It’s always enjoyable and interesting to hear from Dr Chlebowski about the Women’s Intervention Nutrition Study. It’s an inspiring study because it seemed to come up today with a therapy for triple negative disease that’s more effective than anything else we’ve got. What did you make of…? First of all, tell me what we heard today.
What he showed was those women randomised to the low fat diet did better, particularly if they were ER negative, with a pretty astounding survival benefit after twenty years of follow-up. Now, as he was careful to point out at the end, this was a not prospective analysis; it was retrospective, and it has all those caveats but, nevertheless, with the sizable reductions in the risk of recurrence and improvement in survival that he showed it’s very intriguing. Since weight loss is so important for many other health problems in today’s climate, it makes total sense to me to take overweight women and really encourage weight loss, much more than we’ve done in the past, as a treatment for breast cancer even though it hasn’t been proven yet and will require additional studies.
Now you’ve moved straight on to weight loss because, in fact, Dr Chlebowski did, and I think in the view of present thinking, quite rightly point the finger at weight loss rather than fat reduction which was in vogue twenty years ago when the study started. But now we’re a lot more worried about calories. What do you think about this? Do you think women with breast cancer should think of losing weight?
Yes, I think so. First of all we know from many, many studies that obesity increases the risk of getting breast cancer in the first place. Then there are several studies now that if you are overweight and once you are diagnosed with breast cancer you have a worse survival. So there’s every reason to lose weight and this one shows in a study, albeit with the caveats that we mentioned, that it may be particularly effective in a subset of breast cancer. But because it improves diabetes, it improves heart disease, it improves your cholesterol, hypertension, so many other factors, it makes total sense for total health purposes to keep your weight at a correct weight.
So collectively for women, irrespective of what subcategory they fall into, there was a benefit if they have a reduction of calories then?
There’s also data to suggest that overweight women may not benefit as much from aromatase inhibitors in the oestrogen receptor positive group. Now this study was done before aromatase inhibitors were used widely so I think there is reason to lose weight no matter what kind of breast cancer you have. Whether it’s oestrogen receptor positive or ER negative there would be reason to keep your weight at an ideal weight.
And triple negative breast cancer, it is starting to look like an exciting new treatment then?
It could be. If it’s true, if the data are true, it would be the best treatment we have for triple negative breast cancer, as good or better than chemotherapy which, right now, is the standard for it.