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Topic: Diabetes risk and hormone tx

Forum: Clinical Trials, Research News, Podcasts, Study Results —

Share your research articles, interpretations and experiences here. Let us know how these studies affect you and your decisions.

Posted on: May 14, 2018 04:46PM

besa wrote:

https://www.medpagetoday.com/hematologyoncology/br...

Diabetes Risk Elevated in Breast Ca Survivors Treated with Hormone Tx

Dx 2007, IDC, 2cm, Stage IIA, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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May 15, 2018 09:14AM dtad wrote:

Wow! Add another side effect to the list!

Dx 3/20/2015, IDC, Left, 1cm, Stage IA, Grade 2, ER+/PR+, HER2- Dx 4/10/2015, ILC, 1cm, Stage IA, Grade 2, ER+/PR+, HER2- Surgery 5/21/2015 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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May 15, 2018 02:24PM Hopeful82014 wrote:

Yes, another side effect - but one that can probably be prevented, now that we know. It can also (usually) be successfully managed. Everyone makes their own decisions but I'd rather deal with the side effects of AIs than the side effects of recurrent or metastatic cancer.

Dx IDC
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May 15, 2018 09:53PM ruthbru wrote:

Below is the key paragraph I took out of the study. 'Key', for me, because lifestyle seems to be the biggest predictor of Type 2 diabetics, with or without hormonal therapy.

"Because women in the current analysis who developed diabetes were significantly more likely to be obese than those who did not (P<0.001), they may have already been predisposed to develop diabetes independent of any effect that hormonal therapy might have had on their diabetes risk, Shafaee explained. Women who developed diabetes in the study were also significantly less likely to engage in any physical activity than women who did not (P<0.001), and being active appears to be protective against the development of both breast cancer and diabetes in general."

"Invisible threads are the strongest ties." Friedrich Nietzsche Dx 2/2007, Stage IIA, Grade 3, 0/11 nodes, ER+/PR-, HER2-
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May 15, 2018 11:19PM Lula73 wrote:

“Following the diagnosis of diabetes, the same group of women were more likely to be obese, to consume an unhealthy diet, and to be physically inactive -- all risk factors for diabetes. "Our findings demonstrate that diabetes management in our cohort was clearly suboptimal, as diabetes cases led an unhealthy lifestyle, characterized by obesity, lack of exercise, and poor nutrition," Hamood said.

"Therefore, we believe that strategies should be targeted to the prevention of diabetes, which maximizes survival and minimizes the net health and economic burden of diabetes. A first step to realization of this goal is lifestyle modification targeting both dietary and physical activity behavior and by screening for diabetes.”

I’m not saying that diabetes is inevitable or that it can’t be prevented, however, i do think the reality is that for women taking Anti-hormonals diabetes is a possibility we need to watch for and odds are medication management will be required. Prevention of diabetes in this scenario as well as diet/exercise as a treatment is so much harder than in someone without BC. I’ve worked in diabetes care for 15 years and obesity care for 4. I see the struggles everyday and most of these individuals don’t have cancer on their plate too meaning they don’t have the same challenges as we do...we have the same ones they do + more

Overweight/obesity are the leading factors in the development of type 2 diabetes. If you weren’t overweight/obese before BC diagnosis, weight gain that potentially puts you into one of these two categories is likely. For those that were already in the overweight/obesity category, maintaining weight much less losing weight is likely going to be unlikely. What follows is why:

As already pointed out, those that were diagnosed with diabetes in the trial tended to be overweight/obese so no big surprise there. Some of the participants were already overweight/obese when they started, so without intervention on their weight it was likely just a matter of time regardless of anti-hormonal therapy.

Suppressing/removing estrogen from the body, recovery time from surgery for BC as well as fatigue and weakness from rads/chemo leading to inactivity, use of steroids in many chemo treatments, anti-depressants that are often needed, and “poor diet” are all factors that contribute to a diagnosis of diabetes.

We have no control over the severe and abrupt slow down of metabolism with therapies affecting estrogen. The side effects from cancer treatment do not lend themselves to being able to significantly increase your physical activity.

Activity is going to be limited by surgery and fatigue/weakness/pain from rads/chemo/anti-hormonals. We could try to push through but it puts us at risk of more acute medical issues/dangers (I.e. falls, total exhaustion, fainting, etc).

Steroids are a crucial component of many chemo regimens so no control there either

Without the anti-depressants we may not even make it out of bed except to grab the Ben & Jerry’s, Krispy Kremes/Dunkin Donuts, and cheesecake as we try to self medicate/self comfort or we may even go to further extremes which are classified as acute health risks.

The foods we eat are often dictated by what we can afford. And we all know the costs associated with treating cancer take a significant toll on our finances. No way I can afford to do all my shopping at Whole Foods buying only organic, and free of all the popular “bad things” of the day like gluten, eggs, dairy. Cost often leads us to purchasing foods that are more calorie dense especially when we’re having to stretch it to feed a family.

Aside from cost, many of us have aversions to certain foods and in some cases most foods due to the various treatments we’re receiving and PTSD from puking up whatever we last ate before a chemo or sometimes a rads session. We get our calories where we can. I personally lived on macaroni and cheese and pork roast with white gravy and biscuits with my first cancer go round. Nothing else was appealing. Most everything else was nauseating.

I’m not trying to make excuses. And I’m not trying to be a Debbie Downer either. Is anyone even surprised by the study findings considering? Until we find different treatments that aren’t as hard on our bodies yet have the same or better efficacy, we are going to be at risk for weight gain and because of the weight gain, at risk for diabetes.


-Lula Dx 1/2017, DCIS/IDC, Right, 1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 2/13/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 3/2/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/1/2017 Prophylactic ovary removal Hormonal Therapy 1/2/2018 Femara (letrozole)
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May 15, 2018 11:47PM Hopeful82014 wrote:

Lula, thanks for your insights drawn from your professional experiences. I am interested in this statement: "...the severe and abrupt slow down of metabolism with therapies affecting estrogen."

I did not have issues with my weight prior to breast cancer nor for about my first year+ on AIs. However, at this point I find it almost impossible to avoid weight gain except on the most restrictive diet, despite a very solid and consistent workout regimen. My oncologist claims to be puzzled by this and has defaulted to saying 'well, maybe you have a slow metabolism.' It makes sense that metabolism would be affected by loss of estrogen but it doesn't make sense to me that MOs would be so blase and oblivious to this issue. If they'd even acknowledge how hard this makes life it would be helpful!

Given that body fat generates estrogen this strikes me as a real issue in preventing recurrence.

Have you seen studies that address this issue, particularly dealing with normal weight women facing this on AIs?

Dx IDC
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May 16, 2018 02:08AM - edited May 16, 2018 02:10AM by Lula73

Hopeful- estrogen plays a role in regulating our metabolism. When estrogen declines/stops the androgens become the dominant hormone. Androgen stimulates fat storage in the abdomen and breasts while the lack of estrogen causes the overall metabolic rate and caloric burn rate during physical activity to slow. 2 ways we can help combat this is to work on building more lean muscle (muscle burns more calories than fat while at rest and during exercise) and when we engage in exercise like walking/jogging to make sure we're doing it at a moderate to high intensity.

In my experience MOs are blasé about it because there's no alternative treatment that doesn't have the same result. And it's not happening to them. And he has other, more needy patients waiting so he can't spare the time to talk about weight gain from an AI as it's trivial.

So the fat-estrogen connection... Ovaries produce ~80% if our estrogen. The adrenal glands in combination with fat produce the other ~20% through abpricess known as aromatization. once we hit menopause our ovaries stop producing estrogen. So 80% of our estrogen is gone and the 20% from the adrenal process now becomes our new “normal" 100%. The aromatase inhibitor therapy inhibits the aromatase enzyme that's required for the androgens (which are released from the adrenal glands) to be converted to estrogen by our fat cells. It should be noted that unless you're anorexic you have fat - there's a layer between your skin and muscle structure called subcutaneous fat and then theres the fat that surrounds and cushions our organs underneath the muscle called visceral fat. Some of us just have more of it than others. Once you've inhibited the aromatase enzyme from doing its thing, the fat can't work to turn the androgens to estrogen so no estrogen is being stored or produced in the fat at this point. That is how the AIs work to help prevent recurrence. Here's a link to another thread where I've described it in more detail as it relates to % of ER+ results (it’s the first post on page 4)

https://community.breastcancer.org/forum/78/topics/864060?page=4#post_5206774

I hope this helps!


-Lula Dx 1/2017, DCIS/IDC, Right, 1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 2/13/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 3/2/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/1/2017 Prophylactic ovary removal Hormonal Therapy 1/2/2018 Femara (letrozole)
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May 16, 2018 01:38PM Hopeful82014 wrote:

Lula - thank you. I understood much of the above already but didn't get at all the effect of androgen on fat storage, which really helps make sense of the physical changes I see in my body after a few years on letrozole (and hate). Of course, if loss of estrogen has a known effect on metabolism, WHY is post/peri-menopausal weight gain (with or w/out AIs) generally shrugged off as due to women slowing down (I wish!) or simply "age" when there is a known physiological reason for it? Wouldn't it be more helpful to help women understand more clearly the forces at work in their bodies? Wouldn't it be more helpful if "survivorship" advice was tailored to the specific needs of those of us on endocrine therapy?

I know MOs are busy and, as you said, it's NOT happening to their bodies but this isn't just an issue of vanity. It's a health issue and I feel that we are OWED a lot more cogent information, advice and support than we're getting. If our MOs can't do it, we need resources who can. (Yeah, I know, not likely to happen but one can dream, right?)

In the meantime, I guess I'll be spending more time jogging (not walking) and swinging the kettlebells. ;)

Again, thanks for helping put a couple of critical pieces of the puzzle in place!

Sorry for side-tracking the thread.

Dx IDC

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