More than 20,000 Australians, primarily women, are diagnosed with breast cancer annually. The positive news is that 92 out of every 100 women will survive for at least five years after diagnosis. However, women often face lasting and significant side effects from cancer treatment, such as pain and fatigue, which can extend for years. There’s also the persistent fear of cancer returning, even past the celebrated five-year survival milestone. What steps can you take to enhance your chances of a longer, healthier life post-diagnosis? Increasing physical activity and reducing sedentary behavior are key. Ideally, this means working towards and maintaining about 150 minutes of regular exercise weekly, including both aerobic activities like walking and resistance exercises targeting specific muscle groups, performed at moderate to high intensity to elevate your heart rate. Observational studies indicate a link between exercise, longevity, and reduced cancer recurrence risk. Preliminary clinical trial evidence supports these findings as well.
Women with breast cancer who exercise and remain active tend to experience better quality of life, strength, fitness, and fewer severe side effects during treatment. Additionally, women who consume a healthy diet rich in vegetables, fruits, legumes, nuts, whole grains, and fish tend to live longer post-diagnosis than those consuming diets high in refined or processed foods and red meat. This is largely because a healthy diet lowers the risk of other health issues like heart disease, rather than directly affecting breast cancer mortality risk. In fact, many women, especially older ones or those with early stage breast cancer, face a higher risk of dying from heart disease than breast cancer. A nutritious diet can help maintain a healthy weight and good heart health. Interest is growing in specific diets like ketogenic or low-carb diets and fasting during cancer treatment. However, current guidelines suggest there is no significant evidence supporting their benefit.
Further research is underway, inspired by a 2020 study that hinted at improved treatment response with a “fasting mimicking diet” (low calorie, low protein) prior to and on chemotherapy days. However, adherence to such a diet proved challenging – only one in five women in the study managed to stick with it throughout all chemotherapy sessions. Excessive body weight has also been associated with poorer survival outcomes after a breast cancer diagnosis. However, clinical trials demonstrating that weight loss post-diagnosis can improve survival are still pending. Current trials aim to explore this question. Weight gain following breast cancer treatment is common, with complex causes, and excess weight can exacerbate treatment side effects. A recent study showed that when women receive support to lose a modest amount (five percent of body weight), they see improvements in physical quality of life and pain reduction, alongside lowered risk of heart disease and diabetes.
Furthermore, besides these well-established strategies, emerging research suggests two more behaviors related to our body clock may influence health outcomes after a breast cancer diagnosis. Disrupted sleep is a frequent issue among breast cancer patients and can persist long after treatment has ended. Those who frequently struggle to fall asleep or stay asleep at night, as compared to those who seldom or never have sleep issues, face a higher risk of mortality from any cause. Moreover, the duration and quality of sleep are important. Averaging more than nine hours of sleep per night, as opposed to seven or eight, is linked to a 48% increased risk of breast cancer recurrence, though the reasons for this are not yet understood. Preliminary research suggests the timing of meals matters. Extending the time between the final meal of one day and the first meal of the next might help lower the risk of breast cancer returning. Women who fasted for fewer than 13 hours overnight, as opposed to 13 hours or more, showed a 36% increased risk of breast cancer recurrence. However, the study’s authors suggest that randomized trials are necessary to determine whether longer overnight fasting can genuinely lower disease risk.
Furthermore, the World Cancer Research Fund has established recommendations to minimize cancer risk and prevent recurrences. Yet, research indicates most women do not follow these recommendations post-diagnosis. Changing habits after breast cancer can be challenging, primarily because of fatigue and stress. Initiating an exercise regimen post-treatment can seem daunting or even scary. It’s advisable to start small, like increasing exercise by ten to fifteen minutes weekly. Having an exercise companion is beneficial, as numerous exercise programs cater to those who’ve had breast cancer. Common concerns about exercise post-diagnosis include avoiding lymphoedema, which affects about 20% of breast cancer survivors who’ve had lymph nodes removed, and dealing with discomfort from wigs or irritation from radiation. Guidance specific to these issues is available. Similar to setting exercise goals, rather than aiming for a perfect diet, focus on incorporating more vegetables into your meals each week.