For Breast Cancer

Nutritional Issues for Common Cancer Sites

Breast Cancer

Side effects of breast cancer treatments may include fatigue, weight gain, weight loss, nausea, vomiting, and changes in normal eating patterns. Many breast cancer survivors seek nutritional guidance for controlling unwanted weight gain, weight loss, limiting fat intake, and answers to questions about the use of complementary and alternative nutrition therapies.36

Weight Maintenance and Dietary Fat

Obesity has been shown to adversely affect prognosis, so breast cancer survivors should be encouraged to achieve and maintain a healthy weight that is appropriate for their height. Moderate physical activity during and after treatment will help survivors maintain lean muscle mass while avoiding excess body fat.4 Even if ideal weight reduction is not achieved, it is likely that any amount of weight loss with the goal of normalizing weight levels is beneficial and therefore should be encouraged.37-43 However, weight loss should not be attempted during active treatment, but should be initiated during the recovery phase. Weight loss of one to two pounds a week is recommended, whereas more rapid weight loss requires expert nutritional supervision.

Although many studies have examined the relationship between the incidence of breast cancer and dietary fat intake,37 a strong relationship between dietary fat consumption and the primary occurrence of breast cancer has not been demonstrated. Even less is known about the impact of dietary fats on breast cancer growth after diagnosis and treatment. The few studies on the relationship between dietary fat and recurrence of breast cancer suggest that low levels of fat in the diet might be associated with lower recurrence rates and better survival.40-43,46-60

With nutritional supervision, a low-fat diet, even as low as 20% of calories from fat, can be started during therapy or can be initiated following treatment, in the recovery period. Breast cancer survivors should obtain the majority of their added fat from monounsaturated fats sources such as olive or canola oil, avocado, and nuts. In addition, they should limit their intake of saturated fats from sources such as red meat, poultry, and fat-containing dairy products.

Insufficient scientific evidence exists to make specific recommendations with regard to the effects of omega-3 fatty acids or fish oil supplements on breast cancer.139-140 The use of concentrated omega-3 fatty acid supplements and flaxseed oil can not be recommended at this time. Nevertheless, although such supplements are not advisable, food sources that contain these nutrients, such as fish (salmon, trout, sardines), are recommended. Several studies in this area are underway, but at this time, breast cancer survivors should be encouraged to select foods that are good sources of omega-3 fatty acids, such as fish and walnuts, while adhering to a low-fat diet.

Soy

Soy, soy-containing foods, and soy components such as isoflavones, exert both estrogenic and antiestrogenic effects.145-154 Soy may also have other anticancer effects not related to phytoestrogens.156 There is conflicting scientific information regarding the actual health benefit of soy at this time. Although the antiestrogenic effects of soy may mimic the beneficial effects of pharmacological antiestrogens such as tamoxifen, soy can also be proestrogenic, demonstrating adverse effects on markers of cancer risk in breast tissues.148 Therefore, it would be most prudent for breast cancer survivors to use only moderate amounts of soy foods as part of a healthy plant-based diet, avoiding very high levels of soy. Moreover, breast cancer survivors should not intentionally augment their diets with more concentrated sources of soy, such as soy-containing pills or powders, or supplements containing isolated or concentrated isoflavones.

Alcohol

Research has shown that consumption of alcohol is associated with an increased risk of breast cancer.37 The adverse effects of alcohol on breast cancer risk may be due to the effects of alcohol on estrogen levels in women. As the effects of alcohol on breast cancer survival are unknown at this time, it would be prudent to avoid high levels of alcohol (more than one to two drinks per day). For women with estrogen-responsive breast cancers, however, total avoidance of alcohol may be the best choice.

Fruits and Vegetables

Fruits and vegetables contain many phytochemicals that may help to prevent cancer or improve cancer prognosis. All cancer survivors, including breast cancer survivors, should be encouraged to consume at least five servings of fruits and vegetables per day. Although the correlation between dietary fiber and breast cancer recurrence is not clear, high fiber intake may reduce estrogen levels. A diet high in whole grains, legumes, vegetables, and fruit, is a good choice for breast cancer survivors.2

Physical Activity

There is growing evidence that regular physical activity may be beneficial for breast cancer prevention, especially in premenopausal women.71-77 Additional benefits of regular physical activity include prevention and management of heart disease and osteoporosis, as well as improved quality of life. Regular physical activity is essential for weight management.

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