Impact of caloric restriction and adapted physical activity in preoperative breast cancer patients

BACKGROUND: Breast cancer (BC) is the second most common cancer worldwide and the most common malignancy in women. Breast cancer patients account for as much as 36% of oncological patients. 1 in 8 women is likely to become ill. In the last twenty years, the concept of nutritional support as part of a comprehensive cancer management program has gained increasing interest. RATIONALE OF THE STUDY: This thesis aims to understand whether significantly reducing risk factors after the discovery of breast cancer can still bring back an unfavorable microenvironment to the development of the tumor and metabolic benefits in oncological patients. In literature, there are still no studies analyzing tumor biology changes in cancer patients who have not been treated yet. AIM OF THE STUDY: The present study primarily aims to evaluate the efficacy of caloric restriction and adapted physical activity on reducing cancer aggressiveness and blocking its growth, which are concerns measurable through radiological imaging and histological examination. Secondarily, there is the evaluation of metabolic risk class reduction and patients’ perception of their wellness and quality of life. METHODS: Patients submit to a caloric restriction diet and an adapted physical activity program in the 40-60 days between the diagnosis of breast cancer and the surgery to remove the tumoral mass. Included patients had a unifocal invasive tumor lesion of the breast <= 30mm found at screening and confirmed by MRI and fine needle aspiration. The food plan adopted is based on a slightly hypocaloric dietetic scheme, without any intake of animal-derived fats and proteins or simple sugar. RESULTS: Anthropometric parameters differ between time T0 and T1; a positive balance of body composition has been observed, with » 2% body fat decrease (P value <0,05), and body water showing » 2% increase (P value <0,05). We observed a consistent difference between waist circumference at T0 and at T1 (-5,67 cm, P value of 0,05) and a mean blood pressure decrease of around 7 mmHg for both systolic and diastolic values (P value <0.,05). At T1, some patients exhibited a reduction of metabolic risk class (Chi Squared test 23,017 and P value <0,01). The difference in BMI and weight is also clearly observable with a mean 4,6 kg weight loss for our patients (P value <0,05). All these parameters have an influence on quality of life of the patients who declare to feel a state of wellness compared to baseline. Regarding tumor aggressiveness in terms of its biology, the lifestyle adopted by patients following our indications has an impact on tumor grade, which remains stable in term of grading from the diet start until surgery and shows a mild decrease of Ki67 proliferation index (P value <0,05). Whereas measurements of tumoral lesion dimension with MRI found a mean decrease of » 3 mm from T0 to T1, but this difference was not statistically significant. CONCLUSIONS: The proposed scheme of caloric restriction and adapted physical activity has a modulatory effect on the tumoral mass, slowing down its biological aggressiveness and preventing it from growing during the testing window of 40-60 days between diagnosis and surgery. Moreover, metabolic transformation measured at T1 is beneficial as well. Preliminary valid results are already visible, prosecution of this study is therefore essential to establish a definitive impact of caloric restriction as a coadjuvant option to current therapies for breast cancer