J Mammary Gland Biol Neoplasia (2013) 18:257–266 DOI 10.1007/s10911-013-9307-3
Clinical Studies Examining the Impact of Obesity on Breast Cancer Risk and Prognosis Rishi Jain & Howard D. Strickler & Eugene Fine & Joseph A. Sparano
Received: 3 October 2013 / Accepted: 24 October 2013 / Published online: 13 November 2013 # Springer Science+Business Media New York 2013
Abstract Obesity is associated with an increased risk of breast cancer, and increased risk of recurrence in women who develop breast cancer. Evidence suggests that the risk of estrogen-receptor (ER)-positive breast cancer is increased in obese postmenopausal women, whereas in premenopausal women the risk of triple negative breast cancer is increased. Nonetheless, the presence of obesity at diagnosis, and possibly weight gain after diagnosis, may independently contribute to an individual’s risk of recurrence of both pre- and postmenopausal breast cancer. Factors associated with adiposity that are likely contributing factors include hyperinsulinemia, inflammation, and relative hyperestrogenemia. Some studies suggest that some aromatase inhibitors may be less effective in obese women than lean women. Clinical trials have evaluated pharmacologic (eg, metformin) and dietary/lifestyle interventions to reduce breast cancer recurrence, although these interventions have not been tested in obese women who may
R. Jain Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA H. D. Strickler Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA E. Fine Department of Radiology, Division of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA J. A. Sparano Department of Medicine/Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA J. A. Sparano (*) Weiler Division, Montefiore Medical Center, 1825 Eastchester Road, 2South, Rm. 47, Bronx, NY 10461, USA e-mail: [email protected]
be most likely to benefit from them. Further research is required in order to identify adiposity-associated factors driving recurrence, and design clinical trials to specifically test interventions in obese women at highest risk of recurrence. Keywords Obesity . Breast cancer . Body mass index . Prognosis . Recurrence Abbreviations BCSS BMI CI DFS ER FDG-PET HER2 HOMA HR IGF LC mTOR OR OS PI3K RFS
breast cancer specific survival body mass index confidence interval disease free survival estrogen receptor fluorodeoxyglucose positron emission human epidermal growth factor receptor 2 homeostasis model assessment hazard ratio insulin-like growth factor low carbohydrate mammalian target of rapamycin odds ratio overall survival phosphoinositide 3-kinase relapse free survival
Introduction Obesity is a major public health problem in the United States (U.S.) and other industrialized nations, and is associated with an increased risk of numerous comorbidities, including cancer and cancer-related death [1, 2]. Obesity rates have increased 2-fold in adults and 3-fold in children the past 30 years in the U.S., and childhood obesity is a
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risk for lifelong obesity [3]. Among American women above the age of 20, an estimated 34 % are obese (body mass index [BMI] 30 kg/m2 or higher) and 27 % overweight (BMI 25 to
Clinical Studies Examining the Impact of Obesity on Breast Cancer Risk and Prognosis Rishi Jain & Howard D. Strickler & Eugene Fine & Joseph A. Sparano
Received: 3 October 2013 / Accepted: 24 October 2013 / Published online: 13 November 2013 # Springer Science+Business Media New York 2013
Abstract Obesity is associated with an increased risk of breast cancer, and increased risk of recurrence in women who develop breast cancer. Evidence suggests that the risk of estrogen-receptor (ER)-positive breast cancer is increased in obese postmenopausal women, whereas in premenopausal women the risk of triple negative breast cancer is increased. Nonetheless, the presence of obesity at diagnosis, and possibly weight gain after diagnosis, may independently contribute to an individual’s risk of recurrence of both pre- and postmenopausal breast cancer. Factors associated with adiposity that are likely contributing factors include hyperinsulinemia, inflammation, and relative hyperestrogenemia. Some studies suggest that some aromatase inhibitors may be less effective in obese women than lean women. Clinical trials have evaluated pharmacologic (eg, metformin) and dietary/lifestyle interventions to reduce breast cancer recurrence, although these interventions have not been tested in obese women who may
R. Jain Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA H. D. Strickler Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA E. Fine Department of Radiology, Division of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA J. A. Sparano Department of Medicine/Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA J. A. Sparano (*) Weiler Division, Montefiore Medical Center, 1825 Eastchester Road, 2South, Rm. 47, Bronx, NY 10461, USA e-mail: [email protected]
be most likely to benefit from them. Further research is required in order to identify adiposity-associated factors driving recurrence, and design clinical trials to specifically test interventions in obese women at highest risk of recurrence. Keywords Obesity . Breast cancer . Body mass index . Prognosis . Recurrence Abbreviations BCSS BMI CI DFS ER FDG-PET HER2 HOMA HR IGF LC mTOR OR OS PI3K RFS
breast cancer specific survival body mass index confidence interval disease free survival estrogen receptor fluorodeoxyglucose positron emission human epidermal growth factor receptor 2 homeostasis model assessment hazard ratio insulin-like growth factor low carbohydrate mammalian target of rapamycin odds ratio overall survival phosphoinositide 3-kinase relapse free survival
Introduction Obesity is a major public health problem in the United States (U.S.) and other industrialized nations, and is associated with an increased risk of numerous comorbidities, including cancer and cancer-related death [1, 2]. Obesity rates have increased 2-fold in adults and 3-fold in children the past 30 years in the U.S., and childhood obesity is a
258
risk for lifelong obesity [3]. Among American women above the age of 20, an estimated 34 % are obese (body mass index [BMI] 30 kg/m2 or higher) and 27 % overweight (BMI 25 to
