DOI QR코드

DOI QR Code

Diabetes, Overweight and Risk of Postmenopausal Breast Cancer: A Case-Control Study in Uruguay

  • Ronco, Alvaro L. (Oncology and Radiotherapy Unit, Pereira Rossell Women's Hospital) ;
  • Stefani, Eduardo De (Epidemiology Group, Dept of Pathology, School of Medicine, UDELAR) ;
  • Deneo-Pellegrini, Hugo (Epidemiology Group, Dept of Pathology, School of Medicine, UDELAR) ;
  • Quarneti, Aldo (Oncology and Radiotherapy Unit, Pereira Rossell Women's Hospital)
  • Published : 2012.01.31

Abstract

Obese postmenopausal women increase their risk of developing breast cancer (BC), in particular if they display an android-type pattern of adiposity, which is also associated to increased risks of diabetes mellitus, hypertension and cardiovascular disease. In order to explore the associations among anthropometry (body mass index, body composition, somatotype), some specific items of medical history (diabetes, hypertension, dislypidemias, hyperuricemia) and the risk of BC in Uruguayan women, a case-control study was carried out between 2004-2009 at our Oncology Unit. 912 women of ages between 23-69 years (367 new BC cases and 545 non hospitalized, age-matched controls with a normal mammography) were interviewed. Twenty body measurements were taken in order to calculate body composition and somatotype. Patients were queried on socio-demographics, reproductive history, family history of cancer, a brief food frequency questionnaire and on personal history of diabetes, dislypidemias, hyperuricemia, hypertension and gallbladder stones. Uni- and multivariate analyses were done, generating odds ratios (ORs) as an expression of relative risks. A personal history of diabetes was positively associated to BC risk (OR=1.64, 95% CI 1.00-2.69), being higher among postmenopausal women (OR=1.92, 95% CI 1.04-3.52). The risks of BC for diabetes in postmenopausal women with overweight combined with dislypidemia (OR=9.33, 95% CI 2.10-41.5) and high fat/muscle ratio (OR=7.81, 95% CI 2.01-30.3) were significantly high. As a conclusion, a personal history of diabetes and overweight was strongly associated to BC. The studied sample had a subset of high-risk of BC featured by postmenopausal overweight and diabetic women, who also had a personal history of hypertension and/or dyslipidemia. The present results could contribute to define new high risk groups and individuals for primary as well as for secondary prevention, since this pattern linked to the metabolic syndrome is usually not considered for BC prevention.

Keywords

References

  1. Agnoli C, Berrino F, Abagnato CA, et al (2010). Metabolic syndrome and postmenopausal breast cancer in the ORDET cohort: a nested case-control study. Nutr Metab Cardiovasc Dis, 20, 41. https://doi.org/10.1016/j.numecd.2009.02.006
  2. American College of Radiology (1998). Breast imaging reporting and data system (BI-RADS). 3rd ed., American College of Radiology, Reston, VA.
  3. Bjorge T, Lukanova A, Jonsson H, et al (2010). Metabolic syndrome and breast cancer in the me-can (metabolic syndrome and cancer) project. Cancer Epidemiol Biomarkers Prev, 19, 1737-45. https://doi.org/10.1158/1055-9965.EPI-10-0230
  4. Bray F, Mc Carron P, Parkin DM (2004). The changing global patterns of female breast cancer incidence and mortality. Breast Cancer Res, 6, 229-39. https://doi.org/10.1186/bcr932
  5. Breslow NE, Day NE (1980). Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. IARC Sci.Publ. 32. IARC, Lyon.
  6. Campagnoli C, Pasanisi P, Peris C, et al (2008). Insulin-like Growth Factor-I and Breast Cancer: Epidemiological and Clinical Data. In: Pasqualini JR (ed) Breast Cancer: Prognosis, Treatment and Prevention. 2nd ed. Informa Healthcare, New York.
  7. Campbell KL, Westerlind KC, Harber VJ, Friedenreich CM, Courneya KS (2005). Associations between aerobic fitness and estrogen metabolites in premenopausal women. Med Sci Sports Exerc, 37, 585-92. https://doi.org/10.1249/01.MSS.0000158185.23595.24
  8. Campbell KL, Westerlind KC, Harber VJ, et al (2007). Effects of aerobic exercise training on estrogen metabolism in premenopausal women: a randomized controlled trial. Cancer Epidemiol Biomarkers Prev, 16, 731-9. https://doi.org/10.1158/1055-9965.EPI-06-0784
  9. Capasso I, Esposito E, Pentimalli F, et al (2011). Metabolic syndrome affects breast cancer risk in postmenopausal women: National Cancer Institute of Naples experience. Cancer Biol Ther, 10, 1240-3.
  10. Carter JEL (2002). The Heath-Carter anthropometric somatotype- Instruction Manual. Surrey, Canada, TeP and Rosscraft.
  11. Cauley JA, Zmuda JM, Danielson ME, et al (2003). Estrogen metabolites and the risk of breast cancer in older women. Epidemiology, 14, 740-4. https://doi.org/10.1097/01.ede.0000091607.77374.74
  12. Chaudhuri PK, Chaudhuri B, Patel N (1986). Modulation of estrogen receptor by insulin and its biologic significance. Arch Surg, 121, 1322-5. https://doi.org/10.1001/archsurg.1986.01400110114019
  13. Connolly BS, Barnett C, Vogt KN, et al (2002). A meta-analysis of published literature on waist-to-hip ratio and risk of breast cancer. Nutr Cancer, 44, 127-38. https://doi.org/10.1207/S15327914NC4402_02
  14. De Rose EH, Pigatto E, Celi R (1984). Kinanthropometry, physical education and sport training. SEED, Brasilia. (in Portuguese)
  15. De Stefani E, Ronco AL, Mendilaharsu M, Guidobono M, Deneo-Pellegrini H (1997a). Meat intake, heterocyclic amines, and risk of breast cancer: a case-control study in Uruguay. Cancer Epidemiol Biomark Prev, 6, 573-81.
  16. De Stefani E, Correa P, Ronco A, et al (1997b). Dietary fiber and risk of breast cancer. Nutr Cancer, 28, 14 9. https://doi.org/10.1080/01635589709514547
  17. De Stefani E, Deneo-Pellegrini H, Mendilaharsu M, Ronco AL (1998). Essential fatty acids and breast cancer: a case-control study in Uruguay. Int J Cancer, 76, 491-4. https://doi.org/10.1002/(SICI)1097-0215(19980518)76:4<491::AID-IJC8>3.0.CO;2-M
  18. Falk RT, Fears T, Xu X, et al (2005). Urinary estrogen metabolites and their ratio among Asian American women. Cancer Epidemiol Biomarkers Prev, 14, 221-6.
  19. Faulkner J (1968). Physiology of swimming and diving. In Falls H: Exercise Physiology. Academic Press, Baltimore.
  20. Feig SA (1999). Role and evaluation of mammography and other imaging methods for breast cancer detection, diagnosis, and staging. Semin Nucl Med, 29, 3-15. https://doi.org/10.1016/S0001-2998(99)80026-9
  21. Ferlay J, Shin HR, Bray F, et al (2010). GLOBOCAN 2008. Cancer Incidence and Mortality Worldwide: IARC CancerBase No.10. Lyon, France: International Agency for Research on Cancer. Available at: http://globocan.iarc.fr. [Accessed 17.08.2010].
  22. Food and Agricultural Organization (2010). http://faostat.fao. org/site/610/Desktop Default.aspx? PageID=610#ancor [Accessed 30.04.10].
  23. Freund E (1885). Diagnosis des Carcinomas. Wiener Medizinische, B1, 268 (in German).
  24. Furberg AS, Veierod MB, Wilsgaard T, Bernstein L, Thune I (2004). Serum high-density lipoprotein cholesterol, metabolic profile, and breast cancer risk. J Natl Cancer Inst, 96, 1152-60. https://doi.org/10.1093/jnci/djh216
  25. Glicksman AS, Rawson RW (1956). Diabetes and altered carbohydrate metabolism in patients with cancer. Cancer, 9, 1127-34. https://doi.org/10.1002/1097-0142(195611/12)9:6<1127::AID-CNCR2820090610>3.0.CO;2-4
  26. Goodwin PJ, Ennis M, Pritchard KI, et al (2002). Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol, 20, 42-51. https://doi.org/10.1200/JCO.20.1.42
  27. Grote VA, Becker S, Kaaks R (2010). Diabetes mellitus type 2 - an independent risk factor for cancer? Exp Clin Endocrinol Diabetes, 118, 4-8. https://doi.org/10.1055/s-0029-1243193
  28. Guastamacchia E, Resta F, Mangia A, et al (2003). Breast cancer: biological characteristics in postmenopausal type 2 diabetic women. Identification of therapeutic targets. Curr Drug Targets Immune Endocr Metabol Disord, 3, 205-9. https://doi.org/10.2174/1568008033340199
  29. Hamelers IH, Steenbergh PH (2003). Interactions between estrogen and insulin-like growth factor signaling pathways in human breast tumor cells. Endocr Relat Cancer, 10, 331- 45. https://doi.org/10.1677/erc.0.0100331
  30. Hanley AJ, Festa A, D'Agostino Jr RB, et al (2004). Metabolic and inflammation variable clusters and prediction of type 2 diabetes: factor analysis using directly measured insulin sensitivity. Diabetes, 53, 1773-81. https://doi.org/10.2337/diabetes.53.7.1773
  31. Hirose K, Toyama T, Iwata H, et al (2003). Insulin, insulin-like growth factor-I and breast cancer risk in Japanese women. Asian Pac J Cancer Prev, 4, 239-46.
  32. Jaumandreu S, Varas X, Mezzera J, et al (2001). Cytologic diagnosis in palpable nodules of the breast. Arch Ginecol Obstet, 39, 148-53 (in Spanish).
  33. Larsson SC, Mantzoros CS, Wolk A (2007). Diabetes mellitus and risk of breast cancer: a meta-analysis. Int J Cancer, 121, 856-62. https://doi.org/10.1002/ijc.22717
  34. Macaulay VM (1992). Insulin-like growth factors and cancer. Br J Cancer, 65, 311-20. https://doi.org/10.1038/bjc.1992.65
  35. McTernan PG, Anderson LA, Anwar AJ, et al (2002). Glucocorticoid regulation of p450 aromatase activity in human adipose tissue: gender and site differences. J Clin Endocrinol Metab, 87, 1327-36. https://doi.org/10.1210/jc.87.3.1327
  36. Maiti B, Kundranda MN, Spiro TP, Daw HA (2010). The association of metabolic syndrome with triple-negative breast cancer. Breast Cancer Res Treat, 121, 479-83. https://doi.org/10.1007/s10549-009-0591-y
  37. Michels KB, Solomon CG, Hu FB, et al (2003). Type 2 diabetes and subsequent incidence of breast cancer in the Nurses' Health Study. Diabetes Care, 26, 1752-8. https://doi.org/10.2337/diacare.26.6.1752
  38. Muck BR, Trotnow S, Hommel G (1975). Cancer of the breast, diabetes and pathological glucose tolerance. Arch Gynakol, 220, 73-81. https://doi.org/10.1007/BF00673150
  39. Muti P, Quattrin T, Grant BJ, et al (2002). Fasting glucose is a risk factor for breast cancer: a prospective study. Cancer Epidemiol Biomarkers Prev, 11, 1361-8.
  40. Novosyadlyy R, Lann DE, Vijayakumar A, et al (2010). Insulinmediated acceleration of breast cancer development and progression in a nonobese model of type 2 diabetes. Cancer Res, 70, 741-51. https://doi.org/10.1158/0008-5472.CAN-09-2141
  41. Parkin DM, Whelan SL, Ferlay J, et al (2002). Cancer incidence in five continents, vol 8. IARC Scientific Publications No. 155, IARC, Lyon.
  42. Pasanisi P, Berrino F, De Petris M, et al (2006). Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer, 119, 236-8. https://doi.org/10.1002/ijc.21812
  43. Potischman N, McCulloch CE, Byers T, et al (1991). Associations between breast cancer, plasma triglycerides, and cholesterol. Nutr Cancer, 15, 205-15. https://doi.org/10.1080/01635589109514128
  44. Reaven GM (1988). Banting lecture 1988. Role of insulin resistance in human disease. Diabetes, 37, 1595-607. https://doi.org/10.2337/diabetes.37.12.1595
  45. Rock CL, Demark-Wahnefried W (2002). Can lifestyle modification increase survival in women diagnosed with breast cancer? J Nutr, 132, 3504-7S. https://doi.org/10.1093/jn/132.11.3504S
  46. Ronco AL, De Stefani E, Mendilaharsu M, Deneo-Pellegrini H (1996). Meat, fat and the risk of breast cancer: a case-control study from Uruguay. Int J Cancer, 65, 328-31. https://doi.org/10.1002/(SICI)1097-0215(19960126)65:3<328::AID-IJC9>3.0.CO;2-1
  47. Ronco AL, De Stefani E, Boffetta P, et al (1999). Vegetables, fruits, and related nutrients and risk of breast cancer: a case control study in Uruguay. Nutr Cancer, 35, 111-9. https://doi.org/10.1207/S15327914NC352_3
  48. Ronco AL, De Stefani E, Boffetta P, et al (1999). Vegetables, fruits, and related nutrients and risk of breast cancer: a case control study in Uruguay. Nutr Cancer, 35, 111-9. https://doi.org/10.1207/S15327914NC352_3
  49. Ronco AL, De Stefani E, Fabra A (2003). White meat intake and the risk of breast cancer: a case-control study in Montevideo, Uruguay. Nutr Res, 23, 151-62. https://doi.org/10.1016/S0271-5317(02)00496-7
  50. Ronco AL, De Stefani E, Boffetta P, et al (2006). Food patterns and risk of breast cancer: A factor analysis study in Uruguay. Int J Cancer, 19, 1672-8.
  51. Ronco AL, Silveira S, De Stéfani E, Deneo-Pellegrini H, Mendilaharsu M (2007). Factores socioculturales y psicologicos y cancer de mama: un estudio caso-control en Montevideo, Uruguay. Biomedicina, 3, 6-17.
  52. Ronco AL, Mendoza B, Varas X, et al (2008). Somatotype and risk of breast cancer: a case-control study in Uruguay. Braz J Epidemiol, 11, 215-27. https://doi.org/10.1590/S1415-790X2008000200004
  53. Ronco AL, Boeing H, De Stefani E, et al (2009a). A case-control study on fat to muscle ratio and risk of breast cancer. Nutr Cancer, 61, 466-74. https://doi.org/10.1080/01635580902725995
  54. Ronco AL, Stoll M, De Stefani E et al (2009b). Rh factor, family history and risk of breast cancer: a case-control study in Uruguay. Cancer Det Prev, 32, 277-85. https://doi.org/10.1016/j.cdp.2008.12.005
  55. Ronco AL, De Stefani E, Aune D, et al (2010a). Nutrient patterns and risk of breast cancer in Uruguay. Asian Pac J Cancer Prev, 11, 519-24.
  56. Ronco AL, De Stefani E, Stoll M (2010b). Hormonal and metabolic modulation through nutrition: towards a primary prevention of breast cancer. The Breast, 19, 322-32. https://doi.org/10.1016/j.breast.2010.05.005
  57. Ronco AL, De Stefani E, Deneo-Pellegrini H, et al (2010c). Dietary patterns and risk of ductal carcinoma of the breast: a factor analysis in Uruguay. Asian Pac J Cancer Prev, 11, 1187-93.
  58. Ronco AL, De Stefani E (2010d). Diabetes, overweight and risk of breast cancer: a case-control study in Uruguay. Proceedings of the XVI World Congress of the Senologic International Society. Valencia, Spain, October 20-22nd, 2010.
  59. Rosato V, Bosetti C, Talamini R, et al (2011). Metabolic syndrome and the risk of breast cancer in postmenopausal women. Ann Oncol, 22, 2687-92. https://doi.org/10.1093/annonc/mdr025
  60. Sachdev D, Yee D (2001). The IGF system and breast cancer. Endocr Relat Cancer, 8, 197-209. https://doi.org/10.1677/erc.0.0080197
  61. Schott S, Schneeweiss A, Sohn C (2010). Breast cancer and diabetes mellitus. Exp Clin Endocrinol Diabetes, 118, 673-7. https://doi.org/10.1055/s-0030-1254116
  62. Sinagra D, Amato C, Scarpilta AM, et al (2002). Metabolic syndrome and breast cancer risk. Eur Rev Med Pharmacol Sci, 6, 55-9.
  63. Soler M, Chatenoud L, Negri E, et al (1999). Hypertension and hormone related neoplasms in women. Hypertension, 34, 320-5. https://doi.org/10.1161/01.HYP.34.2.320
  64. Tsugane S, Inoue M (2010). Insulin resistance and cancer: epidemiological evidence. Cancer Sci, 101, 1073-9. https://doi.org/10.1111/j.1349-7006.2010.01521.x
  65. United Nations Organization (2009), Human development index rankings. Available at: http://hdr.undp.org/en/statistics/. [accessed 27.04.10].
  66. U.S. Census Bureau (2010). International data base, http://www. census.gov/ipc/www/idb/ country.php [accessed 30.04.10].
  67. Varas X, Leborgne F, Leborgne JH (1992). Non palpable, probably benign lesions: role of follow-up mammography. Radiology, 184, 1409-14.
  68. Verheus M, Peeters PH, Rinaldi S, et al (2006). Serum C-peptide levels and breast cancer risk: results from the European Prospective Investigation into Cancer and Nutrition (EPIC). Int J Cancer, 119, 659-67. https://doi.org/10.1002/ijc.21861
  69. Vona-Davis L, Howard-McNatt M, Rose DP (2007). Adiposity, type 2 diabetes and the metabolic syndrome in breast cancer. Obes Rev, 8, 395-408. https://doi.org/10.1111/j.1467-789X.2007.00396.x
  70. Warburg O (1930). The metabolism of tumors. Constable Press, London.
  71. Westerlind KC, Williams NI (2007). Effect of energy deficiency on estrogen metabolism in premenopausal women. Med Sci Sports Exerc, 39, 1090-7.
  72. Wilson AM, Ryan MC, Boyle AJ (2006). The novel role of C-reactive protein in cardiovascular disease: risk marker or pathogen. Int J Cardiol, 106, 291-7. https://doi.org/10.1016/j.ijcard.2005.01.068
  73. World Cancer Research Fund/American Institute for Cancer Research (2007). Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington DC.
  74. Xue F, Michels KB (2007). Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence. Am J Clin Nutr, 86, 823-35. https://doi.org/10.1093/ajcn/86.3.823S

Cited by

  1. Hypertension and the Risk of Breast Cancer in Chilean Women: a Case-control Study vol.13, pp.11, 2012, https://doi.org/10.7314/APJCP.2012.13.11.5829
  2. Diabetes increases the risk of breast cancer: a meta-analysis vol.19, pp.6, 2012, https://doi.org/10.1530/ERC-12-0242
  3. Repercussions of Breastfeeding by Diabetic Women for Breast Cancer vol.14, pp.11, 2013, https://doi.org/10.7314/APJCP.2013.14.11.6233
  4. Prevalence of the Metabolic Syndrome and Associated Factors in Korean Cancer Survivors vol.14, pp.3, 2013, https://doi.org/10.7314/APJCP.2013.14.3.1773
  5. Vascular Endothelial Growth Factor (VEGF) Gene Polymorphisms and Breast Cancer Risk in a Chinese Population vol.14, pp.4, 2013, https://doi.org/10.7314/APJCP.2013.14.4.2433
  6. Type 2 Diabetes Mellitus, Oral Diabetic Medications, Insulin Therapy, and Overall Breast Cancer Risk vol.2013, pp.2090-4649, 2013, https://doi.org/10.1155/2013/181240
  7. Association of Polymorphisms in Stress-Related TNFα and NPY Genes with the Metabolic Syndrome in Han and Hui Ethnic Groups vol.15, pp.14, 2014, https://doi.org/10.7314/APJCP.2014.15.14.5895
  8. Breast Cancer in Tunisia: Association of Body Mass Index with Histopathological Aspects of Tumors vol.15, pp.16, 2014, https://doi.org/10.7314/APJCP.2014.15.16.6805
  9. Vascular endothelial growth factor (VEGF) gene polymorphisms and breast cancer risk in Punjabi population from North West India vol.35, pp.11, 2014, https://doi.org/10.1007/s13277-014-2404-0
  10. Metabolic Syndrome and Breast Cancer Risk: A Case-Cohort Study Nested in a Multicentre Italian Cohort vol.10, pp.6, 2015, https://doi.org/10.1371/journal.pone.0128891
  11. β-Adrenergic Receptors : New Target in Breast Cancer vol.16, pp.18, 2016, https://doi.org/10.7314/APJCP.2015.16.18.8031
  12. Risk factors of breast cancer and knowledge about the disease: an integrative revision of Latin American studies vol.22, pp.1, 2017, https://doi.org/10.1590/1413-81232017221.09272015
  13. The Effect of Insulin Resistance on Breast Cancer Risk in Latinas of Mexican Origin vol.12, pp.9, 2014, https://doi.org/10.1089/met.2014.0071
  14. Racial and Ethnic Disparities in the Impact of Obesity on Breast Cancer Risk and Survival: A Global Perspective vol.6, pp.6, 2015, https://doi.org/10.3945/an.115.009647