Category Archives: Peer Reviewed Publications

Total Body Fat Vs. Belly Fat in Breast Cancer Risk

I came across this very interesting study through a Medical News Today article (link below). The paper manuscript itself is free, but comes across as a little difficult to read on the downloadable PDF version , because of the way it appears to be output by the journal. However, it is always good to be able to access the full paper, and not simply the summary.

The premise

Among several risk factors, body fat is a breast cancer risk. There apparently have been contentions about where specific biomarkers that indicate breast cancer are produced, with some previous studies. This study has shown that overall weight loss is more beneficial in terms of breast cancer biomarker production reduction, rather than focusing on belly fat alone.

The current study

The current study is limited to post-menopausal women. Conducted in the Netherlands, 243 overweight women were recruited. They lost 5 – 6kg over a period of 16 weeks. A set of biomarkers, indicative of sex hormones, leptin and inflammation were compared before and after the weight loss. The fat changes themselves were measured using X-ray and MRI scans.

The latter appears to be important. The MNT article includes a statement that this study is different than previous ones that used waist measurements. I can see this being quite an important difference. X-rays and MRI scans definitely appear to be more fastidious methods of assessing fat changes, specific to a body region.

Results

Increased belly fat, according to Dr. Evelyn Monninkhof, the lead in the study indicates, increases the risk for several chronic diseases, independent of total body fat. She indicates however, that sex hormones, are more affected by total body fat and not just localized fat, as concluded from the study.

She also points that their next steps is to look at how to reduce levels of total fat and abdominal fat. This said, it appears that women, especially those postmenopausal and those approaching menopause can benefit from exercise and nutritional changes that lead to total fat loss, and hopefully, abdominal fat loss along the way. It is always important to contact licensed medical and/or nutritional professionals when considering exercise and/or dietary changes.

References:

  1. The MNT Article: http://www.medicalnewstoday.com/releases/317498.php
  2. The Endocrinology Paper: http://erc.endocrinology-journals.org/content/early/2017/05/16/ERC-16-0490.abstract?sid=9f3c9977-0e81-4583-bdf5-07b3f182f911
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/woman-with-umbrella-on-beach-247304/

Some results on breast reconstruction following mastectomy

The Preface

One of my life goals, and specifically, as it pertains to this site, is to spread the news about free and open, well composed, peer-reviewed scientific publications. Following that tradition, today’s blog focuses on another key area of women’s health – breast cancer, mastectomy and post-mastectomy reconstruction.

The Paper

ASCO and MedPage Today are reporting this paper in the Journal of Clinical Oncology, available on MedPage Today for free (link below), that highlights one year, post operative patient survey results, that highlight differences in satisfaction with breasts, among women who opted for two forms of breast reconstructive surgery.

The two forms are Autologous Recovery or Flap Recovery and Implant Reconstruction.

Autologus Recovery

Autologous Recovery, as some of you might guess, involves tissue from the patient’s own body, reconstructed and used as breast tissue. There are two types of tissue recovery possible: free flap, where the tissue is severed from its blood vessel connections and moved or, a pedicled flap, where the blood vessels are still attached as the tissue is moved. Tissue usually arises from areas such as the belly or the back. A link with details is supplied below.

Implant Reconstruction

Implant reconstruction doesn’t last a life time, the key difference between this and autologous recovery, and may need multiple surgeries. Usually composed of silicone and saline, these implants are sized and implanted into the body. This method is less invasive, and easier with delayed reconstructive options, and provides the patients with multiple breast shape options, allowing for the most suitable form to be chosen and used. Formerly, this was the best option for women with smaller breasts, because they also usually had less tissue available for reconstruction, but autologous recovery has made strides in this area, so this is no longer seen as a big advantage. Refer to the link below for more information.

The present study

The present study enrolled a large number of patients, 1632, in total, across 11 sites; that were undergoing immediate postmastectomy reconstruction for either invasive cancer and/or carcinoma in situ. There is some argument over whether carcinoma in situ is actually cancer. Regardless of the status of this debate, this is the title for a group of cells/tissue that is precancerous and has not metastasized but is expected to. This is common in breast and a few other cancers, and patients many times choose to undergo mastectomy to fend off cancer.

Patient Reported Outcomes (PRO)

The study was conducted by evaluating Patient Reported Outcomes, also known as PRO. This is a method where validated questionnaires are used, to assess treatments and/or symptoms, from the patients’ perspectives, going beyond clinical measurements, which, for the longest time where the mainstay of medical comparative evaluation. There are barriers to the prevalence of PROs, as internet access, data availability, etc. remain challenges, however it is becoming an accepted research form, especially where patients themselves would be the best judges of outcomes.

Care must be taken when interpreting patient reported outcomes, valuable as they are, and especially so, when using them for labeling claims. The FDA has also weighed in.

In this study, using  a generic PRO measure, Patient-Reported Outcomes Measurement Information System–29, patients were quizzed before, and one year after surgery. If you want to read and learn more about PROMIS, I have appended a link below.

The Results and Conclusions

Using the scoring system, and based on the response of 1183 patients, the researchers concluded that patients with Autologous Recovery/Reconstruction had better satisfaction  with their breasts and mental well being. Anxiety and depression were reduced in both groups, however, neither group had fully recovery of chest health. There was increased pain with Autologous Recovery, while patients with Implant Reconstruction had reduced fatigue. overall, it appears patients who underwent Autologous Reconstruction had a slight edge. I have attached links to the summary and the article below.

References:

  1. The ASCO study summary: https://www.medpagetoday.com/reading-room/asco/breast-cancer/64962?xid=NL_ASCORR_2017-05-11&eun=g5100781d39r&pos=1111 Note: The full paper link is available on the same page. 
  2. Autologous Recovery: http://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous
  3. Implant Reconstruction: http://www.breastcancer.org/treatment/surgery/reconstruction/types/implants
  4. PROMIS: http://www.nihpromis.com/?AspxAutoDetectCookieSupport=1#1
  5. A Paper on Patient-Reported Outcomes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227331/
  6. Carcinoma in situ: https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46488
  7. FDA Guidance on the use of Patient-Reported Outcome Measures: https://www.fda.gov/downloads/drugs/guidances/ucm193282.pdf
  8. Image Courtesy, Pexels: https://www.pexels.com/photo/flower-pink-peony-blouse-112324/