Improving quality of life: Sex, drugs, diet, and physical activity | SABCS 2024

Day one of the 2024 San Antonio Breast Cancer Symposium opened with a lively —although not musical—session called “Sex, Drugs, Rock and Roll.” Experts from around the country addressed these key topics.

Sexuality after cancer

Session experts shared that more than 50% of people diagnosed with breast cancer—and possibly as many as 90% depending on how the question is asked—report sexual problems. A 2010 survey found that people diagnosed with cancer did not receive medical care to address sexuality concerns, even when they raised them with their healthcare teams.

Sexuality includes intimacy, sensuality, body image, arousal, desire, climax, and satisfaction. Men and women see intimacy differently, and sexual activities are not necessarily required for satisfaction.

Breast cancer surgery can affect women’s feelings about sensuality. Before mastectomy (with or without breast reconstruction), many women are not aware that the chest and breast area will be numb after surgery. The numbness can be long-term or permanent.

To address vaginal dryness, a common sexual side effect of aromatase inhibitors and other treatments, LBBC Medical Advisory Board member Don Dizon, MD, FACP, FASCO recommends vaginal moisturizers (regular use) and lubricants (as needed).

Two European studies found that using vaginal estrogen is safe for people who’ve been diagnosed with breast cancer. Still, it is important to ask your doctor if vaginal estrogen is right for you.

Dr. Dizon typically discourages the use of food-based oils as lubricants although a small study reported favorable results for olive oil. Lidocaine can be used in the clinic to treat entry point tenderness experienced by women on aromatase inhibitors.

Dr. Dizon advises people with cancer to work with their partners toward shared goals. He recommends using language such as “I wish,” “I want,” and “I hope” in conversations and, importantly, avoiding blame.

Natural does not always mean safe: Cannabis and other supplements

Many people with breast cancer are interested in natural ways to manage symptoms and side effects. One study found that 50-85% of people diagnosed with breast cancer use dietary supplements after diagnosis. Vitamins and other supplements are not regulated by the FDA, so little is known about their effectiveness and potential interactions with other medicines.

According to experts, there are some vitamins that can be helpful for people diagnosed with breast cancer. For example, studies have shown that women with sufficient vitamin D levels have better breast cancer clinical outcomes.

Still, experts said, natural does not always mean safe:

• Turmeric, melatonin, and medicinal mushrooms may increase estrogen activity and be harmful to people with breast cancer.
• These supplements, along with fish oil, may increase the risk of bleeding.
• Even multivitamins can contain harmful botanicals.

Cannabis (marijuana) is another supplement that has generated a lot of interest in the breast cancer community, but little is known about its effectiveness. Two active ingredients—THC and CBD—can be taken in multiple ways including smoking, vaping, eating, and applying to the skin. People try cannabis to relieve:

• Pain
• Insomnia
• Stress
• Lack of appetite

However, some data suggest cannabis may interfere with common cancer drugs such as paclitaxel, doxorubicin, and tamoxifen.

There are many misconceptions about cannabis. In one national study, 49% of users thought that cannabis could treat cancer. Most concerning is people’s reluctance to talk to their doctors about cannabis use. This is especially true in states where it is illegal.

The American Society of Clinical Oncology now partners with the Society for Integrative Oncology to better understand and educate people with cancer about supplements.

Expert Heather Greenlee, ND, PhD, MPH said that the Fred Hutchinson Cancer Center supports these recommendations:

• Avoid vitamin D deficiency.
• Lavender aromatherapy may help with anxiety.
• Ginseng may help with fatigue.
• Cannabis may help with persistent nausea and vomiting.

The bottom line: If you have been diagnosed with breast cancer, tell your doctor about any vitamins or supplements you are taking or thinking about taking.

Move more and eat well: Physical activity and diet

Research consistently supports the value of physical activity for people with breast cancer. Being active can relieve fatigue, improve physical function and muscle mass, and help with insomnia, anxiety, and depression, among other benefits. Yet many people—especially women and older people—are still sitting. Notable findings include:

• 40-60% of people diagnosed with cancer are entirely inactive.
• People who are regularly active have a 48.5% less likelihood of death.
• Meeting physical activity guidelines is associated with a 31% lower risk of breast cancer recurrence.
• While there’s no evidence to guide how many specific steps a day are required for an overall health benefit, there are many benefits with 7,000 steps per day. 10,000-12,000 steps per day is even better, with benefits plateauing after 12,000 steps.

Some activity is better than no activity. While all activity is helpful, the biggest benefit jump happens when people move from no activity to some activity.

Diet matters. The Pathways Study found that eating a diet rich in fruits, vegetables, and whole grains—and avoiding red and processed meats—reduces the risk of death among people with breast cancer. It also lowers the risk of heart disease.

Recommended diets include the American Cancer Society diet, the Mediterranean diet, the Healthy Eating Index, and Dietary Approaches to Stop Hypertension (DASH).

Dietary fiber—found in fruits, vegetables, grains, and beans, including soy—is linked with better health outcomes among people with breast cancer. Doctors no longer recommend reducing soy if you eat soy. They do recommend avoiding soy-based dairy alternatives that contain a lot of sugar. For more information, watch our video "Is it safe to eat soy after a breast cancer diagnosis?"

Alcohol is known to increase risk of breast cancer and, less definitively, the risk of recurrence among people who have already had breast cancer. Less is known about whether alcohol might increase the likelihood of a second primary cancer.

What does this mean for you?

Patient advocate Tamika Bryant brought the research home with these key takeaways:

• There are no miracle cures. Trust your medical team enough to tell them what you are taking or considering. Work with them to explore options.
• Cancer is a social disease that transforms relationships. Intimacy is an unspoken journey that deserves to be acknowledged and supported. Think of sexuality and intimacy more broadly. Exploring sexuality may lead to different but equally meaningful outcomes.
• Movement matters and it’s never too late to start. Move more, sit less, and focus on progress, not perfection.
• Try to eat right. The lack of consistent recommendations around healthy eating can add to stress. We need to continue to advocate for better research and clearer guidelines, not rigorous rules that add to anxiety.

For more information, visit:

Sex and intimacy

Nutrition and exercise