الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common cancer and leading cause of cancer deaths among women worldwide. In Egypt, breast cancer is the most common cancer among women, representing 24% of total cancer cases (37% in women and 0.8% in men) according to latest records of Egypt National Cancer Institute (NCI).
The only well-established nutritional related risk factors for breast cancer are obesity and alcohol consumption. High intake of meat, dairy products and fat may increase risk while high intake of fiber, fruits, vegetables, antioxidants and phyto-oestrogens may reduce the risk.
Biological mechanisms underlying the relationship between obesity and cancer are complex and not fully understood. They include obesity-related hormones, growth factors, modulation of energy balance and calorie restriction, multiple signaling pathways, and inflammatory processes affecting cancer cell promotion and progression.
Weight gain in women with breast cancer may negatively affect quality of life, predispose women to weight-related disorders such as hypertension, cardiovascular, orthopedic problems and diabetes. In addition, weight gain following breast cancer diagnosis has been associated with increased rates of recurrence and death. Finally, weight gain in this population tends to be accompanied by adverse changes in body composition, with increases primarily in fat mass rather than lean mass.
Since nearly all breast cancer women with positive hormone receptor tumors receive adjuvant hormonal therapy, it was important to investigate the impact of different adjuvant hormonal therapies on the nutritional status of these patients.
This study is an attempt to clarify how body weight and body composition, may change in postmenopausal breast cancer patients receiving adjuvant hormonal therapy, after considering many variables that are potentially associated with weight gain such as caloric intake , level of physical activity and changes in appetite.
The study was conducted at the outpatient clinic of Oncology and Nuclear Medicine department, Faculty of Medicine, Alexandria University and the outpatient nutrition clinic of High Institute of Public Health, Alexandria University.
A prospective approach was used to conduct this study (pre-test and post-test comparative study). This study involved 50 newly diagnosed postmenopausal breast cancer patients who were starting to receive adjuvant hormonal therapy after completion of other breast cancer treatment regimens. The patients were divided into two equal groups where 25 of these patients were starting to receive tamoxifen, while the other 25 patients were starting to receive aromatase inhibitors (AIs).
A pre-treatment assessment was carried using a pre-designed interview questionnaire recording data about personal characteristics, medical history, gynecological and obstetrical history, physical activity, dietary habits and frequency of consumption of certain foods. To estimate the mean caloric intake and mean macronutrients intake a 24 hours recall was conducted. Also body weight, height, waist and hip circumference, body composition and BMI were measured prior to application of hormonal therapy and once again after 6 months of implementation of hormonal treatment.
On analyzing the results of the study, it was observed that all breast cancer patients participated in the study had a mean BMI >30, thus supporting a strong association between obesity and occurrence of breast cancer, as was found in most epidemiological studies correlating obesity with incidence of breast cancer.
On studying the impact of tamoxifen on nutritional status of breast cancer patients, the results revealed a significant increase in mean body weight, where mean body weight at the beginning of the study was 86.72+12.98 and increased to 88.28±14.12 kg at the end of the study, with a mean change of +1.7 %. Also, experienced significant changes in their body composition after 6 months of treatment compared to baseline, where percentage body fat mass was significantly increased on the expense of percentage fat free mass. The mean percentage body fat mass was significantly increased from 47.29±3.84% to 48.30±4.35% with percent change of +2.1%, while the mean fat free mass was significantly decreased from 52.70±3.84% to 51.69±4.35% with a percent change of -1.9%.
On studying the impact of AIs on nutritional status of breast cancer patients, the results revealed a slight decrease in mean body weight but without any significant difference between the initial and follow-up visit, where mean body weight at the beginning of the study was 87.58±12.81 and decreased to 86.28±13.05 kg at the end of the study, with a mean change of -1.2%. Also, the AIs treated group experienced slight changes in their body composition after 6 months of treatment compared to baseline but without any significant difference, where percentage body fat mass was slightly decreased and percentage fat free mass was slightly increased. The mean body fat mass was decreased from45.89±7.55 to 45.38±7.69% with percent change of -1.1%, while the mean fat free mass was increased from 54.12±7.56 to 54.62±7.69% with percent change of +0.94%.
However, on comparing the percent of change in body weight and body composition over the treatment period between the two treatment groups, the results demonstrated that tamoxifen treated group experienced significant increase in body weight, WHR, percentage body fat and total body water compared to AIs treated group. While they experienced significant decrease in percentage fat free mass and skeletal muscle mass compared to AIs treated group.
Many variables that are potentially associated with weight gain such as caloric intake, level of physical activity and changes in appetite were examined, but there was no significant difference between the two treatment groups. Suggesting that the difference between the two groups was related to different pharmacological properties of the two drugs, and that tamoxifen use was a predictor of weight gain and adiposity among breast cancer patients. Another explanation for the difference in changes in body weight and body composition between the two treatment groups is the difference in age and years passed since natural menopause between the two treatment groups.
This study investigated cooking habits among breast cancer patients, most of patients were preferring margarine and butter as type of cooking fat, deep frying and stewing as a cooking method. Multiple reuse of frying oil and not removing poultry’s skin before cooking were also observed among the studied sample, suggesting that all of these habits may contribute to breast cancer and obesity occurrence among the studied sample.