WEIGHT LOSS IN OBESE BREAST CANCER SURVIVORS

肥胖已被证明与乳腺癌患者的不良预后有关。肥胖程度越高，生存时间越短，复发率越高。减肥是否能对肥胖乳腺癌幸存者的预后产生有利影响尚不清楚，这是我们想要问的最终问题。作为第一步，需要在这一人群中建立有效的减肥方法。我们用内部资金开始了一项试点研究，为肥胖的乳腺癌幸存者制定了一种个性化的减肥方法，初步数据令人鼓舞。我们希望能够将这项研究延长整整18个月，并分析正在收集的血液样本，以寻找癌症风险的标志。48名肥胖的癌症幸存者已经登记在册。在基线时，对每个妇女进行精神评估，并进行关于饮食、健康、锻炼和心理社会因素的问卷调查。由于我们要求女性做出重大的生活方式改变，我们希望将干预延长一整年(而不是6个月)，并增加6个月的跟踪点来检查减肥的维持情况。更好地理解行为因素对减肥的影响应该有助于我们设计一项以复发为终点的成功的更大规模的研究。作为第二个目标，我们建议分析采集的血液样本中预计会受到减肥影响的癌症风险标记物：氧化DNA损伤、胰岛素样生长因子1(IGF-1)和IGF结合蛋白3。这些标记物的变化程度将与其他已知的受减肥影响的血浆指标：瘦素、血糖、血脂和甘油三酯水平进行比较。这项研究应该有助于确定某些心理社会因素与体重减轻的程度有关，进而确定体重减轻是否与乳腺癌风险的选定标记物的变化有关。

Obesity has been shown to be associated with a poor prognosis in breast cancer patients. Survival time is decreased and recurrence rates are increased with greater obesity. Whether or not weight loss can have favorable effects on prognosis in obese breast cancer survivors is not known, and that is the ultimate question we would like to ask. As a first step, effective methods for weight loss need to be established in this population. We started a pilot study with internal funds develop an individualized approach towards weight loss in obese breast cancer survivors, and preliminary data is encouraging. We would like to be able to extend this study for a full 18 months and analyze the blood samples that are being collected for markers of cancer risk. Forty eight obese cancer survivors have been enrolled. At baseline, a psychiatric evaluation was obtained for each women and questionnaires on diet, health, exercise and psychosocial factors were administered. Since we are asking women to make large lifestyle changes, we would like to extend the intervention for a full year (instead of 6 months) and add a 6-month follow-up point to examine maintenance of weight loss. A better understanding of the influence of behavioral factors on weight loss should help us design a successful larger study with recurrence as the endpoint. As a secondary aim, we propose to analyze the blood samples collected for markers of cancer risk which are expected to be affected by weight loss: oxidative DNA damage, insulin-like growth factor 1 (IGF-1), and IGF-binding protein 3. The extent of changes in these markers will be compared with other plasma measures that are known to be affected by weight loss: leptin, glucose, lipids and triglyceride levels. This study should be useful to determine certain psychosocial are associated with extent of weight loss, and in turn whether weight loss is associated with changes in selected markers of breast cancer risk.