Intended for healthcare professionals

Rapid response to:

Analysis

Breast screening: the facts—or maybe not

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b86 (Published 28 January 2009) Cite this as: BMJ 2009;338:b86

Rapid Response:

Metabolic screening for breast cancer?

If "cellular disorder in a cancer is an indication of a decline in
internal energy production manifest as a glycolytic switch or more
specificially an anaerobic shift", as previously proposed(1), one might
presume that fatty acids are the major source of nutrient for ATP
resynthesis by oxidative phosphorylation by glandular tissue in breasts
and that glucose the is major source for ATP resynthesis by anaerobic
glycolysis in breast cancers. If so the beneficial effect of exercise in
reducing the risk of developing breast cancer (2) might have been due to
preventing a shift in substrate dependence from fatty acids to glucose.
Furthermore, given the preliminary data (3), outcome from treatments for
breast cancer might prove to be superior in those who are placed on
exercise after having been treated for breast cancer (3).

If there is a reversible metabolic defect in breast cancer, as would
seem very likely(4), metabolic screening might have the potential to
detect women at risk years if not decades before they develop conventional
clinical evidence of breast cancer. That would give them ample opportunity
to undertake preventative measures including exercise programs.

1. Is TNM staging an impediment to innovation in cancer therapy?
Richard G Fiddian-Green
cmaj.ca, 28 Feb 2006 eLetter re: Is TNM staging an impediment to
innovation in cancer therapy?
Richard G Fiddian-Green
cmaj.ca, 28 Feb 2006

2. Cher M. Dallal, MS; Jane Sullivan-Halley, BS; Ronald K. Ross, MD;
Ying Wang, MS; Dennis Deapen, DrPH; Pamela L. Horn-Ross, PhD; Peggy
Reynolds, PhD; Daniel O. Stram, PhD; Christina A. Clarke, PhD; Hoda Anton-
Culver, PhD; Argyrios Ziogas, PhD; David Peel, PhD; Dee W. West, PhD;
William Wright, PhD; Leslie Bernstein, PhD. Long-term Recreational
Physical Activity and Risk of Invasive and In Situ Breast Cancer. The
California Teachers Study. Arch Intern Med. 2007;167(4):408-415.

3. Margaret L. McNeely, Kristin L. Campbell, Brian H. Rowe, Terry P.
Klassen, John R. Mackey, and Kerry S. Courneya. Effects of exercise on
breast cancer patients and survivors: a systematic review and meta-
analysis. CMAJ. 2006 July 4; 175(1): 34–41.

4. Cancer's sweet tooth: the Janus effect of glucose metabolism in
tumorigenesis. Lancet. Volume 367, Number 9510, 18 February 2006.

Competing interests:
None declared

Competing interests: No competing interests

03 March 2009
Richard G Fiddian-Green
FRCS, FACS
None