Breast Cancer Diet Intervention Study

It has been postulated that a "Western‐style" diet, rich in carbohydrates (especially high glycemic carbohydrates) may have an effect on the incidence of breast cancer, and perhaps also prognosis. This may be mediated through the insulin‐related pathways in breast cells which may show insulin‐dependent proliferation, which may alter outcome. Aims: To study: 1. The inter‐patient variation in insulin and insulin‐related characteristics in the blood taken just before the operation from breast cancer patients, on a usual pre‐operative fasting schedule; 2. The influence of the variation in insulin and insulin‐related characteristics on proliferation and other cell biological features in the breast cancers of these patients; 3. Whether 4 and 18‐hours pre‐operative hyperglycaemic glucose loading (to reduce postoperative insulin resistance) influences proliferation (Mitotic Activity Index (MAI) and other cell biological features in breast cancer* 4. The influence of the short‐term effect of a pre‐operative low‐glycaemic carbohydrate isocaloric diet on proliferation and other cell biological features of the primary breast cancer cells (Low‐glycemic isocaloric diet intervention study); 5. Epidemiological risk factors: The correlation between epidemiological risk factors, insulin and insulin‐related characteristics, proliferation, cell biological features and other biomarkers in breast cancer patients. 6. Estrogen Receptor positive tumors will be analyses separately. 7. Relapse free survival 8. Breast Cancer Specific Survival. The Short‐term effect of carbohydrates will be assessed in a randomized intervention study, where 30 patients receive oral carbohydrates 18 and 4 hours before surgery and 30 patients receive fasting procedure/water. Primary Outcome 1. Proliferation in the tumor as measured by MAI. Secondary Outcomes: 1. Serum insulin characteristics (S‐insulin, S‐ insulin c‐peptide, S‐IGF and S‐IGFBP3) will be measured at various peri‐surgical timepoints 2. Changes in metabolic profile* in the tumor and in serum samples 3. Patient Reported Outcome Measures (PROM) on well being 4. Relapse free survival 5. Breast Cancer Specific Survival ‐ Metabolic profile assessed by High Resolution Magnetic Resonance Spectroscopy (HR‐MRS) in the tumor and in serum samples.