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Mechanisms influencing breast cancer (BC) development and recurrence include hyperglycemia, hyperinsulinemia, high insulin-like growth factor-1, high circulating estrogen, inflammation and impaired cellular differentiation/apoptosis. A lifestyle program that targets all the above mechanisms may be warranted. Low glycemic index (GI) foods produce lower post-prandial glucose and insulin responses and have been associated with lower BC risk. Moderate physical activity post-diagnosis reduces BC recurrence and mortality, partly explained by reduced insulin and estrogen levels. Vitamin D increases cell differentiation/apoptosis and high serum vitamin D levels improve BC survival. Yet no trial has evaluated the combined effect of a low GI diet, moderate physical activity and vitamin D supplementation on BC recurrence in the context of a Mediterranean lifestyle setting. Women (30-74 yr) who had undergone surgery for primary histologically confirmed BC (stages I-III) within the previous 12 months, in cancer centres in Italy, will be randomized to follow, for a maximum of 33 months, either a high intensity treatment (HIT) composed of low GI diet + exercise + vitamin D (60 ng/mL serum concentration) or a lower intensity treatment (LITE) with general advice to follow a healthy diet and exercise pattern + vitamin D to avoid insufficiency. Both interventions are on a background of a Mediterranean diet. Considering a 20% recurrence rate within 3 years for BC cases and a predicted rate of 10% in the HIT group, with power of 80% and two-sided alpha of 0.05, the subject number required will be 506 (n = 253 in each arm). Clinic visits will be …
BioMed Central
Publication date: 
1 Dec 2017

Livia SA Augustin, Massimo Libra, Anna Crispo, Maria Grimaldi, Michele De Laurentiis, Massimo Rinaldo, Massimiliano D’Aiuto, Francesca Catalano, Giuseppe Banna, Francesco Ferrau, Rosalba Rossello, Diego Serraino, Ettore Bidoli, Samuele Massarut, Guglielmo Thomas, Davide Gatti, Ernesta Cavalcanti, Monica Pinto, Gabriele Riccardi, Edward Vidgen, Cyril WC Kendall, David JA Jenkins, Gennaro Ciliberto, Maurizio Montella

Biblio References: 
Volume: 17 Issue: 1 Pages: 1-13
BMC cancer