Breast Cancer is the most commonly diagnosed cancer for females, with 1 in every 8 women(1) being affected by this disease across their lifetime and with 17,730 new breast cancer cases being diagnosed in 2017 alone(1) . Breast Cancer is characterised by the uncontrolled rate of cell growth within the breast tissue, which then has the potential to metastasis (spread) to other parts of the body. The uncontrolled tissue growth can cause a change in breast and nipple size or shape and cause pain and redness. This article will discuss the diagnostic process, why exercise is an important adjunct treatment and what considerations need to be made when designing an exercise program.
Diagnosis
The diagnostic process for determining the presence of Breast Cancer is called ‘the triple test”. This involves:
- Personal history and clinical breast examination.
- Imaging test that can include a mammogram or ultrasound.*
- Biopsy which can include a core biopsy or fine needle aspiration (removal of suspect tissue with a needle).
*early detection and regular mammogram testing can significantly improve survival rates via early detection and early treatment. Please don’t be afraid to get tested.
From the triple test, your medical team will be able to:
- Identify the absence or presence of Breast Cancer.
- Identify the stage and grade of Breast Cancer.
Common words used during the diagnostic process include:
- Grade: How fast the cancer might grow.
- Stage: How far the cancer has spread.
- Localised: Cancer has not spread beyond breast tissue.
- Locally advanced: Cancer has extended beyond the breast tissue but still confined with the breast.
- Advanced: Cancer has spread to organs next to the breast.
- Metastatic: Cancer spread to different parts of the body.
Exercise as an adjunct treatment
Exercise is an extremely beneficial tool in the treatment process for breast cancer patients. Research has shown that patients who undertake an exercise program during treatment have been able to tolerate a greater percentage and frequency dosage of treatment in the group that performed exercise during its treatment cycles(2), which highlights that patients may be able to tolerate a greater percentage of their outlined treatment plan. Exercise has also shown improvements in strength, (particularly shoulder strength), reductions in fatigue(3) and changes in body composition such as preserving or even improving muscle mass and reducing fat mass(4) through the treatment process.
As previously mentioned in our prostate cancer and exercise article, other benefits of aerobic and strength training have been found to:
- Increase physiological processes such as blood flow – an increase in blood flow allows more blood with oxygen to diffuse into the site of the tumour which can offset the hypoxic environment associated with cancer cells
- Improvements in immune function through physiological processes – in combination with increased blood flow, allow more of the body’s immune system to flood the infected area
- Offset negative effects of treatment, reducing – fatigue, sarcopenia, osteoporosis and loss of cardiovascular fitness parameters.
Exercise Program Considerations
Similar to the exercise regime for prostate cancer patients, there is no “one best program” for breast cancer patients. Like with any patient, an individualised approach needs to be taken to meet the patient’s needs. Below are some tips to construct an exercise program.
- Exercise screening: A screening not only should outline the stage and grade of the patient’s breast cancer, but should also determine risks for exercise, identify the presence of co-morbidities and whether the need for medical clearance needs to be obtained from specialist.
- Understand the absolute and relative risk of exercise along with each stage of treatment.
- Understand the patients side effects of their respective treatment which can include shoulder restrictions, cancer related fatigue, bone pain, cording (axillary web syndrome) and cardio-toxicity.
- An assessment that gives you the “big picture” e.g. when I take breast cancer out of the question, what do I see?
- Wellness sheet, rating of perceived exertion (RPE) scales to establish exercise trends.
- Tracking of blood pressure pre/during exercise to make sure blood pressure matches exercise intensity.
- Having variable intensity and volume of exercise programs planned, for when the patient may present with higher amounts of cancer related fatigue.
- Treatment cycles plan, to know when de-load and progressive overload principles can be applied.
Like working with patients with prostate cancer, every breast cancer patient you see will be at varying stages through their treatment journey. Understanding where they are with their treatment, well planned principles of exercise testing and programming will ensure that the exercise modality is suitable and effective for the patient. Here are just a couple more tips to wrap this up:
- Understanding patient symptoms will vary from day to day so be planned ahead of session for how they come in.
- It’s a learning experience. Every time you assess or program someone with breast cancer, you will learn how to better go about it.
- To monitor their exercise through various tools that helps you establish their response.
To find out more on what you should be doing for your particular case, come on in and see the expert team at Absolute. A multidisciplinary team of highly skilled clinicians here to work alongside your oncology specialist.
Written By Accredited Exercise Physiologist & Performance Coach Adam Luther.
References:
- Australian Institute of Health & Welfare. 2017. Australian Cancer Incidence and Mortality (ACIM) books: Breast Cancer
- Courneya, K., Segal, R., Mackey, J., Gelmon, K., Reid, R., Friedenreich, C., Ladha, A., Proulx, C., Vallance, J., Yasui, Y., & McKenzie, D. (2007). Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology. 25(28): 4396-4404.
- Meneses-Echávez, J. F., González-Jiménez, E., & Ramírez-Vélez, R. (2015). Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer, 15(1).
- Neil-Sztramko, S., Winters-Stone, K., Bland, K., & Campbell, L. (2017). Updated systematic review of exercise studies in breast cancer survivors: attention to the principle of exercise training. British Journal Sports Medicine.
