We’re blogging once a week during Breast Cancer Awareness Month about the latest in breast cancer-related treatment and research at Penn Medicine. This week, we took a look at the latest studies underway around exercise after breast cancer.
The nation’s 2.4 million breast cancer survivors already have strength in numbers, and they’re a powerful lobby for research funding and public awareness campaigns about early detection of the disease, but ongoing research at Penn Medicine offers them the chance to gain literal strength.
Research led by Kathryn Schmitz, PhD, MPH, an associate professor of Epidemiology and Biostatistics and a member of the Abramson Cancer Center, has reversed decades of physical activity advice given to breast cancer survivors. After finishing treatment, these women have typically been told to avoid lifting much of anything heavier than a handbag – no grocery bags, no toddlers, and certainly, no free weights in the gym. Her research, published in the New England Journal of Medicine and the Journal of the American Medical Association, changed all that, laying out a specific weightlifting regimen that has proven to not only improve symptoms in women who already have the dreaded limb-swelling condition called lymphedema, but also to stave it off altogether among those at risk.
The work on lymphedema – so dreaded that women who took part in that trial said they were as afraid of getting it as they were of their cancer recurring – is just the start of Penn’s efforts to integrate the power of exercise into cancer care. Schmitz leads Penn’s new Transdisciplinary Research on Energetics and Cancer (TREC) Survivor Center, which is powered by a $10 million National Cancer Institute grant to study the relationship between exercise, weight loss, and cancer recurrence among the nation's 12 million survivors of the disease.
As with the precision involved in delivering cancer care via IV and oral chemotherapy, surgery and radiation therapy, Schmitz says, patients need guidance to reap the true benefits of exercise after cancer, and to learn how do it properly and safely. She worries, especially, that women heard the news about the role of weightlifting for lymphedema and began exercising on their own, putting them at risk of making their problems worse or even causing new injuries.
“Exercise has to be elevated so that just like chemotherapy, there is a place for people to receive it, there are professionals who know how to dose it, who know how to back off based on symptoms,” she said. “If we want to see the kinds of benefits among the general population that we see in trials, we need to disseminate the findings and apply the same level of precision and dosage to exercise that we give to chemotherapy. Exercise is, indeed, medicine.”
But while insurers stand to save plenty of money if less women got lymphedema after breast cancer, unlike when new cancer drugs hit the market, exercise offers no immediate profit prospects for pharmaceutical or biotechnology companies – and no multi-million dollar advertising campaign advising patients to query their doctors about it. That’s where Schmitz’s newest lymphedema study comes in. The project aims to translate the weightlifting findings from the medical journals into actual clinical practice, by getting doctors to “prescribe” physical therapy, and creating a process for women who are referred into the program to be evaluated and taught the proper mechanics of the lymphedema-busting exercises by trained therapists. (Breast cancer survivors who are interested in getting that type of care can check out the Strength After Breast Cancer Program, which provides women with education about lymphedema and a series of group classes that equip them to do these special exercises at home or in a gym.)
A report issued this year about the relationship between physical activity and cancer by the UK charity and cancer research champion MacMillan Cancer Support called exercise the “underrrated wonder drug.” That idea applies not only to exercise’s role in prevention and treatment of post-cancer conditions like lymphedema, but also to prevention and recurrence of cancer itself. Another new trial, dubbed “WISER Survivor,” targets overweight breast cancer survivors who have lymphedema – Schmitz is aiming to enroll 555 of them -- to examine how exercise not only controls their lymphedema, but also, perhaps, plays a role in preventing recurrence of their cancer. (It’s a similar idea to the one behind the ongoing “WISER Sister” exercise trial, which aims to use treadmill exercise as a prevention strategy for women who do not have breast cancer but are at high risk of the disease because they carry the BRCA genes or otherwise have a strong family history of the disease. Data from the pilot of that trial shows that among women involved in the exercise regimen, levels of estrogen – a hormone that plays a role in the development of breast cancers – decreased by roughly 20 percent. Eventually, Schmitz hopes to be able to quantify how much exercise is needed for a hormone-level reduction that would meaningfully reduce a woman’s risk of getting breast cancer.)
If you’re a breast cancer patient or survivor, or know you’re at risk of developing the disease, we’d love to hear about what role exercise plays in your life.