S16 Ep44: Lifestyle Interventions, Exercise Programs, and Metabolic Medications Are Key to Holistic Breast Cancer Survivorship: With Sara Nunnery, MD, MSCI; and Neil M. Iyengar, MD

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In today's episode, filmed live onsite at the 43rd Annual Miami Breast Cancer Conference, Dr Nunnery sat down with Neil M. Iyengar, MD, an associate professor and co-director of Breast Medical Oncology in the Department of Hematology and Medical Oncology at the Emory University School of Medicine, as well as the director of Survivorship Services at the Winship Cancer Institute of Emory University in Atlanta, Georgia.

Their conversation centered around lifestyle and medical interventions pertinent to breast cancer survivorship. Dr Iyengar explained that although endocrine therapies can be life-saving, they disrupt estrogen signaling, which can lead to cardiometabolic dysfunction, including increased risks for diabetes, heart disease, and bone health issues. He noted that weight gain associated with these treatments is often tied to the induction of a post-menopausal state, which disrupts energy homeostasis and promotes inflammation.

A key theme of the conversation was Dr Iyengar’s explanation of a "drug development paradigm" for lifestyle changes. Rather than offering generic advice, his research focuses on precision lifestyle interventions, treating diet and exercise as prescribed medical therapies with specific "doses". He highlighted that body mass index (BMI) is an insufficient tool for risk stratification, as high body fat despite a normal BMI is a significant risk factor for cancer recurrence.

The discussion also covered the rising use of GLP-1 receptor agonists to manage metabolic health. These drugs replicate natural hormones to maintain glycemic balance and reduce hunger. Dr Iyengar addressed the black box warning for thyroid cancer associated with this class of drugs, noting that although the data are mixed, the protective benefits against obesity-related cancers appear to outweigh the risks. Finally, he emphasized that exercise is a critical tool for managing treatment adverse effects like fatigue, noting that although starting is difficult, the "return on investment" for patient health is immense.