Metabolic syndrome and breast cancer prognosis

Abstract

Metabolic syndrome (MS), conventionally defined by the presence of at least three out of five dysmetabolic traits (abdominal obesity, hypertension, low plasma HDL-cholesterol, high plasma glucose and high triglycerides), has been associated with an increased risk of several age-related chronic diseases, including breast cancer (BC). This may have prognostic implications for BC survivors. 2,092 early stage BC survivors aged 35-70, recruited in eleven Italian centres 0-5 years after surgical treatment (1.74 years on average), were followed-up over 2.8 years on average for additional BC-related events, including BC-specific mortality, distant metastasis, local recurrences and contralateral BC. At recruitment, 20 % of the patients had MS. Logistic regression models were carried out to generate OR and 95 % confidence intervals (CI) for new BC events associated with MS, adjusting for baseline pathological prognostic factors. New BC events occurred in 164 patients, including 89 distant metastases. The adjusted ORs for women with MS versus women without any MS traits were 2.17 (CI 1.31-3.60) overall, and 2.45 (CI 1.24-4.82) for distant metastasis. The OR of new BC events for women with only one or two MS traits was 1.40 (CI 0.91-2.16). All MS traits were positively associated with new BC events, and significantly so for low HDL and high triglycerides. MS is an important prognostic factor in BC. As MS is reversible through lifestyle changes, interventions to decrease MS traits in BC patients should be implemented in BC clinics.

Comorbidities and Their Management: Potential Impact on Breast Cancer Outcomes

“…Similar to the rest of the US population, breast cancer patients bear substantial comorbidity burdens, particularly as they age, with rates of severe comorbidities rising to over 30 % among women age 65 and older (Edwards et al 2013 ;Cho et al 2013 ). Rising rates of breast cancer risk factors, such as obesity, metabolic syndrome, and reduced levels of physical activity may further contribute to high rates of comorbidity in breast cancer patients (Guh et al 2009 ;Berrino et al 2014 ;Hair et al 2014 ). Improvements in breast cancer survival in recent decades, however, have primarily been experienced among cancer patients without comorbidities, and less so among those with moderate or severe comorbidities (Cronin-Fenton et al 2007 ;Land et al 2012a ).…”

Lifestyle modifications for patients with breast cancer to improve prognosis and optimize overall health

“…13 In a recent study involving early stage breast cancer survivors, patients with metabolic syndrome were at significantly increased risk of distant metastasis (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.24-4.82) compared with those without the syndrome.…”

“…[9][10][11][12] Another possible mechanism is metabolic syndrome (presence of at least three of the following five components: abdominal obesity, hypertension, low level of highdensity lipoproteins, high plasma glucose level and high triglyceride levels). 13 In a recent study involving early stage breast cancer survivors, patients with metabolic syndrome were at significantly increased risk of distant metastasis (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.24-4.82) compared with those without the syndrome. 13 Most patients with breast cancer gain weight both during and after active treatment, and much of the weight is never lost.…”

“…13 In a recent study involving early stage breast cancer survivors, patients with metabolic syndrome were at significantly increased risk of distant metastasis (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.24-4.82) compared with those without the syndrome. 13 Most patients with breast cancer gain weight both during and after active treatment, and much of the weight is never lost. The average reported weight gain is 2.5-5 kg, 5 but a gain of 10 kg or more is not uncommon.…”

The estrogen receptor as a mediator of the pathological actions of cholesterol in breast cancer

“…Recently, obesity and the metabolic syndrome have emerged as important “environmental” risk factors for several different cancers (6,7). Of particular note is the observation that obesity increases the risk of post-menopausal ER-positive breast cancer by over 50% (8) The potential impact of this observation is highlighted by the fact that ~40% of the US population is clinically obese and that obesity is rising most rapidly in women over 60 years of age (9).…”