Can Dietary and Physical Activity Modifications Reduce Breast Density in Postmenopausal Women? The DAMA Study, a Randomized Intervention Trial in Italy

Masala, Giovanna; Assedi, Melania; Sera, Francesco; Ermini, Ilaria; Occhini, Daniela; Castaldo, Maria; Pierpaoli, Elena; Caini, Saverio; Bendinelli, Benedetta; Ambrogetti, Daniela; Palli, Domenico

doi:10.1158/1055-9965.epi-18-0468

Cited by 20 publications

(32 citation statements)

References 50 publications

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“…We have previously shown that the overall annual MD change is − 1.0 cm 2 [15]. In contrast to overall MD, natural MD change is not strongly influenced by typical risk factors for breast cancer, except for BMI and physical activity, although results remain inconclusive for postmenopausal women [15,[22][23][24][25]. MD can however be decreased.…”

Section: Introductionmentioning

confidence: 92%

Hormonal determinants of mammographic density and density change

et al. 2020

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Background: Mammographic density (MD) is a strong risk factor for breast cancer. We examined how endogenous plasma hormones are associated with average MD area (cm 2) and annual MD change (cm 2 /year). Methods: This study within the prospective KARMA cohort included analyses of plasma hormones of 1040 women. Hormones from the progestogen (n = 3), androgen (n = 7), oestrogen (n = 2) and corticoid (n = 5) pathways were analysed by ultra-performance supercritical fluid chromatography-tandem mass spectrometry (UPSFC-MS/MS), as well as peptide hormones and proteins (n = 2). MD was measured as a dense area using the STRATUS method (mean over the left and right breasts) and mean annual MD change over time. Results: Greater baseline mean MD was associated with overall higher concentrations of progesterone (average + 1.29 cm 2 per doubling of hormone concentration), 17OH-progesterone (+ 1.09 cm 2), oesterone sulphate (+ 1.42 cm 2), prolactin (+ 2.11 cm 2) and SHBG (+ 4.18 cm 2), and inversely associated with 11-deoxycortisol (− 1.33 cm 2). The association between MD and progesterone was confined to the premenopausal women only. The overall annual MD change was − 0.8 cm 2. Hormones from the androgen pathway were statistically significantly associated with MD change. The annual MD change was − 0.96 cm 2 and − 1.16 cm 2 lesser, for women in the highest quartile concentrations of testosterone and free testosterone, respectively, compared to those with the lowest concentrations. Conclusions: Our results suggest that, whereas hormones from the progestogen, oestrogen and corticoid pathways drive baseline MD, MD change over time is mainly driven by androgens. This study emphasises the complexity of risk factors for breast cancer and their mechanisms of action.

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Section: Introductionmentioning

confidence: 92%

Hormonal determinants of mammographic density and density change

et al. 2020

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“…At the study level, only one RCT [29] included in the review was judged to have a low risk of bias. Common issues included a lack of information about allocation concealment [31,33], participant retention of < 85% [30][31][32], the absence of 'intention to treat' analyses [31][32][33], and a lack of prospective registration on a public trials registry [30][31][32][33]. In addition, two RCTs only followed-up outcomes for 3-months, which limits our understanding of the long-term effectiveness of lifestyle interventions.…”

Section: Discussionmentioning

confidence: 99%

“…One study objectively measured physical activity via accelerometery [29], three studies employed self-report questionnaires [30,31,33], and one study used both objective (accelerometery) and self-report measures [32]. Data from one RCT were insufficient to pool [33]. A meta-analysis of the remaining four RCTs [29][30][31][32] consisting of 440 participants showed a statistically significant increase in physical activity in the intervention groups compared with controls (SMD 0.31, 95% CI 0.13 to 0.50; p = 0.001; low quality evidence).…”

Section: Physical Activitymentioning

confidence: 99%

Section: Fruit and Vegetable Intakementioning

confidence: 99%

“…Four RCTs assessed self-reported fruit and vegetable intake, either using the Dietary Instrument for Nutrition Education (DINE) [29][30][31] or the Food Frequency Questionnaire [33]. Data reported in one study [33] were insufficient to include in the meta-analysis. Pooled data from the three remaining RCTs [29][30][31] involving 432 participants showed a statistically significant increase in favour of the intervention compared with control (SMD 0.33, 95% CI 0.01 to 0.64; p = 0.041; low quality evidence).…”

Section: Fruit and Vegetable Intakementioning

confidence: 99%

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Effectiveness of diet and physical activity interventions amongst adults attending colorectal and breast cancer screening: a systematic review and meta-analysis

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Hicks

Saxton

2020

Cancer Causes Control

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Purpose To estimate the effectiveness of tailored physical activity and dietary interventions amongst adults attending colorectal and breast cancer screening. Methods Five literature databases were systematically searched to identify randomised controlled trials (RCTs) of tailored physical activity and/or dietary interventions with follow-up support initiated through colorectal and breast cancer screening programmes. Outcomes included markers of body fatness, physical activity, and dietary intake. Mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using random effects models. Results Five RCTs met the inclusion criteria encompassing a total of 722 participants. Diet and physical activity interventions led to statistically significant reductions in body mass (MD − 1.6 kg, 95% CI − 2.7 to − 0.39 kg; I2 = 81%; low quality evidence), body mass index (MD − 0.78 kg/m2, 95% CI − 1.1 to − 0.50 kg/m2; I2 = 21%; moderate quality evidence), and waist circumference (MD − 2.9 cm, 95% CI − 3.8 to − 1.91; I2 = 0%; moderate quality evidence), accompanied by an increase in physical activity (SMD 0.31, 95% CI 0.13 to 0.50; I2 = 0%; low quality evidence) and fruit and vegetable intake (SMD 0.33, 95% CI 0.01 to 0.64; I2 = 51%; low quality evidence). Conclusion There is low quality evidence that lifestyle interventions involving follow-up support lead to modest weight loss and increased physical activity and fruit and vegetable intake. Due to the modest intervention effects, low quality of evidence and small number of studies, further rigorously designed RCTs with long-term follow-up of modifiable risk factors and embedded cost–benefit analyses are warranted (PROSPERO ref: CRD42020179960).

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Adipocytokine plasma level changes in a 24-month dietary and physical activity randomised intervention trial in postmenopausal women

et al. 2022

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Can Dietary and Physical Activity Modifications Reduce Breast Density in Postmenopausal Women? The DAMA Study, a Randomized Intervention Trial in Italy

Abstract: A modification of dietary habits or an increase in PA in postmenopausal women may reduce MBD. Further studies are needed to confirm these findings for planning breast cancer preventive strategies.

Cited by 20 publications

References 50 publications

Hormonal determinants of mammographic density and density change

Hormonal determinants of mammographic density and density change

Effectiveness of diet and physical activity interventions amongst adults attending colorectal and breast cancer screening: a systematic review and meta-analysis

Adipocytokine plasma level changes in a 24-month dietary and physical activity randomised intervention trial in postmenopausal women

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