OBESITY IN WOMEN TREATED FOR BREAST CANCER - CONTROVERSIAL OBSERVATIONS ASSOCIATED WITH MENOPAUSAL STATUS AT DIAGNOSIS
Breast cancer is a polymorphic disease, obesity being an important risk factor. The aim of the study is to assess different clinical, imagistic, biological determinants of fat mass and of gonadotropic axis in breast cancer treated patients according to their menopausal status at diagnosis. Material and methods: Seventy-eight breast cancer female patients were recruited cross-sectionally. All women were at menopause (physiologic or therapeutically induced). Fat mass was assessed by dual-energy X-ray absorptiometry, and immunoassays were used to determine serum hormones levels. Results: Post-menopausal diagnosed women showed statistically significant higher BMI (t=-3.159, p=0.002), abdominal (t=-2.305, p=0.036) and hip circumference (t=-2.683, p=0.009), but not hip/abdominal ratio (t=-0.647, p=0.520); also, they had significantly higher body fat mass (either total, subtotal or trunk fat; p<0.05). No statistically significant differences were observed in fasting glucose (t=-0.800, p=0.426), cholesterol (t=-0.566, p=0.573) nor triglycerides (t=0.969, p=0.336). Insulin levels, however, were significantly increased in post-menopausal group (t=-2.420, p=0.018), and subsequently HOMA-IR index assessing insulin-resistance was significantly increased (t=-2.305, p=0.024). Regarding sex hormones, no statistically significant differences were observed in circulating estrogens (estradiol and estrone) nor androgens (total testosterone and calculated free androgen index). However, for both pre-menopause and post-menopause groups, no statistically significant differences were observed in sex hormones according to weight status (obese vs non-obese). Conclusions: There is significant difference between weight status and risk of breast cancer regarding menopausal status, many reports showing that obesity is a risk factor in post-menopause patients and a protective factor in pre-menopause women, underlying the polymorphism of breast cancer disease.
2. Cohen SS, Park Y, Signorello LB, et al. A pooled analysis of body mass index and mortality among African Americans. PLoS One 2014; 9(11): e111980.
3. Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity (BMI of 40-59 kg/m2) and mortality: a pooled analysis of 20 prospective studies. PLoS Med 2014; 11(7): e1001673.
4. Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010; 363(23): 2211-2219.
5. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355(8):763-78.
6. WHO European Regional Obesity Report 2022 https://apps.who.int/iris/ bitstream/ han-dle/10665/353747/9789289057738-eng.pdf. World Health Organization. Regional Office for Europe; 2022.
7. Trifan A, Stratina E, Nastasa R, Stanciu C. Obesity: the covered risk of cancer. Med Surg J- Rev Med Chir Soc Med Nat Iasi. 2023; 127(1): 5-8.
8. Costache II. Traditional cardiovascular risk factors and cancer - coincidence or correlation? Med Surg J - Rev Med Chir Soc Med Nat Iasi 2021;125(3): 327-334.
9. International Agency for Research in Cancer. World Health Organization. Global Cancer Observatory (GLOBOCAN 2020). [Internet] https://gco.iarc.fr/. 2023.
10. Furtunescu F, Bohiltea RE, Voinea S, et al. Breast cancer mortality gaps in Romanian women compared to the EU after 10 years of accession : Is breast cancer screening a priority for action in Romania ? (Review of the Statistics). Exp Ther Med 2021; 21(3): 268.
11. International Agency for Research in Cancer. World Health Organization. Cancer Attributable to Obesity [Internet] https://gco.iarc.fr/causes/obesity/home. 2012.
12. World Health Organization. Obesity and Overweight. [Internet] https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. 2023.
13. Cinteza M, Pana B, Cochino E, et al. Prevalence and control of cardiovascular risk factors in Romania cardio-zone national study Maedica 2007; 2(4): 277-88.
14. Dorobantu M, Bădilă E, Ghiorghe S, Darabont RO, Olteanu M, Flondor P. Total cardiovascular risk estimation in Romania. Data from the SEPHAR study. Rom J Intern Med 2008; 46(1): 29-37.
15. Roman G, Bala C, Radulian G. Obesity and health-related lifestyle factors in the general population in Romania: A cross sectional study. Acta Endocrinol (Buc) 2015; 9(1): 64-71.
16. Michels KB, Terry KL, Willett WC. Longitudinal Study on the Role of Body Size in Premenopausal Breast Cancer. JAMA Intern Med 2006; 166(21): 2395-2402.
17. Berstad P, Coates RJ, Bernstein L, et al. A case-control study of body mass index and breast cancer risk in white and African-American women. Cancer Epidemiol Biomarkers Prev 2010; 19(6): 1532-1544.
18. Harris HR, Willett WC, Terry KL, Michels KB. Body fat distribution and risk of premenopausal breast cancer in the Nurses’ Health Study II. J Natl Cancer Inst. 2011; 103(3): 273-278.
19. van den Brandt PA, Spiegelman D, Yaun SS, et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol 2000; 152(6): 514-527.
20. Bergström A, Pisani P, Tenet V, Wolk A, Adami HO. Overweight as an avoidable cause of cancer in Europe. Int J Cancer 2001; 91(3): 421-430.
21. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. The Lancet 2008; 371(9612): 569-578.
22. Schoemaker MJ, Nichols HB, Wright LB, et al. Association of Body Mass Index and Age with Sub-sequent Breast Cancer Risk in Premenopausal Women. JAMA Oncol 2018; 4(11): 1-10.
23. Pierobon M, Frankenfeld CL. Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis. Breast Cancer Res Treat 2013; 137(1): 307-314.
24. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007; 335(7630): 1134.
25. Brown KA. Metabolic pathways in obesity-related breast cancer. Nat Rev Endocrinol. 2021;17(6): 350-363.
26. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 2012; 62(4): 243-274.
27. Rock BCL, Demark-Wahnefried W. Nutrition and Survival After the Diagnosis of Breast Cancer: A Review of the Evidence. J Clin Oncol 2017; 20(15): 3302-3316.
28. Chan DSM, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer - systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol 2014; 25(10): 1901-1914.
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