women with these mutations have an increased risk of developing breast cancer and would benefit from effective chemoprevention. This study examines whether the PARP inhibitors, veliparib and olaparib, delay mammary gland tumor development in a BRCA1-deficient (BRCA1(Co/Co);MMTV-Cre;p53(+/-)) mouse model. In dose de-escalation studies, mice were fed with control, veliparib (100 mg/kg diet), or olaparib (200, 100, 50, or 25 mg/kg diet) continuously for up to 43 weeks. For intermittent dosing studies, mice cycled through olaparib (200 mg/kg diet) for 2 weeks followed by a 4-week rest period on control diet. To examine biomarkers, mice were fed with olaparib using the intermittent dosing regimen and mammary glands were evaluated by immunohistochemistry. In mice treated with veliparib or olaparib (200 mg/kg diet), the average age of the first detectable tumor was delayed by 2.4 and 6.5 weeks, respectively, compared with controls. Olaparib also increased the average lifespan of mice by 7 weeks. In dose de-escalation studies, lower concentrations of olaparib delayed tumor development but were less effective than the highest dose. When fed intermittently, olaparib delayed the onset of the first palpable tumor by 5.7 weeks and significantly reduced proliferation and induced apoptosis in hyperplastic mammary glands. In summary, veliparib and olaparib are effective for delaying tumor development and extending the lifespan of BRCA1-deficient mice, and intermittent dosing with olaparib was as effective as continuous dosing. These results suggest that the use of PARP inhibitors is a promising chemopreventive option.
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Affiliation(s)
- Ciric To
- Authors' Affiliations: Departments of Pharmacology, and
| | - Eun-Hee Kim
- Authors' Affiliations: Departments of Pharmacology, and
| | | | | | | | | | | | - Karen T Liby
- Authors' Affiliations: Departments of Pharmacology, and Medicine, Dartmouth Medical School, Hanover, New Hampshire
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