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Physical activity (PA) has an established role in the promotion of health and fitness and the prevention of disease. Expected overall benefits include reduction of all-cause morbidity and death, weight control, improved quality of life, improved bone health and decreased falls of elderly subjects, , deeper cognition, and reduced risk of depression, anxiety, and sleeplessness. Currently, PA is a mainstay in the management of cardiovascular diseases, metabolic syndrome, diabetes, and bone health. Recently, the perception of its role in primary and secondary prevention, interception, and treatment of cancer, however, is also gaining importance. Regular walking, the simplest type of PA, is associated with reduced all-cause and cardiovascular disease mortality, and a role in cancer prevention is of increasing interest. Furthermore, PA improves the quality of life of cancer patients, attenuating side effects of chemotherapy, decreasing sarcopenia, increasing fitness, and inhibiting the recurrence and progression of some cancer types. It promotes emotional and psychological benefits in patients, inducing positive changes. While mechanisms, effective levels and useful amount of PA practice are well established in cardiology, they are yet to be fully determined in oncology. Nevertheless, PA is recommended to reduce cancer risk in the general population, and it has been introduced in programs for the prevention of second cancers. In perspective, it will help as integrative therapy in cancer patients and for cancer survivors. The number of beneficial effects in the cancer continuum is highlighted in this review.
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Epidemiological studies demonstrate the key role of cancer prevention in reducing global cancer mortality. However, within Europe there are persisting important disparities in incidence and cancer-related mortality. The future strategy of cancer prevention will aim at reducing these disparities through abolition of tobacco educational campaigns to a correct diet and lifestyle through primary prevention, increasing screening (secondary prevention). We also consider focusing on genetics and precision oncology to identify high-risk individuals, and on tertiary prevention to reduce second cancer risk. The application of these approaches could reduce cancer mortality by 35% and increase cancer survival to 70% in 2070. Tobacco control and abolition remain key measures across Europe.
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Segunda Neoplasia Primária , Neoplasias , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/prevenção & controle , Medicina de Precisão , Dieta , Estilo de Vida , Europa (Continente)/epidemiologiaRESUMO
BACKGROUND: Strategies for breast cancer prevention in women with germline BRCA1/2 mutations are limited. We previously showed that recombinant human chorionic gonadotropin (r-hCG) induces mammary gland differentiation and inhibits mammary tumorigenesis in rats. The present study investigated hCG-induced signaling pathways in the breast of young nulliparous women carrying germline BRCA1/2 mutations. METHODS: We performed RNA-sequencing on breast tissues from 25 BRCA1/2 mutation carriers who received r-hCG treatment for 3 months in a phase II clinical trial, we analyzed the biological processes, reactome pathways, canonical pathways, and upstream regulators associated with genes differentially expressed after r-hCG treatment, and validated genes of interest. RESULTS: We observed that r-hCG induces remarkable transcriptomic changes in the breast of BRCA1/2 carriers, especially in genes related to cell development, cell differentiation, cell cycle, apoptosis, DNA repair, chromatin remodeling, and G protein-coupled receptor signaling. We revealed that r-hCG inhibits Wnt/ß-catenin signaling, MYC, HMGA1 , and HOTAIR , whereas activates TGFB/TGFBR-SMAD2/3/4, BRCA1, TP53, and upregulates BRCA1 protein. CONCLUSION: Our data suggest that the use of r-hCG at young age may reduce the risk of breast cancer in BRCA1/2 carriers by inhibiting pathways associated with stem/progenitor cell maintenance and neoplastic transformation, whereas activating genes crucial for breast epithelial differentiation and lineage commitment, and DNA repair.
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Neoplasias da Mama , Mama , Humanos , Feminino , Ratos , Animais , Gonadotropina Coriônica/genética , Gonadotropina Coriônica/farmacologia , Neoplasias da Mama/genética , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/metabolismo , Proteína BRCA1/genética , Proteína BRCA1/metabolismo , Transformação Celular Neoplásica/genética , Mutação , Transdução de SinaisRESUMO
Preventive, predictive, and personalized medicine (PPPM) has created a wealth of new opportunities but added also new complexities and challenges. The European Cancer Prevention Organization already embraced unanimously molecular biology for primary and secondary prevention. The rapidly exploding genomic language and complexity of methods face oncologists with exponentially growing knowledge they need to assess and apply. Tissue specimen quality becomes one major concern. Some new innovative medicines cost beyond any reasonable threshold of financial support from patients, health care providers, and governments and risk sustainability for the health care system. In this review, we evaluate the path for genomic guidance to become the standard for diagnostics in cancer care and formulate potential solutions to simplify its implementation. Basically, introduction of molecular biology to guide therapeutic decisions can be facilitated through supporting the oncologist, the pathologist, the molecular laboratory, and the interventionist. Oncologists need to know the exact indication, utility, and limitations of each genomic service. Minimal requirements on the label must be addressed by the service provider. The interventionist is there to bring the most optimal tissue sample to pathology where the tissue is expanded to a variety of appropriate liquid-based samples. The large body of results then should be translated into meaningful clinical guidance for the individual patient. Surveillance, with the appropriate application of health economic indicators, can make this system long lasting. For governments and health care providers, optimal cancer care must result in a cost-effective, resource-sustainable, and patient-focused outcome.
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Neoplasias/prevenção & controle , Neoplasias/terapia , Publicações Periódicas como Assunto , Quimioprevenção/métodos , Quimioprevenção/tendências , Estudos Epidemiológicos , Europa (Continente)/epidemiologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Neoplasias/epidemiologia , Neoplasias/etiologia , Publicações Periódicas como Assunto/estatística & dados numéricos , Vigilância da População/métodos , Editoração/tendências , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologiaRESUMO
Recent innovations in tissue acquisition from the human breast have led to the development of unique direct frontal systems. We intend to evaluate efficacy and safety in a multicenter clinical study. Efficacy was considered optimal if the diagnosis by transcutaneous biopsy was identical to the surgical specimen in case of malignancy or in line with clinical follow-up when benign. One hundred and seventy-three women (aged 22-95 years) with a suspect lesion in the breast were eligible for transdermal biopsy. One hundred and seventeen biopsies were performed with the Spirotome and 56 with the Coramate under radiological or ultrasound guidance. Sample quality was evaluated by comparing the pathology results of the samples with definitive pathology at subsequent surgery or follow-up in case of benign lesions. An average of 1.66 biopsies per procedure were obtained. All patients had sufficient sample size (up to 5 mm diameter/20 mm length) to make a reliable diagnosis. The average length was 1.39 cm and the average diameter 3.72 mm. There were three false-negative diagnoses, leaving a correct diagnosis in 170 patients. None of the patients suffered from a serious complication, and the procedure was generally well tolerated. The new direct frontal transdermal tissue acquisition approach gives adequate diagnostic results through high-quality tissue samples. No major patient discomfort was noted.
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Biópsia por Agulha/métodos , Neoplasias da Mama/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Adulto JovemRESUMO
Animal and 'in vitro' experiences learned that human chorionic gonadotropin (hCG) is capable to protect from breast cancer. Receptors for hCG/luteinizing hormone (LH) are present on human female and male breast cancer cells. hCG decreases proliferation and invasion of breast cancer MCF-7 cells by inhibiting NF-kappa B, AP-1 activation and other genes. Doxorubicin toxicity is enhanced by conjugation with beta-hCG in MCF-7 cells. All these pieces of evidence suggest that hCG is active in human breast cancer. Direct proof however is missing. We performed a pilot study phase I trial for testing the inhibitory effects or recombinant hCG (rhCG) on primary breast cancer. Twenty-five postmenopausal women with newly diagnosed breast cancers of more than 1.5 cm were biopsied before randomization to receive either 500 microg rhCG (n=20) or placebo. After 2 weeks, surgery was done and tissues were analysed with regard to morphological, immunohistochemical and biochemical changes in tissues and plasma. rhCG reduces significantly the proliferative index and the expression of both the oestrogen receptor and progesterone receptor. rhCG does not modify the hormonal level of estradiol, progesterone, inhibin and follicle stimulating hormone (FSH) but increases significantly the level of LH. In a second pilot study, we tested the clinical efficacy through an open-label single centre study in 13 postmenopausal women with metastatic breast cancer. A 500 microg rhCG once every 2 days shows activity in postmenopausal metastatic breast cancer. The time to progression is relatively short. Response to previous hormonal treatment is indicative for rhCG activity. Given the data in primary and metastatic breast cancer rhCG further large scale investigation is highly warranted. rhCG can be an realistic option in (chemo-) prevention trials.
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Neoplasias da Mama/prevenção & controle , Carcinoma/tratamento farmacológico , Gonadotropina Coriônica/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Carcinoma/patologia , Feminino , Humanos , Metástase Neoplásica/tratamento farmacológico , Pós-MenopausaRESUMO
Breast cancer is more than ever the leading cause of death in women. In this article, we investigate the influence of lifestyle factors, and in particular nutrition (i.e. soft drinks), on physical development, puberty, breast growth and menarche to understand the potential impact of these environmental and lifestyle factors on the induction of breast cancer susceptibility. A questionnaire was obtained from 1146 girls of 10 schools in Belgian Limburg, attending the second year of secondary school. Their mean age was about 13 years. The analyses of the data were performed with 'survival analysis', in particular with the 'Cox regression' model for menarche. This project was conducted in the school year of 1999-2000. In the univariate and multivariate analysis investigating the most important variables of the period from birth to the age of menarche, there was clear evidence that lifestyle factors, including nutrition, have an effect on breast development and menarche. The following variables were significantly related to breast development and menarche: body mass index, drinking high-carbohydrate drinks, i.e. soft drinks, height of the father and the mother, weight of the mother at the start of pregnancy, history of mononucleosis, origin and education of the parents and physical activity. Lifestyle factors, including nutrition (i.e. soft drinks), affect the age at puberty and menarche. The same factors are known to be related to breast cancer risk. Better control of these variables during puberty might reduce breast cancer risk later in life.