The association of metabolic syndrome with triple-negative breast cancer

Abstract

Metabolic syndrome, a conglomerate of obesity, insulin resistance, dyslipidemia, and hypertension has been linked with an increased risk of breast cancer. We investigated the possible association of highly aggressive triple-negative breast cancer and the metabolic syndrome. Information on metabolic syndrome components and tumor characteristics were reviewed in a cohort of 176 patients (including 86 triple-negatives). Retrospective comparison was performed using Pearson Chi-square test or Student's t test for data analysis. A statistically significant association of triple-negative breast cancer with the metabolic syndrome was observed. In accordance with the NCEP (National Cholesterol Education Program) definition, 58.1% of triple-negative patients had metabolic syndrome compared to only 36.7% of non-triple-negative patients (P = 0.004). Consistently, by the AACE (American Association of Clinical Endocrinologists) criteria, 52.3% of triple-negative patients had metabolic syndrome as compared to 34.4% of non-triple-negative patients (P = 0.017). Blood glucose, triglyceride, and HDL levels but not hypertension or BMI (body mass index) showed significant independent association with triple-negative breast cancer. Additionally, triple-negative tumors displayed a significantly higher histological grade and relative paucity of ductal carcinoma in situ (DCIS) when compared to the non-triple-negative tumors (P < 0.001). Our study suggests that metabolic syndrome is significantly more prevalent in triple-negative breast cancer patients as opposed to non-triple-negative patients. Furthermore, triple-negative breast cancer showed a significantly higher histological grade and a relative absence of DCIS. Whether the presence of metabolic syndrome preferentially increases the risk of developing triple-negative-breast cancer remains to be elucidated with future prospective studies.

Triple-negative breast cancer in Hispanic patients

“…We also observed that TNBC was associated with high histologic grade, as reported previously. 20 Another similar feature between African-American patients with breast cancer and our study population is the frequency of high histopathologic grade at diagnosis (48% in AfricanAmerican patients and 51% in our study population), which is higher than that reported in white patients with breast cancer (32%).…”

“…However, BMI was not associated independently with TNBC, consistent with our findings when we analyzed the entire breast cancer population (a subanalysis in premenopausal and postmenopausal breast cancer patients was not carried out by the authors). 20 Another study demonstrated that the association between ER/ PR and HER2 expression and BMI varies according to menopause status. 47 In premenopausal women, BMI was associated inversely with hormone receptor expression; but, in postmenopausal women, BMI had a positive association with hormone receptor and HER2 levels.…”

“…18 Hypertension, diabetes, overweight, and obesity also have been associated with increased risk of breast cancer and with decreased survival and poor prognosis in premenopausal and postmenopausal women with breast cancer. 19,20 Some studies have associated overweight and obesity with the presence of the TN phenotype. 21 To our knowledge, the prevalence and prognosis for Hispanic women with TNBC have not been studied previously.…”

Pretreatment Insulin Levels as a Prognostic Factor for Breast Cancer Progression

“…These results are barely comparable with the currently available clinical and experimental evidence, because there are no data onthe prognostic value of insulin level or IR in HER2-negative BC. The few data available point to a higher prevalence of metabolic syndrome [51] or obesity [52] in triple-negative BC (TNBC) patients as opposed to non-triple-negative patients; it has been advocated that obesity-related defective estrogen surveillance might allow steroid receptor-negative BC to more easily escape detection than steroid receptor-positive BC [52]. Meanwhile, it has been shown that metformin is able to inhibit proliferation and colony formation of TNBC cells in vitro [53], a finding that was confirmed in mice models in which metformin treatment resulted in decreased growth of TNBC xenografts and decreased tumor formation if administered before tumor cell injection [54].…”

Diabetes, Overweight and Risk of Postmenopausal Breast Cancer: A Case-Control Study in Uruguay

“…New evidence emphasizes that metabolic syndrome increases the risk mainly in postmenopausal women (Capasso et al, 2011) and it has been found as significantly more prevalent in triple-negative BC patients as opposed to non-triple-negative patients (Maiti et al, 2010).…”