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Mode de vie et cancer du sein: quels conseils pour la prise en charge de l’après cancer ?

Lifestyle and breast cancer: what advice for the management of post-cancer?

  • Synthèse / Review Article
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Oncologie

Abstract

It is widely admitted that after adjuvant therapy, about one half of women with localized breast cancer experience a weight gain of 3 kg. It can however reach 8 to 10 kg in numerous cases. Risk factors associated with weight gain are unclear, but women undergoing chemotherapy seem to have an increased risk, especially before the menopause. Retrospective studies suggest that post-treatment weight gain might increase the risk of relapse. Furthermore, the only intervention trial in adjuvant breast cancer, though impaired by methodological pitfalls, suggests that limiting weight gain could increase disease free survival. The use of nutritional complements by cancer patients is usually underestimated. Several compounds, such as vitamins C and, E, selenium or carotenoids, have been investigated in clinical trials whose quality is usually poor. Available date nevertheless suggest a deleterious effect of supplementation with anti-oxydants, in particular at supraphysiological doses. The WHEL trial is the only large randomised trial investigating an healthy diet with vegetables, fruits and fiber after localized breast cancer. An effect of survival is observed in the experimental arm only in patients with sufficient level of physical activity. Physical activity, when practiced regularly, improves asthenia, quality of life and even survival, without any detrimental effect. It should however be initiated after an evaluation of patient’s ability and comorbidities, and be realized in specific centers with careful medical follow-up. Its mechanisms of action include regulation of estrogen, insulin, IGF1 and adipokines. Adapted physical activity should be proposed to patients fulfilling precise inclusion criteria.

Résumé

On estime que près de la moitié des femmes traitées pour un cancer du sein localisé sont affectées par un gain de l’ordre de 3 kg, mais des prises de poids de l’ordre de 8 à 10 kg ne sont pas exceptionnelles. Les facteurs de risque ne sont pas clairement individualisés, mais les patientes recevant une chimiothérapie semblent plus concernées, en particulier avant la ménopause. Les études rétrospectives montrent que la prise de poids pourrait être un facteur de risque de rechute, qui plus est, le seul essai d’intervention actuellement publié dans le cancer du sein, bien que sujet à des critiques d’ordreméthodologique, suggère un effet positif de la réduction du surpoids sur la survie sans récidive. L’utilisation de compléments nutritionnels par les patients est, quant à elle, largement sous-estimée. De nombreux composés ont fait l’objet d’essais cliniques dont la méthodologie est globalement peu convaincante (vitamines C et E, sélénium, caroténoïdes). Les données disponibles suggèrent un effet négatif de la supplémentation en antioxydants (en particulier à des doses supraphysiologiques) pouvant éventuellement affecter l’efficacité du traitement antitumoral. L’essai WHEL (Women’s Healthy Eating and Living) est le seul grand essai randomisé d’intervention, basé sur une supplémentation en fruits et légumes après traitement d’un cancer du sein localisé: il suggère un effet positif de la supplémentation uniquement si elle est associée à une activité physique suffisante. L’activité physique régulière lors des soins en cancérologie améliore la qualité de vie, la fatigue, la survie, en particulier pour les patientes porteuses de cancer du sein, et ce, sans effet secondaire à condition d’être mise en place après un bilan précis des capacités, des comorbidités, d’être réalisée dans des structures adaptées avec un suivi médical des progrès et des difficultés. Les mécanismes d’action passent par des modifications de sécrétion d’estrogène, d’insuline, d’IGF1 et des adipokines. L’activité physique adaptée en cancérologie doit être proposée aux malades répondant à des critères d’inclusion précis.

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Authors and Affiliations

  1. Consultation après cancer (CAC) 93, service d’oncologie médicale, CHU Avicenne, F-93000, Bobigny, France

    L. Zelek & T. Bouillet

  2. Unité de recherche en épidémiologie nutritionnelle (Pr. S. Hercberg), UMR 557 Inserm/U 1125 INRA/CNAM, université Paris-XIII, 1, rue de Chablis, F-93000, Bobigny, France

    L. Zelek, P. Latino-Martel, N. Pecollo, E. Barrandon, S. Czernichow, P. Galan & S. Hercberg

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  1. L. Zelek
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Zelek, L., Bouillet, T., Latino-Martel, P. et al. Mode de vie et cancer du sein: quels conseils pour la prise en charge de l’après cancer ?. Oncologie 12, 289–297 (2010). https://doi.org/10.1007/s10269-010-1878-7

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