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Ibeneme SC1,2, Duru D3, Myezwa H4, Ezuma A3, Lasebikan NN5, Biyi-Olutunde OA6, Oboh OE7, Nwankwo MJ8
1University of Nigeria, Enugu Campus, Medical Rehabilittation, Enugu, Nigeria, 2University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 3University of Nigeria Teaching Hospital, Physiotherapy, Enugu, Nigeria, 4University of Witzwatersrand, Physiotherapy, Johannesburg, South Africa, 5University of Nigeria Teaching Hospital, Radiation Medicine, Enugu, Nigeria, 6University of Port-Harcourt Teaching Hospital, Radiotherapy and Clinical Oncology, Port-Harcourt, Nigeria, 7University of Bern, Radiotherapy, Benin, Nigeria, 8Nnamdi Azikiwe University, Medical Rehabilitation, Nnewi, Nigeria
Background: There is biological plausibility for the role of heritability in systemic inflammation in breast cancer, which is modulated by physical activity. Therefore, just like patients with breast cancer (BRCApts), biomarkers of inflammation including C-reactive protein (CRP) may be altered in their first-degree relatives-FDRs, due to physical inactivity. As such physical inactivity may negatively influence cardiopulmonary indices and may constitute an early warning sign prior to cancer induction. Previous studies have shown a link between inflammation and restrictive lung diseases. Profiling these variables in BRCApts/FDRs may provide insights into the likely epidemiological trends that may warrant specific preventive intervention.
Purpose: To profile CRP and cardiopulmonary indices and determine their relationship with PAL in BRCApts and their FDRs.
Methods: University of Nigeria, Teaching Hospital, Enugu: Forty-nine participants[HM1] (28 BRCApts aged 43.07±9.87yrs and 21 FDRS aged 39.62±11.93yrs) consented to a multiple case study. The MET values and the PAL were determined using the International physical activity questionnaire (IPAQ-short scoring protocol Version 2.0, 2004), and categorized into high(HPAL), moderate(MPAL) and low(LPAL) physical activity levels. Spirometric studies were conducted using the ECG 12 channel with Spirometer(ECG Cardiogima 12m, Italy) according to Morris/Polgar formula. Subsequently, 23 participants (13 BRCApts and 10 FDRs), who consented. participated in a laboratory study to determine the CRP(normal range=0-12mg/L). Data obtained were tested for normality using Kolmogorov´s test and analyzed with Kruskal-Wallis H test, Chi-square, Crammers' V, Lambda and Pearson correlations, after controlling for lifestyle factors (dietary habits, smoking, among others). Alpha was set at p 0.05.
Results: More of the BRCApts(32.1%) than FDRs(9.5%) had a lifestyle of LPAL, just like more of the FDRs than BRCApts had a lifestyle of HPAL(57.1% versus 42.29%) and MPAL (33.33% versus 25%), respectively. CRP was high in 6 out of 13(46.15%) BRCApts compared to 3 out of 10(30%) FDRs. The mean CRP in the BRCApts(12.09±3.16mg/L) was above normal range unlike FDRs(11.78±2.29mg/L). CRP was not significantly varied across all PALs in BRCApts(F=0.375,p=0.696), unlike FDRs(F=5.436,df=2,p=0.038). Predicting CRP from a knowledge of PAL shows a high accord(lambda[A from B] = 0.7) in FDRs and moderate accord(lambda[A from B] = 0.6923) in BRCApts. FEV1/FVC(%) in BRCApts(90.15±9.05%) was significantly higher(p=0.0470) than FDRs(83.91±12.38%). CRP was inversely related to FVC(r=-0.994,p=0.006) in BRCApts, and with FEV1(r=-0.9722,p=0.054) in their FDRs, respectively.
Conclusion(s): FEV1/FVC ratio was >80% in FDRs and BRCApts suggesting possible restrictive lung diseases, which may arise due to chronic sub-clinical immuno-inflammatory state, and high-grade inflammation, respectively, but which might be influenced by PAL in FDRs. BRCApts were less physically active, and possibly experienced fibrotic changes, hence, the inverse relationship between CRP and FVC. PAL could be an influential determinant of the inflammatory state(i.e CRP), in FDRs than BRCApts, with 70% and 69.23% predictive accuracy.
Implications: Respiratory therapy when required for BRCApts and FDRs should incorporate physical activity as a lifestyle modification to modulate or prevent chronic inflammation and consequent restrictive lung diseases. In addition, systemic inflammation and restrictive lung diseases may have predictive utility as correlates of cancer induction, which should be explored in large population studies.
Keywords: Breast cancer, physical inactivity, C-reactive protein, Inflammation, lung diseases
Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors
Purpose: To profile CRP and cardiopulmonary indices and determine their relationship with PAL in BRCApts and their FDRs.
Methods: University of Nigeria, Teaching Hospital, Enugu: Forty-nine participants[HM1] (28 BRCApts aged 43.07±9.87yrs and 21 FDRS aged 39.62±11.93yrs) consented to a multiple case study. The MET values and the PAL were determined using the International physical activity questionnaire (IPAQ-short scoring protocol Version 2.0, 2004), and categorized into high(HPAL), moderate(MPAL) and low(LPAL) physical activity levels. Spirometric studies were conducted using the ECG 12 channel with Spirometer(ECG Cardiogima 12m, Italy) according to Morris/Polgar formula. Subsequently, 23 participants (13 BRCApts and 10 FDRs), who consented. participated in a laboratory study to determine the CRP(normal range=0-12mg/L). Data obtained were tested for normality using Kolmogorov´s test and analyzed with Kruskal-Wallis H test, Chi-square, Crammers' V, Lambda and Pearson correlations, after controlling for lifestyle factors (dietary habits, smoking, among others). Alpha was set at p 0.05.
Results: More of the BRCApts(32.1%) than FDRs(9.5%) had a lifestyle of LPAL, just like more of the FDRs than BRCApts had a lifestyle of HPAL(57.1% versus 42.29%) and MPAL (33.33% versus 25%), respectively. CRP was high in 6 out of 13(46.15%) BRCApts compared to 3 out of 10(30%) FDRs. The mean CRP in the BRCApts(12.09±3.16mg/L) was above normal range unlike FDRs(11.78±2.29mg/L). CRP was not significantly varied across all PALs in BRCApts(F=0.375,p=0.696), unlike FDRs(F=5.436,df=2,p=0.038). Predicting CRP from a knowledge of PAL shows a high accord(lambda[A from B] = 0.7) in FDRs and moderate accord(lambda[A from B] = 0.6923) in BRCApts. FEV1/FVC(%) in BRCApts(90.15±9.05%) was significantly higher(p=0.0470) than FDRs(83.91±12.38%). CRP was inversely related to FVC(r=-0.994,p=0.006) in BRCApts, and with FEV1(r=-0.9722,p=0.054) in their FDRs, respectively.
Conclusion(s): FEV1/FVC ratio was >80% in FDRs and BRCApts suggesting possible restrictive lung diseases, which may arise due to chronic sub-clinical immuno-inflammatory state, and high-grade inflammation, respectively, but which might be influenced by PAL in FDRs. BRCApts were less physically active, and possibly experienced fibrotic changes, hence, the inverse relationship between CRP and FVC. PAL could be an influential determinant of the inflammatory state(i.e CRP), in FDRs than BRCApts, with 70% and 69.23% predictive accuracy.
Implications: Respiratory therapy when required for BRCApts and FDRs should incorporate physical activity as a lifestyle modification to modulate or prevent chronic inflammation and consequent restrictive lung diseases. In addition, systemic inflammation and restrictive lung diseases may have predictive utility as correlates of cancer induction, which should be explored in large population studies.
Keywords: Breast cancer, physical inactivity, C-reactive protein, Inflammation, lung diseases
Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors
Topic: Oncology, HIV & palliative care; Cardiorespiratory; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: University of Nigeria
Ethics committee: Health Research Ethics Committee
Ethics number: NHREC/05/01/2008B
All authors, affiliations and abstracts have been published as submitted.
