As a radiation oncologist who specializes in breast cancer, the month of October is always a special time for me. For those of you who do not know, October is breast cancer awareness month. This annual campaign stands to promote awareness of breast cancer along with increasing the encouragement of women to take the necessary steps to detect it in its early stages as well as to prevent it. The month then ends on a very special note — my birthday on November 1st.
So with my birthday around the corner and a month raising awareness of a major passion in my life, why do I wake up incredibly annoyed every October 1st?
Breast Cancer, Body Fat, and Diet
To answer this question, I have to provide some background information. Breast cancer, a metabolically entwined disease found to occur more often in obese and diabetic women and found to recur more often in obese or overweight women,1 is the most common cancer experienced by women. One in eight women will be diagnosed in her lifetime. More importantly, it is preventable and curable.
At diagnosis, women with breast cancer who are overweight or obese experience a significant increase in the risk of their cancer recurring and have a 540% increased risk of death.2-3
Overweight patients respond poorly to chemotherapy4 and have higher rates of side effects from treatment such as radiation therapy (higher energies and larger fields must be used to penetrate through a larger body habitus and worse skin toxicity occurs). Women who gain weight after treatment may fare worse, with studies showing a 12-pound weight gain, which is fairly common, results in a 1.5 times higher risk of the cancer recurring and a 1.6 times increased risk of dying.
A sobering study has shown that around 20% of women gain this amount after the treatment for breast cancer.1
Perhaps most importantly, (especially after our country has followed the food pyramid dietary recommendations promoting a plethora of bread, pasta, and carbohydrates) women with elevated blood sugar levels generally do much worse with treatment and experience poorer outcomes.1 This is partly because dietary carbohydrates cause the release of a chemical called insulin, which can stimulate tumor cells and make them more resistant to treatment like radiation therapy,5 and also because cancer cells appear to be rather sugar hungry.6
Lowering blood sugar levels may be so vital to killing cancer cells that attempts are being made to aggressively lower blood glucose levels through diet7-8 and a drug called metformin, which also lowers insulin levels.9
Or better put:
“While weight gain in general is associated with several risk factors for breast cancer recurrence, more specifically, worse outcomes are likely linked to disturbed adipose tissue metabolism resulting from (a) failure to accommodate surplus nutrients in adipose tissue that leads to ectopic accumulation of fat in other tissues and (b) qualitative and/or quantitative changes in physiologic processes, including adipokine production.”1
We certainly need breast cancer awareness, especially with the obesity epidemic that will largely affect both the occurrence and treatment of this disease.
But unfortunately, what October really turns into is pizza parties and sugar cookies at cancer centers — actually pink sugar cookies with pink ribbons made of pink sugar frosting. It is one thing for cafés and restaurants to be participating, but when hospitals and cancer centers display these “cigarettes” for breast cancer, a line has to be drawn. Awareness of breast cancer has become a celebration of indulging in the things that, well, lead to breast cancer. Anyone confused? I know breast cancer patients sure are.10
It is understandable for patients to be unaware of these metabolic connections. However, when they see these unhealthy behaviors not only occurring at cancer centers, but being promoted, what message are we communicating to our patients?
Decreasing Sugar Can Kill Cancer Cells
A recent study may sum up my aggravation (or perhaps worsen it). A group recently set out to assess the effect of decreasing the amount of sugar available to cancer cells in a preclinical study.11 In their words:
“glucose (and glutamine) deprivation to typical physiological concentrations result in significant cancer cell killing after as little as 2 h. This supports the possibility of combining anti-glycolytic treatment, such as a carbohydrate-restricted diet, with chemotherapeutics for enhanced cancer cell killing.”
In other words, decreasing the amount of sugar (or sugar cookies) to cancer cells causes them to die in as little as two hours. Even small decreases may work. In the face of toxic treatment, perhaps reducing sugar along with chemotherapy or radiation therapy is the necessary one-two punch to knock out cancer cells. As a radiation oncologist who is bombarding cancer cells with free radicals in an attempt to end their lives, perhaps it is not in my patients’ best interests to bombard them with sugar cookies (with or without pink frosting).
CONT’D: Follow the link HERE to continue reading the remainder of the article.
1. Champ CE, Volek JS, Siglin J, Jin L, Simone NL. Weight Gain, Metabolic Syndrome, and Breast Cancer Recurrence: Are Dietary Recommendations Supported by the Data? Int. J. Breast Cancer 2012;2012:9. doi:10.1155/2012/506868.
2. Kumar NB, Cantor A, Allen K, Cox CE. Android obesity at diagnosis and breast carcinoma survival. Cancer 2000;88(12):2751-2757. doi:10.1002/1097-0142(20000615)88:123.0.co;2-1.
3. Rock CL, Demark-Wahnefried W. Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J. Clin. Oncol. 2002;20(15):3302-3316. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12149305.
4. Litton JK, Gonzalez-Angulo AM, Warneke CL, et al. Relationship Between Obesity and Pathologic Response to Neoadjuvant Chemotherapy Among Women With Operable Breast Cancer. J. Clin. Oncol. 2008;26(25):4072-4077. doi:10.1200/jco.2007.14.4527.
5. Klement RJ, Champ CE. Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R’s through dietary manipulation. Cancer Metastasis Rev. 2014. doi:10.1007/s10555-014-9495-3.
6. Kunkel M, Reichert TE, Benz P, et al. Overexpression of Glut-1 and increased glucose metabolism in tumors are associated with a poor prognosis in patients with oral squamous cell carcinoma. Cancer 2003;97(4):1015-1024. doi:10.1002/cncr.11159.
7. Champ CE, Palmer JD, Volek JS, et al. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J. Neurooncol. 2014;117(1):125-31. doi:10.1007/s11060-014-1362-0.
8. Fine EJ, Segal-Isaacson CJ, Feinman RD, et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition 2012;28(10):1028-1035. doi:10.1016/j.nut.2012.05.001.
9. Nowak, K, Eldredge-Hindy, H, Champ C. Metformin: The sweet link between tumor genetics and metabolism? OA Cancer 2014:2(1):7. Available at: http://www.oapublishinglondon.com/article/1298. Accessed October 18, 2014.
10. Champ CE, Mishra M V, Showalter TN, Ohri N, Dicker AP, Simone NL. Dietary Recommendations During and After Cancer Treatment: Consistently Inconsistent? Nutr. Cancer 2013;65(3):430-439. doi:10.1080/01635581.2013.757629.
11. Mathews EH, Stander BA, Joubert AM, Liebenberg L. Tumor cell culture survival following glucose and glutamine deprivation at typical physiological concentrations. Nutrition 2014;30(2):218-27. doi:10.1016/j.nut.2013.07.024