Metabolic comorbidities and the association with risks of recurrent metastatic disease in breast cancer survivors

Abstract

Background Obesity and other metabolic comorbidities affect over 10% of patients with breast cancer and are closely related with adverse outcomes. Although metabolic comorbidities among breast cancer patients in low- and middle-income countries are suggested to be lower, only a few studies are currently available. Effective management of metabolic comorbidities in cancer patients has been associated with better outcomes. Methods Non-metastatic breast cancer patients (N = 1081) treated in our department (2014–2018) were monitored for the presence of high Body Mass Index (BMI), diabetes or glucose intolerance, dyslipidemia, and hypertension and the development of recurrent metastatic diseases during a median follow-up of 3.9 years. Results Glucose intolerance, hypertension, dyslipidemia, and BMI ≥ 27.7 kg/m2 considered at risk for metabolic comorbidities were found in 26.5, 42.6, 27.7, and 23.3% of breast cancer patients, respectively. Diabetes or glucose intolerance and having both glucose intolerance and dyslipidemia were associated with the risk of recurrent metastatic disease (OR = 1.442, 95%CI = 1.071–1.943, p = 0.016 and OR = 1.495, 95%CI = 1.090–2.049, p = 0.010; respectively). Having three or more metabolic comorbidities was significantly associated with the risk of recurrent metastatic disease (OR = 1.647, 95%CI = 1.139–2.382, p = 0.008) compared to patients without any comorbidity. The metabolic comorbidities were distributed unevenly among breast cancer subtypes. A significant association with recurrent metastatic disease was found in the Luminal B-like subtype. In post-menopausal patients, having more than three comorbidities was associated with a higher risk of recurrent metastatic disease compared to those without any comorbidity (OR = 2.000, 95%CI = 1.035–3.067, p = 0.001). The risks of having three or more metabolic comorbidities were significantly higher in breast cancer survivors who were obese, lived in an urban area, and received hormonal therapy of aromatase inhibitors. Conclusion Metabolic comorbidities were frequently found in breast cancer patients and were associated with higher risks to develop recurrent metastatic disease, particularly in post-menopausal women. Subsequent larger studies are needed to better understand the association of metabolic comorbidities with patients’ quality of life and prognosis, and to explore the potential combination of clinical intervention and lifestyle modification in breast cancer survivors to treat as well as reduce their impact.

Risk Factors, Patterns, and Distribution of Bone Metastases and Skeletal-Related Events in High-Risk Breast Cancer Patients

“…Breast cancer incidence is continuously increasing over the past decades causing a significant morbidity and economic burden including in countries with traditionally low incidence rates (Sung et al, 2021). More than 90% of cancer-associated mortality is associated with primary distant metastases (Anwar et al, 2021;Harries et al, 2014). At primary diagnosis of breast cancer, around 5% patients presented with bone metastases (Harries et al, 2014).…”

Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta‐analysis

“…The meta‐analyses included 101 publications reporting postdiagnosis BMI (assessed from at‐diagnosis to on average 5.8 years postdiagnosis), waist circumference (at‐diagnosis to 7.9 years postdiagnosis), waist‐to‐hip ratio (at‐diagnosis to 2.5 years postdiagnosis) and pre‐ to postdiagnosis weight gain or loss (from 1 year before to 1 year or more after diagnosis) 27,39‐138 . In addition, 119 publications were descriptively synthesized…”

Diet Quality and Dietary Inflammatory Index Score among Women’s Cancer Survivors

“…This risk was even greater if the comorbidity was diagnosed within 5 years of cancer diagnosis, as opposed to more than 5 years since diagnosis [ 57 ]. A similar study in Shanghai found that diabetes and history of stroke were associated with an increased risk of all-cause and non-breast cancer mortality, respectively [ 58 ].…”