Casting for Recovery

September 2014

Jacob Schor ND, FABNO



My dear wife Rena Bloom has gone fishing this weekend.  It may be the first time in her adult life that she’s attempted to catch a fish.  She’s doing this with a non-profit group called Casting for Recovery.


The mission of Casting for Recovery (CfR) is “… to enhance the quality of life of women with breast cancer through a unique program that combines breast cancer education and peer support with the therapeutic sport of fly fishing. The retreats offer opportunities for women to find inspiration, discover renewed energy for life and experience healing connections with other women and nature. CfR’s retreats are open to breast cancer survivors of all ages, in all stages of treatment and recovery and are free to participants.”


Casting for Recovery provides free flyfishing retreats for women with breast cancer

70% of the women who attend Casting for Recovery retreats have never been to a support group.  CfR currently offers 42 retreats across the country, serving nearly 600 women each year.


The concept of Casting for Recovery is pretty unique. On a physical level, the gentle, rhythmic motion of fly casting is similar to physical therapy often prescribed after surgery or radiation to promote soft tissue stretching. On an emotional level,  these weekends provide women the opportunity to experience a new activity among a supportive group of peers. The retreats provide resources to help address quality of life issues after a breast cancer diagnosis, and a new outlet – fly fishing – as a reprieve from the every day stresses and challenges of their cancer. They also provide a chance to get outside and immerse in nature in beautiful surroundings

Fishing is much more than fish. It is the great occasion when we may return to the fine simplicity of our forefathers. Herbert Hoover



Exercise appears to play an imortant role in breast cancer recovery and survival.   “Many studies have been performed to investigate the effects of exercise in patients diagnosed with breast cancer. There is evidence that exercise after the diagnosis of breast cancer improves mortality, morbidity, health related quality of life, fatigue, physical functioning, muscle strength, and emotional wellbeing.” According to a review published in Auguste, given the current scientific data, breast cancer patients should participate in rehabilitation programs including aerobic and strength training. [1] 


Another review published in June also suggested that exercise “… could be an integrative complementary intervention to improve physiological, physical and psychological factors that affect survival and quality of life of these patients.”[2] 



While it is thought that diet interventions and regular physical activity may reduce the risk of breast cancer and its recurrence, there is still no consensus regarding the effectiveness of lifestyle interventions, including diet or exercise program for patients with breast cancer.[3] 


While there may not be consensus about how much or what kind of exercise is most effective, there are repeated strong hints appearing in the scientific literature that the impact may be large.  This past July, Higgins et al reported that exercise caused lung cancer to regress in a mouse model of the disease.  It’s already been reported that exercise improves quality of life in patients undergoing treatment for various kinds of cancer and also that exercise reduces cancer specific mortality in breast and colong cancer patients, but this may be the first study that looked at exercise and lung cancer progression.  Specially bred mice were injected with a line of human lung cancer cells and were monitored until lung tumors were identified via weekly imaging studies.  Once the lung tumors were identified in the mice, they were randomized to either daily exerise (running in a wheel) or to a control group that skipped the workouts. The lung tumors grew significantly slower in the mice that exercised than in the sedentary mice.  Exercise increased p53 protein levels along with other chemical mediators that initiate apoptosis, the form of cellular suicide that we sincerely hopes will occur in cancer cells. [4] 



A paper by Paul Williams that appeared last January issue in the International Journal of Cancer suggested that breast cancer patients might do well to take up running.


Williams analyzed data from runners and who had been diagnosed with breast cancer. When data from runners and walkers were combined, the risk of dying from breast cancer decreased an average of 24% per metabolic equivalent (MET) hours per day of exercise, where one MET hour equals a little less than a mile of brisk walking or about two-thirds of a mile of running.


When analyzed separately, there was significantly lower mortality in the runners.  The runners’ risk for breast cancer mortality decreased over 40% per MET hour per day.  Runners that averaged over 2.25 miles running per day were at 95% lower risk for breast cancer mortality than those that did not meet current exercise recommendations. [5]


The idea that exercise is more than just a ‘feel good’ activity for breast cancer patients isn’t new.  Irwin et al’s 2007 paper suggested a possible 45% reduction in death rate. [6]


The evidence that exercise improves breast cancer survival is inconsistent. We like to focus on the studies that have shown physical activity significantly reduces breast cancer mortality. [7-14]                

Yet not all studies have confirmed these benefits. [15-18]       


When data from separate trials are combined via meta-analyses, there is stronger evidence for improved survival with greater physical activity.  For example data from 13,302 breast cancer survivors of the After Breast Cancer Pooling Project suggest that meeting the current physical activity recommendations is associated with a 25% reduction in breast cancer mortality. [19]



(Those recommendations for physical activity suggest that, “…all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week.”)


Two other meta-analyses reached similar conclusions. Patterson et al found 29% (including lifetime and at diagnosis physical activity) [20]  and Ibrahim et al found 34% reductions [21]  in breast cancer mortality with post-diagnosis physical activity when various study results were combined.



There is little doubt tht this newsletter will provoke emails from our readers who will tell me that fishing involves a great many other parts of a person’s being than simply exercise and provides more benefit than simply standing in cold water and waving one’s arm about.  I won’t argue that, it’s just that there are few references to quote on this.


One might consider DC Parry’s 2008 article on dragon boat racing (DBR) and breast cancer survivorship that reported that “… DBR contributes to women's social, emotional, physical, spiritual, and mental health. In turn, feeling healthy in these five dimensions enhanced the women's survivorship of breast cancer. The findings demonstrate the roles of leisure in the health and well-being of women who are breast cancer survivors.” No the argument sounds good that this is useful no hard data on outcome data were included for the women interviewed in the paper. [22]  


While in general we have data that suggests regular exposure to ‘green space’ improves many health outcomes, I have yet to find any paper directly looking at green space and breast cancer outcomes.  Nor have I found data comparing general green space and the perhaps greater impact of standing in a river on health outcomes.  One would guess that fishing in general is good for you.  It is certainly unlikely to detract from one’s quality of life. 


Casting for Recovery operates on the principle that the natural world is itself a healing force an idea that if fully congruent with the principles of naturopathic medicine and an idea that I applaud.






1. Eyigor S, Kanyilmaz S. Exercise in patients coping with breast cancer: An overview. World J Clin Oncol. 2014 Aug 10;5(3):406-11. doi: 10.5306/wjco.v5.i3.406.

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2. Casla S, Hojman P, Márquez-Rodas I, López-Tarruella S, Jerez Y, Barakat R, Martín M. Running away from side effects: physical exercise as a complementary intervention for breast cancer patients. Clin Transl Oncol. 2014 Jun 4. [Epub ahead of print]


3.  Falavigna M, Lima KM. Effects of lifestyle modification after breast cancer treatment: a systematic review protocol. Syst Rev. 2014 Jul 5;3:72. doi: 10.1186/2046-4053-3-72.

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4.  Higgins KA1, Park D, Lee GY, Curran WJ, Deng X. Exercise-induced lung cancer regression: Mechanistic findings from a mouse model. Cancer. 2014 Jul 2. doi: 10.1002/cncr.28878. [Epub ahead of print]


5.  Williams PT. Significantly greater reduction in breast cancer mortality from post-diagnosis running than walking. Int J Cancer. 2014 Jan 27. doi: 10.1002/ijc.28740.


6.  Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, Baumgartner RN, Baumgartner KB,Bernstein L. Influence of pre- and postdiagnosis physical activity on mortality in breastcancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008 Aug 20;26(24):3958-64. doi: 10.1200/JCO.2007.15.9822.


7.  Holick CN, Newcomb PA, Trentham-Dietz A, Titus-Ernstoff L, Bersch AJ, Stampfer MJ, Baron JA, Egan KM, Willett WC. Physical activity and survival after diagnosis of

invasive breast cancer. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2008;17:379–386.



 8.  Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical Activity and Survival After Breast Cancer Diagnosis. JAMA: The Journal of the American Medical Association. 2005;293:2479–2486.


 9. Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD,

Baumgartner RN, Baumgartner KB, Bernstein L. Influence of pre- and postdiagnosis

physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol 2008;26:3958–64.


10.  Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD,

Baumgartner RN, Baumgartner KB, Bernstein L. Influence of pre- and postdiagnosis

physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol 2008;26:3958–64.


11.  Irwin ML, McTiernan A, Manson JE, Thomson CA, Sternfeld B, Stefanick ML,

Wactawski-Wende J, Craft L, Lane D, Martin LW, Chlebowski R. Physical activity and

survival in postmenopausal women with breast cancer: results from the women's health initiative. Cancer Prev Res (Phila) 2011;4:522–529.


12.  Friedenreich CM, Gregory J, Kopciuk KA, Mackey JR, Courneya KS. Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer



13.  Abrahamson PE, Gammon MD, Lund MJ, Britton JA, Marshall SW, Flagg EW, PorterPL, Brinton LA, Eley JW, Coates RJ. Recreational physical activity and survival among young women with breast cancer. Cancer. 2006;107:1777-85.


14.  Sternfeld B, Weltzien E, Quesenberry Jr CP Jr, Castillo AL, Kwan M, Slattery ML, Caan BJ. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomarkers Prev 2009;18:87–95.


15.  Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, Al-DelaimyWK, Thomson CA, Kealey S, Hajek R, Parker BA, Newman VA, Caan B, Rock CL Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. Journal of Clinical Oncology: official journal of the American Society of Clinical Oncology. 2007;25:2345–51


16.  Borugian MJ, Sheps SB, Kim-Sing C, Van Patten C, Potter JD, Dunn B, Gallagher RP, Hislop TG. Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? Cancer Epidemiol Biomarkers Prev 2004;13:1163–72.


17.  Enger SM, Bernstein L. Exercise activity, body size and premenopausal breast cancer survival. Br J Cancer 2004;90:2138–41.


18.  Cadmus-Bertram L, Patterson RE, Sternfeld B, Shu XO, Pierce JP, Caan BJ. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat. 2012;131:637-43.


19.  Patterson RE, Cadmus LA, Emond JA, Pierce JP. Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66:5–15.


20.  Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28:753-65.


21. Parry DC. The contribution of dragon boat racing to women's health and breast cancer survivorship. Qual Health Res. 2008 Feb;18(2):222-33. doi: 10.1177/1049732307312304.