Cancer Prevention and Management through Exercise and Weight Control (Nutrition and Disease Prevention)

607 Pages·2005·4.49 MB·English

by  Anne McTiernan

Cancer Prevention
and Management
through Exercise
and Weight Control
DK5814_NDPseries 9/22/05 12:16 PM Page 1
NUTRITION AND DISEASE PREVENTION
Editorial Advisory Board
CAROLYN D. BERDANIER, PH.D.
University of Georgia, Athens, Georgia, U.S.A.
FRANK GREENWAY, M.D.
Pennington Biomedical Research Center, Louisiana State University,
Baton Rouge, Louisiana, U.S.A.
KHURSHEED N. JEEJEEBHOY, M.D.
University of Toronto Medical School, Toronto, Canada
MULCHAND S. PATEL, PH.D.
The University at Buffalo, The State University of New York,
Buffalo, New York, U.S.A.
KATHLEEN M. RASMUSSEN, PH.D.
Cornell University, Ithaca, New York, U.S.A.
Published Titles
Genomics and Proteomics in Nutrition
Carolyn D. Berdanier, Ph.D., Professor Emerita, University of Georgia, Athens,
Watkinsville, Georgia
Naima Moustaid-Moussa, Ph.D., University of Tennessee, Knoxville, Tennessee
Perinatal Nutrition: Optimizing Infant Health and Development
Jatinder Bhatia, M.B.B.S., Medical College of Georgia, Augusta, Georgia
Soy in Health and Disease Prevention
Michihiro Sugano, Ph.D., Professor Emeritus at Kyushu University, Japan
Nutrition and Cancer Prevention
Atif B. Awad, Ph.D., Department of Exercise and Nutrition Science, State University
of New York, Buffalo, New York
Peter G. Bradford, Ph.D., Department of Pharmacology and Toxicology,
School of Medicine and Biomedical Science, State University of New York,
Buffalo, New York
Cancer Prevention and Management through Exercise and Weight Control
Anne McTiernan, Fred Hutchinson Cancer Research Center, Seattle, Washington
Cancer Prevention
and Management
through Exercise
and Weight Control
A N N E M T I E R N A N
Edited by C
Boca Raton London New York
A CRC title, part of the Taylor & Francis imprint, a member of the
Taylor & Francis Group, the academic division of T&F Informa plc.
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International Standard Book Number-10: 1-57444-907-9 (Hardcover)
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Library of Congress Cataloging-in-Publication Data
Cancer prevention and management through exercise and weight control / edited by Anne McTiernan.
p. cm. – (Nutrition and disease prevention 5)
Includes bibliographical references and index.
ISBN 1-57444-907-9 (alk. paper)
1. Cancer – Nutritional aspects. 2. Obesity – Complications. 3. Cancer – Prevention. 4. Cancer –
Exercise therapy. 5. Weight loss. I. McTiernan, Anne. II. Series.
RC268.45.C362 2005
616.99’405—dc22 2005048618
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Foreword
Homo sapiens survived the rigors of the African savannah and migrated to the rest of the globe
because of the capacity and the need to move. We evolved as a nomadic species that lived by
cunning and mobility, not by specialized skills and tools of the predator (no slicing teeth, no slashing
claws) or by the herd behavior and acceleration of the herbivore. Movement, to gather and hunt
through the day and to spread far and wide over longer time scales, has helped define who and
what we are.
Even when we abandoned our gatherer–hunter lifestyle for the settled agricultural life, we
moved — to plant, to weed, to reap, to protect the crops, to defend the village. The industrial
laborer and the miner, like the agricultural laborer, earned their bread by the sweat of their brows.
Only in the last hundred years has a significant proportion of humanity — and it is a greater
proportion every day — ceased to move to earn a wage.
There is a price to pay: with lack of physical activity comes obesity, particularly when accom-
panied by a remarkable abundance of food and the insatiable desire of the food manufacturers to
push ever increasing consumption. With obesity come the diseases that we used to think of as the
diseases of affluence. However, these increasingly afflict the urban poor in the developed and
developing world; they are better thought of as the diseases of inertia.
Mostly we think of cardiovascular disease and diabetes in this context, but it is increasingly
clear that cancer is also a disease of inertia. In this book, a broadly multidisciplinary group presents
the evidence and provides the recommendations.
The antidote to diseases of inertia is movement — let’s move!
John Potter, M.D., Ph.D.
Dr. Potter is senior vice president and director of the Division of Public Health Sciences, Fred
Hutchinson Cancer Research Center, Seattle, Washington, and professor of epidemiology, Univer-
sity of Washington. He is internationally known for his work on the role of diet and nutrition in
cancer and served as chair of the World Cancer Research Fund committee that produced the 1997
report, Food, Nutrition and the Prevention of Cancer: A Global Perspective. He is author or coauthor
of more that 350 scientific papers and book chapters. He is co-editor-in-chief of Cancer Epidemi-
ology, Biomarkers and Prevention and is currently U.S. representative and chair of the Science
Council, International Agency for Research on Cancer, Lyon, France. He serves on the U.S. National
Cancer Institute’s Board of Scientific Advisors and is a member of the U.S. National Cancer Policy
Board, Institute of Medicine, National Academy of Sciences.

Preface
Many clinicians, researchers, and lay public associate an expanding waistline and a couch-potato
lifestyle with increased tendency to develop cardiovascular disease and some of its risk factors
(diabetes, hypertension, hypercholesterolemia). These lifestyle factors, however, also play into the
etiology and prognosis of several types of cancers, which is important in the clinical and public
health areas. It is important to public health because cancer is a common disease (one in two men
and one in three women will develop cancer in their lifetime) and overweight or obesity and
sedentary behavior are extremely common and becoming more so (two thirds of American adults
are overweight or obese, and three quarters do not meet the minimal recommendations for 30
minutes of aerobic activity per day). It is important to medicine because a marked increase in a
consistent risk factor will mean an increase in number of cancer cases unless some other widespread
prevention factor negates this effect.
In addition, the implications for poorer prognosis in affected individuals means that treating
oncologists and other health care providers will need to develop new and better therapies to deal
with the declining prognosis in this large segment of the population. Clinicians should be aware
that, because two thirds of the American population is overweight or obese and being overweight
increases risk for cancer, the vast majority of cancers in the future will occur in overweight and
obese individuals.
The association between obesity and a sedentary lifestyle with risk for cancer has been appre-
ciated for several decades. Only in the past 10 years or so, however, has the strength and consistency
of this association been apparent. This is largely due to two things: (1) the increase in prevalence
in overweight, obesity, and sedentary lifestyles; and (2) an increase in the number of epidemiological
studies focusing on these associations.
The American Cancer Society estimates that a third of all cancer deaths could be prevented
through avoidance of obesity and sedentary lifestyles. The World Health Organization’s Interna-
tional Agency for Research on Cancer estimates that 25 to 30% of several cancers could be prevented
if individuals avoided lifetime weight gain and obesity and participated in regular physical activity.
These same organizations and several clinical groups are now recognizing the important role that
physical activity can play in improving quality of life in cancer patients and survivors. This area
is new, so there is great need for a definitive textbook that provides the scientific background and
evidence supporting these relationships, as well as clinical guidelines for bringing physical activity
and weight control into cancer prevention and treatment practices throughout the world.
We are very fortunate to have a world-class roster of authors for this text. The chapter authors
have been chosen because they are the top researchers in the field of obesity, physical activity, and
cancer.
Section I focuses on the research methods used in assessing the associations between physical
activity, energy balance, and cancer risk and prognosis. Observational epidemiological studies can
provide important information about relationships among these variables. More definitive evidence
of the effect of changing behaviors, with resulting change in level of adiposity and amount of
energy expended, is provided through randomized clinical trials. Dr. Prentice, principal investigator
of the Women’s Health Initiative Clinical Coordinating Center and a world expert on nutrition and
cancer describes the benefits and drawbacks of each of these study design methods.
The measurement of energy balance and physical activity are far from straightforward. Energy
balance involves the interplay among energy intake, energy expenditure, and metabolic rate.
Genetic, age, and gender factors also play an important role. Defining what exactly energy balance
is and what aspects of excessive adiposity are most pertinent to cancer and determining how much
physical activity a person is actually doing are all great challenges requiring the concerted input
of measurement experts. Drs. Ainsworth and Coleman present the intricacies of exercise and
physical activity measurement, and Dr. Irwin describes the pluses and minuses of the many ways
of assessing body composition.
The role of physical activity in the incidence of individual cancers is the focus of Section II.
In a comprehensive literature review, Drs. Patel and Bernstein write about the intriguing data
pointing to a role of exercise and physical activity in reducing risk for breast cancer. They compare
and contrast the types of epidemiological studies and the role of exercise and physical activity in
premenopausal and postmenopausal breast cancer. The many studies on exercise, physical activity,
and colon cancer are reviewed by Dr. Slattery, who summarizes how exercise plays a role in colon
cancer etiology. She also reviews the evidence regarding the association between physical activity
and rectal cancer occurrence. Dr. Friedenreich elegantly summarizes the state of knowledge on the
associations between exercise and prostate cancer risk, pointing out why the associations are not
yet firm and suggesting future research pathways.
Section III focuses on mechanisms that may explain the inverse association between physical
activity and incidence of several cancers. Dr. McTiernan reviews the effect of exercise on sex
hormones, which has relevance for several hormone-related cancers such as breast, endometrium,
and prostate. Dr. Frank reviews the role of exercise in reducing insulin resistance and hyperin-
sulinemia; insulin has been shown to promote tumor cells in vitro, and persons with high insulin
levels have increased risk for some cancers and reduced prognosis once diagnosed with breast
cancer. Ms. Wetmore and Dr. Ulrich review the literature on the complicated associations between
physical activity and several markers of immune function, especially ones that may be relevant to
cancer occurrence or prognosis. Dr. Martínez describes the effect of exercise on prostaglandins,
which may in part explain the consistent findings of reduced colon cancer risk among active,
compared with sedentary, persons. Drs. Thompson, Jiang, and Zhu describe the animal model
research that has defined the role of excess adiposity and of energy restriction on tumorogenesis.
The current state of human intervention studies on physical activity and cancer biomarkers is
presented by Dr. McTiernan. Dr. Rankinen reviews the intriguing new field of genetics, physical
activity, and cancer, which may help to define persons who may be helped with activity in terms
of cancer risk.
Section IV focuses on the breadth and depth of knowledge on the effect of overweight and
obesity on cancer incidence. Dr. Ballard-Barbash presents the state of knowledge regarding the
effects of weight, adiposity, lifetime weight change, and risk of breast cancer in premenopausal
and postmenopausal women. Drs. Kaaks and Lukanova present similar information for the effect
of increasing adiposity on the development of endometrial cancer. Drs. Michaud and Giovannucci
present the emerging data linking increased adiposity with increased risk for pancreatic cancer.
The new and increasing body of knowledge regarding the effect of obesity on esophageal cancer
is presented by Drs. Hoyo and Gammon. Dr. Slattery reviews the role of overweight and obesity
in the etiology of colon cancer.
Section V reviews the mechanisms that might explain the association between adiposity and
incidence of several cancers. Drs. Kaaks and McTiernan describe the role of adipose tissue in the
production and metabolism of sex hormones, which is important for several hormone-related cancers
such as breast, endometrium, and prostate cancers. Dr. Blackburn presents the state of knowledge
regarding obesity and insulin resistance, taking from the extensive depth of information available
from diabetic research results. Drs. Priest and Church present data on the effect of adiposity on
cytokines and inflammatory markers that may have particular relevance for cancer. The important
role of animal studies in shedding light on the effect of exercise on biology related to cancer
formation is described in depth by Dr. Colbert. Drs. Tworoger and McGrath present the emerging
body of literature on the genetics of obesity as it pertains to cancer incidence.
Section VI concentrates on the importance of physical activity on aspects of quality of life and
prognosis for many cancer patients. Dr. Winters-Stone describes the studies that have examined
the effect of exercise and physical activity on fatigue in breast cancer patients and survivors. Dr.
Courneya, Ms. Campbell, Ms. Karvinen, and Ms. Ladha describe studies that have explored the
effect of exercise on quality of life in colon and other cancer patients. Drs. Abrahamson and
Gammon describe the emerging information on the role of physical activity in cancer prognosis
and suggest biological mechanisms that might explain the association.
Section VII presents information on the role of overweight and obesity on prognosis of several
cancers. Dr. Goodwin reviews the many studies that have examined the effect of adiposity on breast
cancer recurrence and survival and presents suggested mechanisms for such relationships. Dr. Rock
presents results of recent studies pointing to a role of adiposity on survival and recurrence in patients
with colon, prostate, and other cancers.
The final section, Section VIII, gives the reader clues to how the information presented in the
rest of the book might be implemented at the individual, clinical, and public health levels. Dr.
Fogelholm writes on the use of exercise and physical activity in weight control at the individual
level. Dr. Heber and Ms. Bowerman provide information on dietary and other methods of energy
balance for overweight and obese persons. Dr. Bull describes population-level initiatives to increase
physical activity in population settings. Dr. Pronk provides insight into disseminating exercise and
diet interventions into the primary care setting. Drs. Schwartz and Winters-Stone provide advice
on initiating and maintaining increased exercise and physical activity in cancer patients and survi-
vors. Finally, Drs. Chlebowski, Geller, Harvie and Howell provide guidance on incorporating
exercise and diet recommendations into clinical oncology practice.
We hope that this volume provides a comprehensive review of the roles of energy balance,
physical activity, and cancer incidence and prognosis. The epidemic of overweight and obesity and
the increasing prevalence of sedentary lifestyles will have an impact on the magnitude and quality
of the cancer problem around the globe. Viewed differently, knowing that energy balance is so
important to the risk and prognosis from cancer may be an important incentive for the general
public, persons at high risk, and cancer patients and survivors to increase physical activity, reduce
excess weight, and maintain energy balance lifelong.
Anne McTiernan, M.D., Ph.D.
Fred Hutchinson Cancer Research Center
Seattle, Washington