Results from a study published BMC Cancer journal suggests that weight gain after a diagnosis of breast cancer or ductal carcinoma in situ (DCIC) is a greater problem than previously thought.

Overweight and obesity are strongly implicated in the development of breast cancer. Furthermore, weight gain post-diagnosis is associated with greater morbidity and all-cause mortality.

The published study results, based on the first national survey on weight after breast cancer in Australia, demonstrates that close to two-thirds (63.7%) of women reported weight gain at an average of nine kilograms (20 lbs) after a breast cancer diagnosis. Overall nearly one-in-five women (17%) reported a weight gain of more than 20 kilograms (44 lbs).

Study
Researchers from NICM Health Research Institute, Western Sydney University and ICON Cancer Centre, Sydney Adventist Hospital, Wahroonga, surveyed 309 women with breast cancer living in Australia using an anonymous, self-administered online cross-sectional survey between November 2017 and January 2018.

The national sample consisted mainly of members of the Breast Cancer Network Australia (BCNA).

From the 309 participating women, the researchers obtained complete pre/post-diagnosis weight data from 277 women. This allowed them to calculated pre/post Body Mass Index (BMI) for 270 women. The proportion of women with overweight/obesity rose from 48.5% at diagnosis to 67.4% at the time of the survey.

Most of the participating women were white with stage I-III breast cancer (n = 254) or ductal carcinoma in situ (DCIS) (n = 33). Their mean age was 59.1 years.

Carolyn Ee, Ph.D., lead author, general practitioner and senior research fellow at NICM Health Research Institute, Western Sydney University. Photo courtesy: The University of Western Australia, Australia.

“The majority of women surveyed (77%) reported gaining weight within the first 12-18 months after [initial] diagnosis, which could be the ideal ‘window of opportunity‘ to provide additional support for weight management among women with breast cancer,” noted Carolyn Ee, Ph.D., lead author, general practitioner and senior research fellow at NICM Health Research Institute, Western Sydney University.

“[In addition to] significant weight gain, we also found high levels of concern about weight among our survey participants. Timing may be the key in helping women to manage weight after a diagnosis of breast cancer,” Ee further noted.

“Cancer services and general practitioners play an important role in having early conversations with women, and referring them to a team of qualified healthcare professionals such as dieticians and exercise physiologists with experience in cancer,” she said.

The survey also found:

  • The proportion of women who were overweight or obese increased from 48% at time of diagnosis to 67% at the time of the survey, with the proportion of women who were obese almost doubling from 17% to 32%.
  • The majority (69%) of women gained weight in excess of the rates reported in age-matched controls without breast cancer – an additional 2.42 kilograms (5.33 lbs) over five years.

Interventions
“As doctors, we really need to actively think about weight, nutrition, and exercise and advise about possible interventions,” said Professor John Boyages AM, co-author and radiation oncologist at Icon Cancer Centre says that all women should be prescribed exercise after being diagnosed with breast cancer, according to the Clinical Oncology Society of Australia (COSA) guidelines.

“Breast cancer is the most common cancer in women worldwide, and weight gain is common after breast cancer treatment. Many patients assume they will lose weight. Weight gain adds to self-esteem problems, increases the risk of heart disease and other cancers and several reports suggest it may affect prognosis and also increases the risk of arm swelling (lymphoedema). Prescribing a healthy lifestyle is just as important as prescribing [drugs].”

Fatigue
“After a diagnosis of breast cancer, many women experience fatigue, which can be a barrier to staying active, and studies show exercise is an effective treatment for fatigue. However, for this to be feasible and sustainable, she says supervision by an experienced exercise physiologist is invaluable,” Ee explained.

“Many studies highlight the importance of specialists such as exercise physiologists and nutritionists for breast cancer treatment plans, however, they are often an unfunded component of follow-up care,” observed Kirsten Pilatti, Chief Executive Officer of BCNA.

“For many breast cancer survivors, the cost of accessing the expertise of these specialists puts them beyond their reach. We want a system that helps women and men diagnosed with breast cancer to come out and be able to move on with their life, not be crushed by the experience,” said Pilatti concluded.

The researchers will next analyze the survey data to investigate reasons why women are gaining weight after breast cancer, with several risk factors reported in other studies, including the type of treatment that women receive, and whether or not they were menopausal before diagnosis and treatment.

Reference
[1] Ee C, Cave AE, Naidoo D. Bilinski K, Boyages J. Weight before and after a diagnosis of breast cancer or ductal carcinoma in situ: a national Australian survey. BMC Cancer 20, 113 (2020). https://doi.org/10.1186/s12885-020-6566-4 [Article]