Metabolic syndrome-breast cancer link varies by intrinsic molecular subtype

Immacolata Capasso; Emanuela Esposito; Michelino de Laurentiis; Nicola Maurea; Ernesta Cavalcanti; Gerardo Botti; Antonella Petrillo; Maurizio Montella; Massimiliano D'Aiuto; Carmela Coppola; Anna Crispo; Maria Grimaldi; Giuseppe Frasci; Alfredo Fucito; Gennaro Ciliberto; Giuseppe D'Aiuto

doi:10.1186/1758-5996-6-105

Metabolic syndrome-breast cancer link varies by intrinsic molecular subtype

Diabetol Metab Syndr. 2014 Sep 26;6(1):105. doi: 10.1186/1758-5996-6-105. eCollection 2014.

Authors

Immacolata Capasso¹, Emanuela Esposito¹, Michelino de Laurentiis¹, Nicola Maurea², Ernesta Cavalcanti³, Gerardo Botti⁴, Antonella Petrillo⁵, Maurizio Montella⁶, Massimiliano D'Aiuto¹, Carmela Coppola², Anna Crispo⁶, Maria Grimaldi⁶, Giuseppe Frasci¹, Alfredo Fucito¹, Gennaro Ciliberto¹, Giuseppe D'Aiuto¹

Affiliations

¹ Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
² Division of Cardiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
³ Division of Medicine Laboratory and Clinical Pathology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
⁴ Division of Pathology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
⁵ Department of Radiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
⁶ Division of Epidemiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.

Abstract

Background: Metabolic syndrome (MS) has been shown to increase the risk of breast cancer. Existing data suggest that the strength of metabolic syndrome-breast cancer link varies by intrinsic molecular subtype, but results from worldwide literature are controversial. Primary endpoint of the study was to assess whether MS is a predictor of specific breast cancer (BC) subtype. Secondary endpoint was to determine whether components of MS can individually increase the risk of specific breast cancer subtype.

Methods: Anthropometric and metabolic variables were correlated to breast cancer specific subgroups, retrospectively. Statistical significance was considered when p ≤ 0.05 and 95% CI.

Results: Data analysis suggests that MS per se represents a modifiable risk factor for BC in postmenopausal [OR 6.28 (95% CI 2.79-14.11) p < 0.00001]. MS per se prevalence is higher among Luminal breast cancers in postmenopausal [OR 1.37 (95% CI 1.07-2.80) p = 0.03]. Body Mass Index (BMI) alone is associated to Luminal A subtype breast cancer risk [OR 1.12 (95% CI 0.96-2.196 p = 0.2]. Waist Circumference > 88 cm has been shown to be specifically and statistically significant associated to HER-2+ breast cancer subtypes in postmenopausal [OR 2.72 (95% CI 1.69- 10.72) p = 0.01], whilst in Luminal B it was only marginally statistical associated [OR 2.21 (95% CI 0.77-2.60) p = 0.1]. Insulin resistance showed statistical significant association to HER-2+ and Luminal B tumors [OR 2.11 (95% CI 1.66-6.69) p = 0.05] and [OR 2.33 (95% CI 1.2-4.2) p = 0.006], respectively. Hence, it has emerged that BMI is weakly associated to Luminal A breast cancers in this case series, whereas visceral obesity and insulin resistance are likely to be linked to more aggressive breast cancer subtypes.

Conclusions: New molecular biomarkers unveiling metabolic syndrome related breast carcinogenesis need to be detected to further stratify breast cancer risk by subtypes.

Keywords: BMI; Breast cancer; Insulin-resistance; Metabolic syndrome; Molecular subtype; Waist circumference.