Diet may cut second breast cancers in women without hot flashes

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Public release date: 15-Dec-2008

http://www.eurekalert.org/pub_releases/2008-12/uoc--dmc121208.php

Contact: Steve Benowitz

sbenowitz@...

University of California - San Diego

Diet may cut second breast cancers in women without hot flashes

A secondary analysis of a large, multicenter clinical trial has shown

that a diet loaded with fruits, vegetables and fiber and somewhat lower

in fat compared to standard federal dietary recommendations cuts the

risk of recurrence in a subgroup of early-stage breast cancer survivors

– women who didn't have hot flashes – by approximately 31 percent. These

patients typically have higher recurrence and lower survival rates than

breast cancer patients who have hot flashes. The study team, led by

researchers at the s Cancer Center at the University of California,

San Diego, along with six other sites, including the University of

California, , reported its results online December 15, 2008, in the

Journal of Clinical Oncology.

The results come on the heels of a report last year on the findings of

the original study, the Women's Healthy Eating and Living Trial (WHEL),

which compared the effects of the two diets on cancer recurrence in more

than 3,000 early-stage breast cancer survivors. That study showed no

overall difference in recurrence among the two diet groups.

" Women with early stage breast cancer who have hot flashes have better

survival and lower recurrence rates than women who don't have hot

flashes, " said Ellen B. Gold, Ph.D., professor and chair of the UC

Department of Public Health Sciences and first author of the study. " Our

results suggest that a major change in diet may help overcome the

difference in prognosis between women with and without hot flashes. "

" Our interest in looking at this subgroup came because hot flashes are

associated with lower circulating estrogen levels, while the absence of

hot flashes is associated with higher estrogen levels. Reducing the

effect of estrogen is a major treatment strategy in breast cancer, " said

the WHEL study principal investigator P. Pierce, Ph.D., Sam M.

Walton Professor for Cancer Prevention and director of Cancer Prevention

and Control at the UC San Diego School of Medicine and the s UCSD

Cancer Center. " It appears that a dietary pattern high in fruits,

vegetables and fiber, which has been shown to reduce circulating

estrogen levels, may only be important among women with circulating

estrogen levels above a certain threshold. "

About 30 percent of the original group of 3,088 breast cancer survivors

did not report hot flashes at study entry. The women had been randomly

assigned to one of the two diets between 1995 and 2000 and were followed

until 2006. About one-half (447) of the " no hot flashes " group were

randomized to the special, " intervention " high-vegetable fruit diet

while the other half (453) was given the generally recommended diet of

five servings of fruits and vegetables a day. The team found that those

on the intervention diet had a significantly lower rate of a second

breast cancer event (16.1 percent) compared to those eating the

government-recommended five-a-day dietary pattern (23.6 percent).

The dietary effect was even larger (a 47 percent lower risk) in women

who had been through menopause.

According to Pierce, another possible mechanism has been proposed

recently for why this diet may have affected only 30 percent of the WHEL

study population. Women with estrogen receptor-positive cancers usually

receive hormone therapy (tamoxifen or aromatase inhibitors) aimed at

combating the effect of circulating estrogen. However, more than 30

percent of these women appear to have a gene-drug interaction that

prevents them from getting an effective dose of this therapy.

" This hypothesis says that if the endocrine therapy is working, no

further reduction in estrogen levels would be needed, " said Pierce. " If

your genes are preventing you from getting a therapeutic dose, then

following this rigorous dietary pattern may reduce estrogen levels

enough to reduce risk. " Because this is speculation, he said, the

research team will be using biological samples collected throughout the

study to further investigate the mechanisms behind the study diet's

protective effects.

###

Other co-authors include: Cheryl Rock, Ph.D., Barbara , M.D.,

Madlensky, Ph.D., Loki Natarajan, Ph.D., Wasserman, M.D., Vicky

, M.D., Gail Laughlin, Ph.D., Nazmus Saquib M.D., Ph.D., Sheila

Kealey MPH, Shirley Flatt, Emond and Minya Pu, UCSD; Joanne

Mortimer, M.D., City of Hope; Marcia Stefanek, Ph.D., Stanford

University; Bette Caan, Dr.P.H, Kaiser Permanente, Oakland,

Thomson, Ph.D., University of Arizona, Njeri Karanja, Ph.D., Kaiser

Permanente, Portland, OR; Hajek, Ph.D., M.D. Cancer Center.

The s UCSD Cancer Center is one of the nation's 41 National Cancer

Institute-designated Comprehensive Cancer Centers, combining research,

clinical care and community outreach to advance the prevention,

treatment and cure of cancer. For more information, visit

www.cancer.ucsd.edu.

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

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