Obesity-associated Breast Inflammation among Hispanic/Latina Breast Cancer Patients

Abstract

Breast white adipose tissue inflammation (BWATi) is associated with obesity and higher breast cancer (BC) risk among non-Hispanic white women. Obesity is prevalent in Hispanic/Latina BC patients, and the occurrence of BWATi in this population is not well-characterized. The association between BWATi and body mass index (BMI) was evaluated in Hispanic/Latina BC patients who underwent mastectomy. BWATi was defined as the presence of crown-like structures of the breast (CLS-B), detected by CD68 immunohistochemistry in non-tumor breast tissue. BWATi severity was quantified as number of CLS-B/cm2. Adipocyte diameter was measured using hematoxylin and eosin (H&E) stained breast tissue sections. Preoperative BMI (within 1 week prior to mastectomy) was categorized as normal (18.5 to <25.0 kg/m2), overweight (25.0 to <30.0 kg/m2), class I obesity (30.0 to <35.0 kg/m2), and class II-III obesity (35.0 kg/m2 or above). Patient charts were abstracted to record clinicopathologic features and liver function tests <90 days before mastectomy. The study included 91 women (mean age 69 years; range 36–96 years). Prevalence of BWATi increased with BMI (24% in normal weight, 34% in overweight, 57% in class I obesity, and 65% in class II-III obesity; P for trend <0.01). Severe BWATi (>0.27 CLS-B/cm2) was associated with higher BMI (P for trend=0.046) and greater adipocyte diameter (P=0.04). Adjusting for BMI, neoadjuvant chemotherapy and elevated alanine aminotransferase were associated with severe BWATi, and current smoking was associated with mild BWATi (all P<0.05). BWATi was associated with higher BMI in Hispanic/Latina BC patients, consistent with previously described associations in other populations.

Detection of crown-like structures in breast adipose tissue and clinical outcomes among African-American and White women with breast cancer

“…The association between BMI and CLS-B appears consistent across racial/ethnic groups as evidenced by the present study comparing African-American and White patients as well as previous studies in Taiwanese [20] and Hispanic/Latina [22] breast cancer patient populations. We did not find evidence that race is associated with the detection or density of CLS-B.…”

“…The present study provides additional evidence that higher BMI is strongly associated with the detection and density of CLS-B [16][17][18][19][20][21][22] and provides new evidence that this association is similar in both White and African-American breast cancer patients. Race was not observed to be independently associated with detection or density of CLS-B.…”

“…Previous epidemiologic studies have consistently demonstrated a strong, positive association between obesity, typically measured using body mass index (BMI), and CLS-B [16][17][18][19][20][21][22], although CLS-B are also reportedly present in up to one third of lean women (BMI < 25 kg/m 2 ). These data suggest that factors other than obesity contribute to the formation of CLS-B [23], but few studies have examined associations for other characteristics such as race/ethnicity, smoking status, and reproductive history.…”

Microbiome, bile acids, and obesity: How microbially modified metabolites shape anti‐tumor immunity

“…160 Dannenberg et al reported that breast CLS (CLS-B) associate with poor patient survival, even when lean. [285][286][287] In patients, TAMs impact every aspect of tumorigenesis, growth, and negatively influence response to anticancer therapies through establishing an immunosuppressive microenvironment, thus disallowing anti-tumor immune cells such as tumoricidal macrophages, cytotoxic (CD8+) T cell, and NKT cell activity. 79,155,163,[288][289][290][291][292][293][294][295][296][297][298][299][300][301][302][303] Elevated TAMs in breast tumors are independent prognostic indicators of reduced relapse-free survival and decreased overall survival.…”

“…Obesity‐increased CLS are detected in obese patient breast adipose tissue compared to non‐obese breast 160 . Dannenberg et al reported that breast CLS (CLS‐B) associate with poor patient survival, even when lean 285‐287 . In patients, TAMs impact every aspect of tumorigenesis, growth, and negatively influence response to anticancer therapies through establishing an immunosuppressive microenvironment, thus disallowing anti‐tumor immune cells such as tumoricidal macrophages, cytotoxic (CD8+) T cell, and NKT cell activity 79,155,163,288‐303 .…”