Talk about breast cancer and naturally, people
think of the disease that is the number one cancer among women. But the
truth is that breast cancer is on the rise among both women and men,
and researchers think the national obesity crisis may be to blame.
With two-thirds of Americans now overweight, we can probably expect
more obesity-related cancers. But on the brighter side, weight problems
are extremely treatable, even preventable. So to the extent overweight
is contributing to cancer, this is one risk factor we may actually have
some real control over.
Just how we go about getting that control appears to be critical,
though. Even among the most motivated of people, we see that very few
are successful in independent efforts to lose weight, even if their
life depends on it. And among cancer patients, it clearly does.
Consider some of the numbers: breast cancer in women increased by 52
percent from 1973 to 1998. Part of that increase can be accounted for
by better detection, because mammography is much more available than it
was 30 years ago. But use of post-menopausal estrogen supplements has
also become routine, and these have been clearly linked to cancer in
women.
But in that same period, incidence of breast cancer among men increased
by 26 percent, and that’s without the ingested estrogen and without the
extra detection offered by mammography, since men typically don’t
pursue that procedure.
So what else is going on? Experts say the increase in breast cancer in
both sexes seems to closely track the increase in American obesity,
giving rise to the theory that the obesity crisis may actually be to
blame for the boom in breast cancer.
Obesity has been shown to have a clear relationship with some cancers,
but not with others. For instance, there does not appear to be any
correlation between overweight and prostate cancer in men. Or
sometimes, the relation is clear, but the reasons aren’t. Hence,
researchers are looking at whether acid reflux in overweight people
might account for their greater incidence of esophogeal cancer.
But with breast cancer, there is at least one known culprit: all that
excess estrogen. Fatty tissue produces estrogen, in both men and women.
Studies of menopausal women make the case most clearly. Before
menopause, the ovaries are the primary source of estrogen. But after
menopause, when the ovaries have retired from that duty, fatty tissues
are the main estrogen source.
Among postmenopausal women, estrogen levels are 50 to 100 percent
higher in heavy women, compared to those of healthy weight. Similar
ratios are found among men.
And when estrogen-sensitive tissues get more estrogen exposure, that
leads to more growth of estrogen-responsive breast tumors.
Researchers figure that between 11,000 and 18,000 breast cancer deaths
per year could be avoided in American women over age 50, if they could
maintain a healthy body weight throughout their adult lives. There are
no similar guesstimates for men, because while breast cancer is a
growing problem for men, there is little research on mortality rates
among males, and it is still less of a concern than heart disease or
prostate and colon cancer.
But obesity puts men at higher risk for these diseases, as well, so the
imperative is to drop that excess weight, or at least some of it.
There’s abundant evidence that even a minor weight loss reaps huge
rewards for health. So how do you do it?
It’s tough, especially if you’re an older person, and the average age
of diagnosis for breast cancer is 62 among women, and 67 among men.
Motivation counts, but the research shows that it’s not enough. People
need help. For instance, who would be more motivated to lose weight
than a heavy person who had already survived cancer?
An overweight survivor has a double whammy when it comes to risk of
recurrence, but a study published earlier this year in Obesity Research
said that even among that motivated group, people left to their own
devices, or those who only had a group program did not achieve much
weight loss.
This is no surprise to those of us who have treated obesity for years.
We see people who have tried diet after diet, joined gym and club and
fellowship alike, all to no avail. But when they are treated with a
comprehensive diet and lifestyle modification program that has been
designed specifically for them, things change.
In this latest study, the researchers were pretty unequivocal,
concluding that “for breast cancer survivors to lose weight to reduce
risk factors, intervention is necessary. Of the different intervention
regimens, individualized counseling combined with attending weekly …
meetings was most effective….”
When you’re facing a chocolate éclair, death is perhaps too abstract an
idea, even if you’ve only narrowly escaped it. Without some real
retraining, it’s hard to equate even the greasiest burger with a lethal
tumor. But professional support makes all the difference.
For instance, I’ve been tracking insulin levels in weight management
patients for years, because we know that high insulin levels indicate a
metabolic abnormality that leads to diabetes and weight gain. Now
recent research shows that elevated insulin levels are also a risk
factor for breast cancer recurrence.
Yet very specific changes in lifestyle and diet can significantly
reduce insulin levels in days to weeks, immediately reducing those
disease risks. The disembodied threat of disease is sometimes hard for
people to get their arms around, but when patients can look at their
lab results and see how their behavioral changes directly affect their
blood chemistry, it hits home.
What happens to patients’ bodies on the inside as they lose weight is
more important than the changes they get on the outside, but even at
the best health clubs or peer support groups, they won’t have an
opportunity to see that.
It’s inspiring to see how people embrace a fitness and weight-loss
program when they have more than just a bathroom scale to tell them
that it’s working. Consistent and reliable guidance is essential
because nobody goes from obese to healthy overnight. It takes time.
But cancer takes time, too, so the race is on. With the proper help,
this is a race both men and women have great odds of winning.
THROUGH THICK & THIN
Breast cancer is a growing risk for both men and women, and it’s a
cancer for which the obesity link has been clearly established. Fat
produces excess estrogen; excess estrogen produces breast cancer. And
in the reverse, weight loss reduces cancer risk. The data are clear,
but it doesn’t make the task any easier. What does make it easier, and
more successful, is professional help-—-and the sooner the better.
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Caroline J. Cederquist, M.D. is a board certified Family Physician and
a board certified Bariatric Physicians (the medical specialty of weight
management). Dr. Cederquist is the founder of Bistro MD formerly
Diet To Your Door, a home diet delivery program that specializes in low
calorie gourmet food that is delivered to your home or office. Bistro
MD serves as culmination of Dr. Cederquist's expertise and experience
in the world of medical weight loss.
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