An approach for high risk women : Developing a weight management

An approach for high risk women :
Developing a weight management
programme for overweight women
at high risk for breast cancer,
cardiovascular disease & diabetes
Dr Michelle Harvie
Research Dietitian
Genesis Prevention Centre
University Hospital of South Manchester
Advances in Diabetes and Obesity Care: Therapy, Treatments and Techniques May 14 2012
Outline
Weight, weight loss & risk of cancer,
diabetes & CVD
The NHS Breast Screening Programme
Cardiovascular & diabetes screening
Our planned Healthy Lifestyle Promotion at
Screening (HeLPS) programme
Multivariate RR
Weight gain & risk of breast cancer
2.0
2
1.6
1.2
1.0
1
0
Loss or
Gain
gain 2.0
2.1-10.0
(Reference)
Gain
10.1-20.0
Gain
>20.0
Adult weight change (kg)
Huang et al JAMA 287: 1407, 1997
Weight gain & risk of breast cancer,
diabetes & CVD
12.3 Diabetes
Multivariate RR
10.2 Metabolic
Syndrome
2.0
2
2.7 CVD
1.6
1.2
1.0
1
0
Loss or
Gain
gain 2.0
2.1-10.0
(Reference)
Gain
10.1-20.0
Gain
>20.0
Adult weight change (kg)
Huang et al JAMA 287: 1407, 1997, Colditz GA et al Arch Int Med 122: 481, 1995
Willett W et al JAMA 273: 461, 1995 Everson SA et al Diabetes Care 21: 1637, 1998
Modest weight loss reduces risk of cancer &
diabetes
Study design
Wt loss
RR
Reference
Cohort 34,000
postmenopausal
women USA
> 5%
0.61
(0.46 – 0.80)
Harvie et al
2005
Breast cancer
Cohort 87,000
postmenopausal
women USA
>10kg
~ 15%
0.43
(0.25 – 0.86)
Eliassen et al
2006
Colorectal
cancer
Cohort 7963 Japan
30% female aged > 40
> 5%
0.47
(0.26 – 0.82)
Yamaji et al
2008
Diabetes
RCT 2766 IGT
USA 68% women
45% ethnic minority
> 5%
0.64
(0.76 – 0.58)
USDPP
2009
Breast cancer
Modest weight loss & risk of cardiovascular
disease
Wing et al Diabetes Care. 2011 34(7):1481-6
RCT data
US Diabetes Prevention Study RR 0.38 (0.08 – 1.68) results expected 2014
Da Quing Diabetes Prevention Study RR 0.72 (0.47 – 1.12)
Can we provide lifestyle disease
prevention in the NHS National Breast
Screening Programme ?
Rationale for lifestyle disease
prevention in the NHS BSP
• NHSBSP reaches 70% of women 47 – 73 years
• NHSBSP allows early diagnosis & improved BC survival,
but does not target prevention.
• 30- 40% of BC may be preventable by weight control,
exercise & reduced alcohol WCRF/ Cancer Reform Strategy
• Excess weight & poor lifestyle linked to most chronic
diseases i.e. CVD , diabetes, other cancers & dementia.
• Low cost multi disease prevention interventions are required
with limited healthcare budgets.
PROCAS
Predicting Risk Of Cancer At Screening
Aim
•Develop risk prediction model for use in the NHSBSP
•Assess the feasibility of providing risk information &
introducing prevention at screening
• Target recruitment 60,000 women over 3 years
• Mailed to join study with mammogram invitation
 40-50% Screening attendees agree to join study
 Complete risk information questionnaire & provide
saliva sample for SNP analysis
Risk data collected in PROCAS
Family history
Hormonal factors:
Risk prediction
Parity, age of 1st pregnancy,
breast feeding, use of HRT,
oral contraceptives
Lifestyle factors:
BMI
Adult weight gain
Exercise
Alcohol
Breast density
20 breast cancer SNPs
in saliva samples
+
PROCAS – First 10,000 women
Estimated risks
• 94% of women in PR0CAS want to know their risk
•10% have > 5% 10 year risk of BC (2 x population risk)
Self reported lifestyle risk data
• 65% overweight
• 65% sedentary
• 30% >14 units alcohol /week
Why should we include screening &
prevention of CVD & diabetes ?
• Women in NHSBSP aged 47 – 73 years when CVD &
diabetes screening is worthwhile & cost effective
National Collaborating Centre of Primary Care. NICE 2010 Waugh N, et al Health Tech Assess 2007
• Current CVD screening & weight management is
opportunistic and has poor coverage.
Soljak M et al BMC Cardiovasc Disord 2011; 11:12
• We find significant numbers of women in the NHSBSP
have previously undiagnosed CVD & diabetes risk
profiles: Raised total:HDL chol ratio (50%)
Raised Blood sugar (10- 15%)
Healthy Lifestyle Promotion at Screening
(HeLPS) programme
Questions
• Is multiple disease risk information acceptable and useful to
women?
• Can disease risk information information motivate lifestyle
behaviour change?
• Can we promote weight loss and lifestyle change with a
telephone + web / app intervention?
•
To what extent does this intervention change disease risk
biomarkers?
Acknowledgements
HeLPS
Christi Deaton
Martin Gibson
Anthony Howell
Gareth Evans
Iain Buchan
Louise Donnelly
PROCAS
Alan Hufton
Jenny Diffey
Jane Wardle
Jack Cuzick
Bill Newman
Iain Buchan
LIFESTYLE
Paula Stavrinos Mary Pegington
Debby McMullen
Sarah Dawe
Kath Sellers
Sarah Sahin
Ellen Mitchell
Jill Fox
Genesis Volunteers.
Mary Wilson
Wendy Watson Ursula Beetles
Pam Coates
Fiona Harrison Barbara Eckersley
Ruth Warren
Sue Astley
Sarah Ingham
UHSM
FUNDING
Jamie Sargeant Radiographers
National Institute
Louise Donnelly & Radiologists
of Health Research
Victoria Adrinka
Genesis
Julia Wiseman
CLHARC