Physical activity is an important denominator of body fat, and lifestyle modification interventions would invariably reduce the body lipid content. The Italian case–control study found decreased breast cancer risk in relation to leisure-time and occupational physical activities when each was evaluated separately. Although no results were presented, the authors reported that no meaningful information was added by evaluating a combined score. Similarly, a Norwegian follow-up study reported a reduced risk for a combined measure that was not substantially different from that observed for either exercise or occupational activity alone.
From reviewing the evidence on the biologic plausibility of an association between breast cancer and physical activity to determine whether this information can aid in predicting a decrease among subgroups of women, an optimal time period during which the exercise should be performed, or the frequency, duration, or intensity of physical activity necessaryto reduce breast cancer risk. Ultimately, such information should enhance the development of questionnaires used to assess physical activity in epidemiologic studies (Gammon, M. D, John, E. M, Britton, J. A. , 1998).
Strategy 3: The intervention group would receive an intensive behavioral modification program that would consist of 18 group sessions in the first year and quarterly maintenance sessions thereafter. Each group would consist of 8 to 15 women and would be led by specially trained and certified nutritionists. Each participant would be given her own total fat gram goal based on her height. Self-monitoring techniques would need to be employed in this intervention depending on the determinants, and the active participation would need to be ensured by other individual and targeted strategies.
Motivational interviewing is one such method. A small reduction in energy consumption was reported in the intervention group compared with the comparison group. Women in the intervention group experienced a modest weight loss early in the trial and maintained a greater weight change from baseline throughout follow-up than women in the comparison group (Robins, J. M. and Finkelstein, D. M. , 2000). Capacity Building: The local health authority will be contacted with intervention implementation plan. The data on diet from the health authority on the baseline health conditions of the population, especially the affected individuals.
The dietary data is already available from the regional dietary intake data. The geographic areas wound need to be subdivided on the basis of clusters of cases. The community health nurses and workers would be employed to collect secondary data in relation to breast cancer, and the questionnaire will be designed. The baseline oestradiol levels will be determined in the local hospital pathological laboratory at the beginning and at the end of 1 year. Those who have established breast cancer will be followed up closely in terms of outcome of other therapies for breast cancer.
An inventory of anthropometric data will be collected and maintained throughout the period, and the patients will need to attend clinic and behaviour therapy sessions regularly. Implementation: In order to implement interventions, the work package may be tabulated below. The people who will be implementing such interventions would be classified as the research scientist A and B, Pathologist, Community nurse, Dietician, Physician, and Behaviour therapist. Table 2: Work Package Description for the Project of Dietary Intervention in a Community with Clusters of cases of breast cancer.
Evaluation Plan: The participants would be stratified by stage of disease and age. The patients were advised to consume a diet consistent with current dietary recommendations as mentioned earlier. For evaluation of the result, the protocol would involve intensive telephone-based diet interrogation after the intervention implementation. This protocol would involve clinic visit enrollment in 1 year during which height and weight would be measured using standard procedures, and calculation of body mass index would be done, and these data would be computed.
Commercially available kits would be utilized for measurement of bioavailable oestradiol. As it has been suggested that adopting a low fat diet would reduce serum oestradiol concentration, this would be manifested in the population after intervention implementation. To nullify the confounding factors, the patients who would have lost much of weight due to cancer itself were excluded from the study. Since hormonal levels are the important markers of the disease and the intervention effects, the women in the menstrual phase would be delayed in terms of collection of blood samples until the progestational phase of the menstrual cycle begins.