运动对于已患乳腺癌者为时未晚

2020-07-19 08:50:32

　　虽然超过90%的乳腺癌患者在诊断时为早期病变，但是约25%将最终死于远处转移。更加健康的生活方式能够降低复发死亡发生的风险，对于乳腺癌康复过程中的女性而言，运动可能是降低复发死亡风险的最重要生活方式选择。

　　2017年2月21日，《加拿大医学会杂志》在线发表加拿大森尼布鲁克健康科学中心的系统回顾，分析了哪些生活方式改变可以带来最大获益，发现运动对乳腺癌复发死亡风险的影响最大、最持久，推荐的理想运动量为每周适度锻炼150分钟。

　　该系统回顾通过检索PubMed筛选出于2006年7月～2016年7月发表的36篇原始研究和31篇系统回顾，分析了饮食、运动、体重对乳腺癌女性已经获得成功治疗后健康的影响。

　　结果发现，运动对于已患乳腺癌者而言为时未晚：

乳腺癌诊断前长期积极运动者的任何原因所致死亡、乳腺癌所致死亡风险分别低18%、27%（P＜0.05、＜0.05）
乳腺癌诊断前近期积极运动者的任何原因所致死亡、乳腺癌所致死亡风险分别低27%、16%（P＜0.001、＜0.05）
乳腺癌诊断后开始积极运动者的任何原因所致死亡、乳腺癌所致死亡风险分别低48%、41%（P＜0.01、＜0.05）

　　运动对乳腺癌复发和死亡风险的影响最大、最持久，推荐的理想运动量为每周适度锻炼150分钟。

　　虽然很难单独分析运动带来如此获益的原因，但是可能的原因是运动或许能够抑制损伤细胞及增加癌症扩散风险的炎症。

　　不过，对于那些晚期癌症患者，如果进行运动可能引起过于疲累或疼痛，从而扭曲运动对降低死亡风险的显著获益。因此，进行一项女性随意运动的随机对照研究可能有助于回答这个问题。

　　此外，其他重要的生活方式影响因素还包括在癌症治疗之后限制体重增加、戒烟，而不同种类饮食对乳腺癌复发死亡风险的影响似乎不大。

相关阅读

CMAJ. 2017 Feb 21;189(7):E268-E274.

Lifestyle modifications for patients with breast cancer to improve prognosis and optimize overall health.

Hamer J, Warner E.

Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.

EVIDENCE USED IN THIS REVIEW

We searched PubMed to identify relevant systematic reviews and meta-analyses published within the past 10 years. Key search terms used with "breast cancer recurrence," "breast cancer survival" and "breast cancer mortality" included "weight loss," "weight gain" and "weight management" (10 reviews); "exercise" and "physical activity" (4 reviews); "diet," "nutrition," "dietary fat" and "soy" (8 reviews); "smoking" (3 reviews); "alcohol" (2 reviews); and "vitamin supplementation," "vitamins," "vitamin C," "vitamin E," "vitamin D" and "multivitamins" (5 reviews). A total of 31 reviews or meta-analyses were included (1 article was used for two lifestyle factors). We added 36 primary research articles because they were published after the most recent review of that lifestyle factor, they were designated in one of the reviews as a landmark study, or there were no previous reviews for that lifestyle factor.

KEY POINTS

Physical activity has the strongest effect on reducing the risk of breast cancer recurrence and death.
All patients with breast cancer (except for those who have an abnormally low body mass index before diagnosis) should avoid gaining weight.
Patients who are obese and those who smoke have a higher risk of cancer recurrence, but it is unclear whether their prognosis can be improved by weight loss or smoking cessation.
Soy consumption is not harmful.

DOI: 10.1503/cmaj.160464