When you’ve gone through breast cancer treatment, a looming question may be whether your cancer could come back — and how to reduce that risk.
On the WebMD Reddit AMA about early breast cancer, recurrence risk was a common theme. Users asked about lifestyle habits, types of treatments, and how to recognize signs that cancer has returned. Jane L. Meisel, MD, a professor at Emory School of Medicine at Emory University who specializes in women’s health with a focus in breast cancer, was one of the breast cancer experts who shared their wisdom on the thread.
Recurrence risk involves a set of variables unique to each person with breast cancer, she says. The best estimate of your risk is typically based on the biology of the specific disease subtype you have.
“But I reassure people that it's often the case, with all the treatment that's available to treat early-stage breast cancer, many more patients today are being cured,” says Meisel. “We're able to personalize treatments much more effectively than ever before. And the best way to reduce recurrence risk is to complete as much of the recommended treatment as possible.”
Obesity, GLP-1 Drugs, and Recurrence Risk
Some factors that influence recurrence risk — like the biology of the cancer you’ve already had — aren’t changeable. Others, like body weight, can be. Research consistently shows that being overweight or having obesity can raise your recurrence risk. Weight management has long been a talking point for doctors suggesting disease prevention and wellness in general.
That conversation now often includes GLP-1 drugs, These are medications originally designed for diabetes and now widely used for weight loss. So it makes sense, if you've had breast cancer, to wonder if you should take GLP-1 drugs to lose weight so you're cancer recurrence risk is lower.
The answer isn’t a straightforward yes or no, says Meisel.
We know these drugs can be helpful at promoting weight loss, she says. And we know that having overweight or obesity “can lead to poorer breast cancer outcomes and increased risk of recurrence. So GLP-1 may be one of many tools, along with diet and exercise, you can use to reduce that risk.”
Still, she cautions against thinking of them as a cure-all. “We typically recommend that people not use these drugs during active chemo because nausea and constipation could be a problem,” she explains. “It’s more in the maintenance phase of treatment where they can sometimes be helpful.”
She adds that lifestyle habits like exercise and healthy eating should be the first approach for most people. The benefits of a diet high in fruits, vegetables, and whole grains. and low in processed foods and red meat. go beyond weight management — they also help breast cancer outcomes.
But if you’ve been overweight or had obesity your whole life, a GLP-1 may be the right tool to use along with other treatments for breast cancer to prevent recurrence.
“I have a number of patients in my practice who are on these drugs, who have really seen a huge change in their lives and what they're able to physically do. They were able to lose so much weight successfully with this approach, whereas they haven't been able to successfully lose weight with other strategies,” says Meisel. “So I think it's a tool. But it's not the only tool for reducing weight in order to improve breast cancer outcomes.”
Lifestyle Choices That Matter
Beyond weight, several everyday habits may influence your recurrence risk. One that's important is continuing your cancer treatment as you work to improve your health.
“There's a lot of misinformation on the internet,” says Meisel. “I definitely have people come to me saying they’ve decided not to take an aromatase inhibitor, but instead just eat vegetables and do juicing. They tell me they’re convinced that'll reduce their recurrence risk just as much. But we don't have data to suggest that works.”
An area that’s not as black and white is alcohol consumption. Meisel says she doesn’t counsel people to stop drinking, but she does recommend moderation — ideally less than one drink per day,. Or, if it's compatible with your preferred lifestyle, three drinks or fewer per week.
“Alcohol is tricky because many people enjoy a glass of wine every once in a while. And you don’t want to totally take that away from them,” she says. “If it's empowering to stop drinking completely, then absolutely. But I never want to take something away that I don’t absolutely have to.”
As for exercise, if you don’t already do it, now’s a good time to start. Meisel recommends aiming for at least 150 minutes of vigorous activity each week — about 30 minutes a day, five days a week.
“It’s more than a lot of people feel they can make time for,” says Meisel. “But if your doctor says, ‘I’m strongly recommending it,’ or even ‘I’m prescribing it for you,’ then it may be your sign to reprioritize exercise in your schedule,."
Recognizing Signs of Recurrence
It's important to know how to spot signs of recurrence, so you can catch it early.
“The challenge with breast cancer recurrence is that it can come back either in your breast or axillary lymph nodes or chest wall, but it also can come back in other places,” says Meisel.
Because recurrence looks different for different people, she emphasizes paying attention to symptoms that don’t go away.
“If you develop pain in your mid-back and it lasts for two or three weeks, and you don’t know where it came from or why it’s there, and it’s persistent, then let me know so we can get an X-ray of your spine,” says Meisel. On the other hand, she says, short-term aches caused by things like lifting a heavy suitcase are far less concerning.
For women who’ve had surgery, self-checks can be tricky. Scar tissue can feel different and can cause alarm, but it doesn’t always mean recurrence.
“A lot of times even things that are changing in your breast can be fat necrosis or evolving scar tissue, not actually a breast cancer recurrence,” says Meisel. Her best advice is to be familiar with your body so you can recognize changes — but don’t jump to conclusions before seeing your doctor.
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SOURCE:
Jane L. Meisel, MD, oncologist, professor, Emory School of Medicine.
