Vol 32, No 4

1. Muriel was diagnosed with breast cancer in 2020. After undergoing chemotherapy and surgery, she is cancer negative. She is now 64 years old and wants to implement lifestyle changes to reduce risk, but she’s concerned she is “too old” to reap any benefit of regular physical activity. How would you advise Muriel when it comes to physical activity?

a.. Regular physical activity is associated with lower risk of breast cancer mortality and all-cause mortality in breast cancer survivors.

b. b. Benefits of regular physical activity apply regardless of age.

c. Benefits of regular physical activity are not dependent on weight loss.

d. All of the above

2. Muriel is confused by all the conflicting dietary advice regarding reducing breast cancer risk for survivors. She said she is willing to change her meal pattern but doesn’t know where to start. Muriel usually eats a lot of meat and potatoes but is willing to try plant-based options. Which of the following might you say to Muriel?

a. Keep eating a diet rich in meat and potatoes; the protein helps with recovery.

b. Avoid soybean products, they are not healthy for breast cancer survivors.

c. Adopt a plant forward meal pattern and offset smaller meat portions with increased vegetables, whole grains, pulses (like chickpeas and black beans), and soy foods.

d. Buy only commercial smoothies to save time and forego consumption of all soy; rely on gluten free grains only.

3. Muriel says she enjoys stir fry with lots of vegetables and beef steak strips and her homemade chili is made with beef. Which of the following modifications could assist Muriel in making more plant-based choices?

a. Swap all or some of the meat in the stir fry with tofu.

b. Replace all or some of the beef in the chili with canned beans, pulses or soybeans.

c. Continue to add beef to both recipes just use more anti inflammatory spices like turmeric.

d. A and B

4. Several studies have evaluated the impact of diet on breast cancer recurrence and survival, and two are randomized controlled trials (RCT); these studies examined the impact of diet on recurrence and overall survival. A meta-analysis of these studies suggested modest effects on overall survival. What are the names of these two studies?

a. Women's Intervention Nutrition Study (WINS) and the Women's Healthy Eating and Living (WHEL) study.

b. Women's Intentional Nutrition Study (WINS) and the Women's Heart Healthy Eating (WHE) study.

c. Women’s Breast Health Study (WBHS) and International Healthy Habits Study (IHHS).

d. Women’s Healthy Outcomes Study (WHOS) and Best Diet for Breast Health (BDBH).

5. The Nurses' Health Study (NHS), a long-running prospective cohort study of female nurses, has examined numerous health outcomes in relation to diet and other factors. Analyses based on these data showed that intake of a_________diet was associated with reduced mortality from causes other than breast cancer.

a. Western dietary pattern, high in red and processed meats, refined grains, sweets, high-fat dairy products, and high-calorie fast food

b. Modified Western dietary pattern, high in red meat, whole grains, diet soda, high-fat dairy products, and high-calorie fast food

c. Prudent dietary pattern, which typically includes high consumption of fruits, vegetables, whole grains, poultry, and fish

d. High sodium dietary pattern, high in salty snacks, cured meats, diet soda and processed foods like frozen meals

6. You are a dietitian preparing to educate a group of dietetic interns about key observations from The Nurses' Health Study (NHS) regarding protein intake and increased survival after diagnosis from breast cancer. According to one analysis of the NHS results, there was increased survival among women eating _______protein but not ____ _____.

a. Less, soy foods

b. More, red meat

c. Less, cured meat

d. More, soy foods

7. Key findings of the Pathways Study indicate that ________is/are aligned with healthy eating recommendations around the time of diagnosis are associated with lower risks of non-breast cancer-specific and all-cause mortality.

a. All plant based meal patterns

b. Diet quality

c. All high protein diets

d. Diet duration

8. Jennifer is a 55-year-old breast cancer survivor, 7 years cancer free, seeking nutrition counseling to help reduce recurrence and manage her weight. Jennifer reports consuming a high plant-based diet consisting of refined grains, vegetarian frozen dinners, sweetened juices and prepared, sweetened soy milk-based smoothies. She rarely eats fresh fruit or vegetables. Jennifer’s diet, although plant based, is an example of a/an _______plant based diet and may be associated with increased risk of all cause and non-breast cancer mortality.

a. Unhealthful

b. Healthful

c. Balanced

d. Diverse

9. Designing a more healthful plant-based meal plan might include the following choices:

a. Soy foods

b. Processed vegetarian frozen meals

c. Fresh fruits and vegetables

d. A and C

10. In healthy women, at-risk women, and women with breast cancer, _________delivered in the form of supplements or soy protein -- even in amounts greatly exceeding typical Asian intake -- have no effects on markers of breast cancer risk including mammographic density and breast cell proliferation.

a. Arginine

b. Isoleucine

c. Glutamine

d. Isoflavones

11. You receive a call from Dr. Smith, an oncology resident, who has a patient on the drug tamoxifen. The patient has estrogen receptor positive breast cancer and is vegan, regularly consuming soy foods. Dr. Smith asks your opinion about soy consumption and endocrine therapy and wants to know if he should advise the patient to discontinue all soy foods. What does the current evidence say about this issue?

a. The literature and several strong double blind, placebo-controlled studies conclusively show that consumption of soy foods and isoflavones directly interfere with tamoxifen and should be avoided completely.

b. Very limited clinical data suggest isoflavones do not interfere with tamoxifen treatment. Limited observational data indicate soy does not impact the efficacy of endocrine therapy for breast cancer, including both tamoxifen and aromatase inhibitors.

c. In a combined analysis of the largest Chinese study and the two U.S. studies, soy intake was protective against both estrogen receptor-positive (ER+) and estrogen receptor-negative breast cancer but more so against the latter. However, in this same analysis, soy was more protective for women on tamoxifen who had ER+ breast cancer.

d. B and C

12. There is a bit of controversy as to whether postdiagnosis soy intake impacts breast cancer outcomes. The genesis of the soy and breast cancer controversy can be tied to:

a. 5 strong double-blind placebo-controlled studies showing a direct association between soy consumption and breast cancer in humans.

b. Strong observational studies showing a strong association between soy food and supplement consumption and breast cancer in humans.

c. Several double-blind studies showing a direct association between consumption of soy based infant formulas as a child and adult breast cancer in women.

d. A late 1990s report citing the stimulatory effect of isoflavones on the growth of existing estrogen sensitive mammary tumors in athymic ovariectomized mice.

Continuing Professional Education Credit