her2s are different again--her2positivity is INVERSELY correlated with BMI

[Lani]

ie, the more you weigh the less likely you are to be her2+

Just shows one not to necessarily draw conclusions from data on ALL BREAST CANCERS or ER- breast cancers as a group and apply it to her2s

1: Breast Cancer Res Treat. 2007 Jan 9; [Epub ahead of print]
Body mass index and HER-2 overexpression in breast cancer patients over 50 years of age.

Van Mieghem T,
Leunen K,
Pochet N,
De Moor B,
De Smet F,
Amant F,
Berteloot P,
Timmerman D,
Vanden Bempt I,
Drijkoningen R,
Wildiers H,
Paridaens R,
Smeets A,
Hendrickx W,
Van Limbergen E,
Christiaens MR,
Vergote I,
Neven P.
Department of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
PURPOSE: In breast cancer, in vitro as well as in vivo experiments have shown an inverse relationship between HER-2 and steroid hormone receptors. It is unknown whether circulating estrogens affect HER-2 expression. We hypothesize that the postmenopausal body mass index (BMI) as a surrogate marker for bio-available estrogens, is inversely associated with HER-2 over-expression. PATIENTS AND METHODS: A total of 535 women over age 50 or with known postmenopausal status, with a unilateral, not previously treated, operable breast cancer were evaluated the evening prior to surgery for body weight, height, abdominal and hip circumference over a 3 years period. Waist-to-hip ratio (WHR) and BMI were calculated. HER-2, estrogen receptor and progesterone receptor staining was done by immunohistochemistry. All tumours with DAKO 2+ staining were submitted for HER-2 detection by FISH analysis. HER-2 was defined as positive if DAKO 3+ or FISH positive. We assessed the frequency of HER-2 positivity in each of 6 quantiles for all parameters of body composition and tested for a trend in HER-2 expression across the 6 quantiles. Furthermore, we investigated whether BMI contributed, together with other known predictors for HER-2, in a standard multivariate logistic regression model that predicts HER-2 over-expression. RESULTS: There is a decrease in HER-2 over-expression per increasing quantile of BMI. In a multivariate model-including both steroid receptors-BMI remains an independent predictor for HER-2 over-expression. CONCLUSION: In women over age 50 or with known postmenopausal status with an operable breast cancer, there is an inverse association between BMI and HER-2 over-expression.

[Hopeful]

Why should couch potatoes get an indolent, lazy cancer, and the ones who strive to keep in shape get this "over-achieving" variety? That's just so wrong.

Hopeful

[Leslie's sister]

Yeah, I was thinking the same thing. Not fair. My sister is her2+++ and has a very low BMI. She is 5'4" and around 108.

[karen raines hunt]

I had noticed over the past 2 years that many women I had met that were her 2 + tended to be lean. Weird. I read a Danish report about tall teens (5'7" or over at age 15) being at a higher risk for bc (not just Her 2+) as adults. Based on my observations, when my neighbor was diagnosed with bc last year, I predicted she would be Her 2+ and she was.

Karen

[Margerie]

Well, I am chubby and Her2 3+++ (not lazy though!) I was also premenopausal. I have 2 friends about the same age, with aggressive node+, er+ disease, as chubby as me, but both are her2-.

Maybe I am a thin woman trapped in a rubenesque bod!

[Linda]

I'm lean, too, as is the only other woman I know who is Her+. In fact, about six months before dx, I was told by a fitness trainer, "women who are built like you never get breast cancer." Oh, REALLY? Needess, to say, I've made sure she never tells that to anyone again.
L

[BethSh]

I weighed about 120 at dx and have a friend about the same size, both positive.

Beth

[KellyA]

I was pretty slender at diagnosis (115) and ate a very lowfat diet. With all of the new study results about eating a lowfat diet, I am frustrated. I don't know how much lower I can go than where I was before. My good friend who was diagnosed within a few days of me is about 5'10" and VERY slim and athletic and she is Her 2+ as well. Go figure-

Love, Kelly

[Hopeful]

Well, if the theory that environmental estrogens are to blame has credence, perhaps they get more concentrated in the tissues of women with lower BMI's, and that has something to do with it? I have no idea, really, this is just thinking out loud.

Hopeful

[janet/FL]

I had just lost 35 pounds at time of diagnois from Atkins diet. I wonder if I would not have been Her2+++ if I hadn't lost weight? It was over a two year time period.

[AlaskaAngel]

I had just lost 25 pounds over the year prior to dx too, and was exactly at proper weight for height.

My guess about the question of low fat diet is it depends on what type and balance of fats, and whether organic or not...

And another HER2 I know who is 10 years younger than I am was also at proper weight for height when she was dx'd as HER2.

(Watch out lasagne, here I come!)

[Bev]

The article makes me feel better, sort of. I was tired of always hearing a high BMI was correlated with BC when no one I knew had a high BMI.

Karen, I read something similiar about being tall. I think what I saw said the risk was higher if one grew more than an inch after age 13 and was taller than 5'-4" or so.

[Becky]

Well, I was overweight but not grossly so. I am now in my normal weight range but I am also ER+ but PR neg.


I think, especially for those who are hormone negative for both receptors, if one is thin, there is less circulating estrogen (or at least normal levels) and every cancer needs a go button so the Her2 receptor stays on (it is theorized that precancer and DCIS is all Her2+ but that it mutates and changes when it becomes invasive. So, it you think about it that way, if you have a lot of body fat (and hence excessive amounts of circulating estrogen, why wouldn't a cancer want to be hormone positive - lots of go, go, go there).

Secondly, (as Hopeful was eluding), in a thin woman, there is less "space" so toxins can build up to more critical levels than in a larger woman exposed to the exact same things.

Lastly, there was a study on height vs bc risk. Theory in that study said that taller women were more prone because of their intense growth spurt. Growth (ie: cell reproduction) causes cell mistakes on its own accord - therefore the taller you are the more chance that the first of many ensueing mistakes occurred earlier in your life.

We'll get there one day.

[Hopeful]

Becky,

How about the recent stats that say the low fat diet benefits hormone negatives more than positives? You had some interesting comments on that in a recent thread.

Endocrinology is a fascinating discipline, and I agree with remarks made in another thread that it is high time to add an endo to our bc "team" of medical experts. I think this is the area that will produce most of the refinement in selecting treatments to match the specific bc.

Hopeful

[Becky]

The big thing with the WINS (lowfat diet) trial is (as with any lifestyle trial), what were the other variables involved – especially with the women who were randomized to the lowfat arm. I know when I was diagnosed and got my “change your lifestyle” wakeup call, I changed my diet similarly (lowfat, lots of veggies and fruit, whole grains, less meat). Then I got very inspired and started to walk and do exercise tapes. Is that what these women did too? Does one get inspired to get into shape more when something is working (there was an average 10 lb weight loss – the researcher says this isn’t much but then you look at it and say that an average means half lost less and half lost more). Secondly, if you are already kind of following a diet like this prior to getting on this arm and are already lean or at normal weight, you would not lose as much. (For example, since diagnosis, I have lost 35 lbs. I would really, really like to lose another 10 but I have been at a plateau for awhile. All of us know that happens) and you may already be benefitting from the dietary arm . So, lets say many of these women who had to lose weight are on this arm. They follow it diligently, they begin to lose weight (and you WOULD lose weight). They feel good. Everybody is telling them how good they look. They feel better and less tired and good enough to start taking a daily walk (as this is what I did – I lost about 22 lbs with modifying my diet but after chemo, when my strength came back, I started to walk and lost another 13 lbs just by doing this (about 6-7 hrs per week). What kinds of fat were they coached to include versus to eliminate (remember that Mamacze asked how 20g per day of fat could truly be realized consistently – the answer is vegan). So, in my mind, is it low fat or calorie restriction and exercise? The exercise trial says a hormone negative woman can reduce recurrence by 44% by exercising (moderate to brisk walking) 5-7 hours per week or 3-4 hours per week of jogging (they used MET methods – Metabolic Equivalent Time). Calorie restriction (although not tested or trialed for bc or any other cancer) is known to extent life and reduce disease so…. Add the 2 together and you might be able to make an argument of synergy between the exercise trial (44%) plus calorie restriction to come up with the 66% benefit in the WINS trial (all this is my assumption). Then this would further solidify some thoughts on the insulin, metabolic syndrome, insulin growth factor theories. These are just some of my thoughts.



I agree on endocrinology and I want to start up the chat room again but need to poll on another day as I haven’t started up again because Sunday nights are bad for me. I owe a chat or teleconference on this as AlaskaAngel is very interested in this as well. Insulin, the action of the adrenals, thyroid and of course ovaries are all abetting one another I am sure. Hope this fits on one post. Cheers.

[Adriana Mangus]

Hi Becky: I was 38 when first dx. I was at my lowest ever, 125lbs. 5'3. I belonged to Jazzercise for many years, and that did not prevent my dx. Before that I used to run and have always eaten healthy foods, I did never get sick in the winter time, never had a flu, -until about 2 years ago. Healthy- healthy.

I'm not sure if any studies have been done to connect weight with BC, but I'm skeptical, I believe BC is associated with your family history, genes, etc.

I think I mentioned this before in another posting about a friend of mine, who passed away at the age of 49, she was perfect as far as height and weight, vegetarian since 18 yrs old, dx when she was 47, did ok at the beginning with lumpectomy+chemo+radiation, less than 3 years later she had mets to bone,liver and lungs. Unfortunately it was too much for her frail body to take. I still miss her, she was also my daughter's best friend Mom. Thanks for your input to this site, I really appreciate all the knowledge you share with us.

[R.B.]

My constant cry is that from what I read type of fat is another very important factor.

It is a complex subject.

This is an article that gives an insight into the generalities of how important fats are to body function.

http://www.benbest.com/health/essfat.html

Historically prior to farming / industrialisation fats were a scarce resource in diet.

So for those who think there is some sense in the idea that we have by evolution or design functioned best on what nature provided it is likely a case of BOTH

Balance

And

Limited intake.

Lack of balance which might include lack of omega three, imbalance in threes and sixes, reliance of processed or trans fats etc could from what I read increase risk factors for a range of medical conditions.

Lack of balance plus trans fats etc might be a factor for some of those on low fat diets.

Trans fats (also mineral deficieny, sugar intake,....) are reported as impedeing the ability of the body to convert the mother omega three and six to the long chain derivatives which are so essential to health eg DHA and EPA.

I cannot give definative answers as large enough trials based on hard evidence eg fat levels in the body rather than what you are meant to have ate and BC have not been done. I am also not a professional just somebody who has developed an interest read quite a lot on the subject.

I am afraid you will have to do a little reading yourself, talk to your advisors and come to your own conclusions.

RB