Weight before and after a diagnosis of breast cancer or ductal carcinoma in situ : a national Australian survey

Background: Overweight/obesity are strongly implicated in breast cancer development, and weight gain post-diagnosis is associated with greater morbidity and all-cause mortality. The aim of this study was to describe the prevalence of overweight/obesity and the pattern of weight gain after diagnosis of breast cancer amongst Australian women. Methods: We collected sociodemographic, medical, weight and lifestyle data using an anonymous, self-administered online cross-sectional survey between November 2017 and January 2018 from women with breast cancer living in Australia. The sample consisted mainly of members of the Breast Cancer Network Australia Review and Survey Group. Results: From 309 responses we obtained complete pre/post diagnosis weight data in 277 women, and calculated pre/post Body Mass Index (BMI) for 270 women. The proportion of women with overweight/obesity rose from 48.5% at diagnosis to 67.4% at time of survey. Most women were Caucasian with stage I-III breast cancer (n = 254) or ductal carcinoma in situ (DCIS) (n = 33) and mean age was 59.1 years. The majority of women (63.7%) reported they had gained weight after diagnosis with an average increase of 9.07 kg in this group. Of the women who provided complete weight data, half gained 5 kg or more, 17.0% gained > 20 kg, and 60.7% experienced an increase in BMI of >1 kg/m2. Over half of the women rated their concern about weight as high. Of those women who gained weight, more than half reported that this occurred during the first year after diagnosis. Two-thirds (69.1%) of women aged 35-74 years gained, on average, 0.48 kg more weight per year than age-matched controls. Conclusions: Although the findings from this survey should be interpreted cautiously due to a limited response rate and self-report nature, they suggest that women in Australia gain a considerable amount of weight after a diagnosis of breast cancer/DCIS (in excess of age-matched data for weight gain) and report high levels of concern about their weight. Because weight gain after breast cancer may lead to poorer outcomes, efforts to prevent and manage weight gain must be prioritized and accelerated particularly in the first year after diagnosis

Seasonal reduction in vitamin D level persists into spring in NSW Australia : implications for monitoring and replacement therapy

Context: Seasonal variation in 25-hydroxyvitamin D [25OHD] status and its relationship to gender, age, socioeconomic and geographic determinants in Australians has not been described in large biomedical sampling cohorts. Objectives: To analyse 25OHD levels in all primary tests undertaken consecutively in a 2-year period to determine the prevalence of 25OHD deficiency and its relation to patient setting, gender, age, season, urban or rural residency, socioeconomic status, latitude and longitude. Design: We assessed 24 819 ambulatory and inpatient samples taken from the largest reference laboratory in NSW, Australia between 01 July 2008 and 30 July 2010. Main outcome measures: Serum 25OHD was measured using chemiluminescent immunoassay. Vitamin D deficiency was defined as 25OHD 79 years, socioeconomically disadvantaged and from a major city. Conclusion: This cross-sectional study demonstrates the extent and duration of 25OHD deficiency is greater than expected, and particular individuals are at higher risk. Our findings imply that supplementation guidelines need to be modified and strengthened

The rise and rise of vitamin D testing

Moynihan and colleagues’ report highlights the increasing trend for overdiagnosis, particularly of endocrine disorders. Similar concerns exist for overdiagnosis and overtreatment of vitamin D deficiency. Currently, the appropriate timing and frequency of testing for the diagnosis of vitamin D deficiency is unclear. The cost of testing in Australia increased from $A1m (£0.66m; €0.83m;$1m) in 2000 to $95.6m in 2010, on average 59$C150m (£95m; €120m; $147m) will be spent on vitamin D testing in 2012, up from$38m in 2009. Similarly, the UK has seen a sixfold increase in such tests between 2007 and 2010

The rising cost of vitamin D testing in Australia : time to establish guidelines for testing

We analysed the Medicare Benefits Schedule (MBS) to determine the economic impact of vitamin D testing in Australia from 1 January 2000 to 31 December 2010

The Vitamin D paradox : bone density testing in females aged 45 to 74 did not increase over a ten-year period despite a marked increase in testing for vitamin D

Aim: To determine whether increased vitamin D testing resulted in improved osteoporosis detection in Australian females aged 45-74 yr. Methods: Longitudinal analysis of bone densitometry, 25-hydroxyvitamin D (25(OH)D) and full blood count (FBC) testing between 2001 and 2011. The number and rate of tests per 100,000 individuals and benefit in dollars for bone densitometry, 25(OH)D and FBC from 2001-2011 for individuals aged 45-74 were obtained from Medicare Australia. Results: There was a disproportionate increase in 25(OH)D testing compared to bone density testing from 2001 to 2011, whereby 25(OH)D testing increased from 26,666 to 1.65 million p.a. and bone density testing increased from 41,453 to 66,100 p.a. Bone densitometry increased approximately 1.2 fold, whereas 25(OH)D testing increased by 55.2, 41.2 and 34.3 fold in females aged 45-54, 55-64 and 65-74, respectively. This represents an increase in annual benefits from approximately $2.5-$4.1 million for bone density testing and $0.7-$40.5 million for 25(OH)D testing over the period. Conclusions: This study demonstrates that improved detection of vitamin D deficiency is not being translated into better detection in at risk women of the consequences of vitamin D deficiency on target organs such as bone. This failure to translate rising awareness and better detection of vitamin D deficiency into physiological outcomes is a massive missed opportunity for improved bone health and reduced fracture risk. We propose that clinical practice guidelines be introduced not only for the purpose of diagnosis and testing for vitamin D, but to include recommendations for bone health testing in at risk individuals

Evidence of overtesting for vitamin D in Australia : an analysis of 4.5 years of Medicare Benefits Schedule (MBS) data

Objective: To comprehensively examine pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) testing in each state of Australia to determine the cost impact and value and to add evidence to enable the development of vitamin D testing guidelines. Design: Longitudinal analysis of all 25(OH)D pathology tests in Australia. Setting: Primary and Tertiary Care. Measurements: The frequency of 25(OH)D testing between 1 April 2006 and 30 October 2010 coded for each individual by provider, state and month between 2006 and 2010. Rate of tests per 100 000 individuals and benefit for 25(OH)D, full blood count (FBC) and bone densitometry by state and quarter between 2000 and 2010. Results: 4.5 million tests were performed between 1 April 2006 and 30 October 2010. 42.9% of individuals had more than one test with some individuals having up to 79 tests in that period. Of these tests, 80% were ordered by general practitioners and 20% by specialists. The rate of 25(OH)D testing increased 94-fold from 2000 to 2010. Rate varied by state whereby the most southern state represented the highest increase and northern state the lowest increase. In contrast, the rate of a universal pathology test such as FBC remained relatively stable increasing 2.5-fold. Of concern, a 0.5-fold (50%) increase in bone densitometry was seen. Conclusions: The marked variation in the frequency of testing for vitamin D deficiency indicates that large sums of potentially unnecessary funds are being expended. The rate of 25(OH)D testing increased exponentially at an unsustainable rate. Consequences of such findings are widespread in terms of cost and effectiveness. Further research is required to determine the drivers and cost benefit of such expenditure. Our data indicate that adoption of specific guidelines may improve efficiency and effectiveness of 25(OH)D testing

The bone remodeling environment is a factor in breast cancer bone metastasis

The bone microenvironment is clearly an important determinant of breast cancer metastasis to bone. Once established in bone, the ability for breast cancer cells to hijack normal regulatory pathways for osteoclast differentiation, activation, and survival is known to form the basis of a vicious cycle that promotes both bone destruction and tumor growth. However, the importance of the background remodeling activity in the early stages of breast cancer metastatic establishment in bone has not been systematically investigated. Here we review recent studies that indicate that bone remodeling levels, as influenced by calcium and vitamin D status, do impact the ability of human breast cancer cells to grow in the bones of nude mice. These studies support the assessment and correction of calcium and vitamin D deficient states in women at risk of developing advanced breast cancer

Effect of omega-3 supplementation on the omega-3 blood index and fatty acid biomarkers in healthy individuals

Background: Omega-3 fatty acids are associated with beneficial health outcomes including reduced cardiovascular disease. Few individuals meet their requirements for omega 3 fatty acids through foods. Supplementation may be a viable option. Aim: This open-label trial was designed to examine the effects of a novel krill-oil supplement on omega-3 index, other fatty acids and indicators of safety. Methods: Fifty individuals consumed one capsule of a supplement compromising 1 g krill-oil (290 mg omega-3 providing 160 mg of eicosapentaenoic acid (EPA) and 80mg of docosahexaenoic acid (DHA) daily for 12-weeks, and attended study visits at 0, 6 and 12-weeks. The primary outcome was to investigate efficacy of krill-oil on omega-3 index. Secondary outcomes were to investigate its effects on EPA, DHA, EPA:arachidonic acid (AA), and saturated, monounsaturated and trans-fats. Results: Omega-3 index increased by 10.1% following supplementation (mean(sd): 5.75(1.05) to 6.33(1.02), P < 0.001). The largest increase was seen in the first 6 weeks after which levels stabilised. A statistically significant change was also seen in mean EPA (mean(sd): 0.89(0.31) to 1.17(0.30), p < 0.001), DHA (2.99(0.72) to 3.24(0.79), p = 0.016), EPA:AA (0.10(0.04) to 0.14(0.05), p < 0.001) and monounsaturated fat (24.00(2.95) to 23.0(2.57), p = 0.047). There was weak evidence of a small increase in saturated fat (36.45(1.86) to 37.15(1.79), p = 0.077). No change occurred in trans-fat (0.92(0.28) to 0.91(0.24), p = 0.839). Six participants reported adverse events although only one was deemed supplement related. Conclusion: Krill oil is well tolerated and effectively raises omega-3 index by increasing both EPA and DHA without adversely affecting undesirable fatty-acids. Further trials are required to determine krill-oils effect on biomarkers

Weight management barriers and facilitators after breast cancer in Australian women : a national survey

BACKGROUND: Breast cancer is the most common cancer in women worldwide. Weight gain after breast cancer is associated with poorer health outcomes. The aim of this study was to describe how Australian breast cancer survivors are currently managing their weight. METHODS: Online cross-sectional survey open to any woman living in Australia who self-identified as having breast cancer, between November 2017 and January 2018. RESULTS: We received 309 responses. Most respondents described their diet as good/excellent and reported moderate-high levels of weight self-efficacy. Despite this, the proportion of overweight/obesity increased from 47% at time of diagnosis to 67% at time of survey. More than three quarters of respondents did not receive any advice on weight gain prevention at the time of diagnosis. 39% of women reported being less active after cancer diagnosis, and and few weight loss interventions were perceived to be effective. Facilitators were structured exercise programs, prescribed diets, and accountability to someone else, while commonly cited barriers were lack of motivation/willpower, fatigue, and difficulty maintaining weight. Women who cited fatigue as a barrier were almost twice as likely to be doing low levels of physical activity (PA) or no PA than women who did not cite fatigue as a barrier. CONCLUSIONS: We report high levels of concern about weight gain after BC and significant gaps in service provision around weight gain prevention and weight management. Women with BC should be provided with support for weight gain prevention in the early survivorship phase, which should include structured PA and dietary changes in combination with behavioural change and social support. Weight gain prevention or weight loss programs should address barriers such as fatigue. More research is required on the effectiveness of diet and exercise interventions in BC survivors, particularly with regard to weight gain prevention

Burning daylight : balancing vitamin D requirements with sensible sun exposure

Objective: To examine the feasibility of balancing sunlight exposure to meet vitamin D requirements with sun protection guidelines. Design and setting: We used standard erythemal dose and Ultraviolet Index (UVI) data for 1 June 1996 to 30 December 2005 for seven Australian cities to estimate duration of sun exposure required for fair-skinned individuals to synthesise 1000 IU (25 μg) of vitamin D, with 11% and 17% body exposure, for each season and hour of the day. Periods were classified according to whether the UVI was 60min. Main outcome measure: Duration of sunlight exposure required to achieve 1000 IU of vitamin D synthesis. Results: Duration of sunlight exposure required to synthesise 1000 IU of vitamin D varied by time of day, season and city. Although peak UVI periods are typically promoted as between 10 am and 3 pm, UVI was often ≥ 3 before 10 am or after 3 pm. When the UVI was < 3, there were few opportunities to synthesise 1000 IU of vitamin D within 30 min, with either 11% or 17% body exposure. Conclusion: There is a delicate line between balancing the beneficial effects of sunlight exposure while avoiding its damaging effects. Physiological and geographical factors may reduce vitamin D synthesis, and supplementation may be necessary to achieve adequate vitamin D status for individuals at risk of deficiency