Abstract
Background: Metabolic Syndrome (MS) has been correlated to breast carcinogenesis. MS is common in the general population (34%) and increases with age and body mass index. Although the link between obesity, MS and hormone related cancer incidence is now widely recognized, the molecular mechanisms at the basis of such increase are still poorly characterized. A crucial role is supposed to be played by the altered insulin signalling, occurring in obese patients, which fuels cancer cell growth, proliferation and survival. Therefore we focused specifically on insulin resistance to investigate clinically the potential role of insulin in breast carcinogenesis. Methods. 975 patients were enrolled and the association between MS, insulin resistance, and breast cancer was evaluated. Women were stratified by age and menopausal status. Insulin resistance was measured through the Homeostasis Model Assessment score (HOMA-IR). The cut off value to define insulin resistance was HOMA-IR ≥ 2.50. Results: Higher prevalence of MS (35%) was found among postmenopausal women with breast cancer compared to postmenopausal healthy women (19%) [OR 2.16]. A broad range of BMI spanning 19-48 Kg/m§ssup§2§esup§ was calculated. Both cases and controls were characterized by BMI ≥ 25 Kg/m§ssup§2§esup§ (58% of cases compared to 61% of controls). Waist circumference >88 cm was measured in 53% of cases - OR 1.58- (95% CI 0.8-2.8) and in 46% of controls. Hyperinsulinemia was detected in 7% of cases - OR 2.14 (95% CI 1.78-2.99) and only in 3% of controls. HOMA-IR score was elevated in 49% of cases compared to 34% of controls [OR 1.86], suggesting that insulin resistance can nearly double the risk of breast cancer development. Interestingly 61% of women operated for breast cancer (cases) with HOMA-IR ≥ 2.5 presented subclinical insulin resistance with fasting plasma glucose levels and fasting plasma insulin levels in the normal range. Both android fat distribution and insulin resistance correlated to MS in the subgroup of postmenopausal women affected by breast cancer. Conclusions: Our results further support the hypothesis that MS, in particular insulin resistance and abdominal fat, can be considered as risk factors for developing breast cancer after menopause. We suggest that HOMA-IR, rather than fasting plasma glucose and fasting plasma insulin levels alone, could be a valuable tool to identify patients with subclinical insulin resistance, which could be relevant for primary prevention and for high risk patient screening.
| Original language | English |
|---|---|
| Article number | 14 |
| Journal | Journal of Experimental and Clinical Cancer Research |
| Volume | 32 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2013 |
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Keywords
- Breast cancer
- HOMA-IR
- Insulin resistance
- Metabolic syndrome
- Postmenopausal
ASJC Scopus subject areas
- Cancer Research
- Oncology
Cite this
Homeostasis model assessment to detect insulin resistance and identify patients at high risk of breast cancer development : National Cancer Institute of Naples experience. / Capasso, Immacolata; Esposito, Emanuela; Pentimalli, Francesca; Montella, Maurizio; Crispo, Anna; Maurea, Nicola; D'Aiuto, Massimiliano; Fucito, Alfredo; Grimaldi, Maria; Cavalcanti, Ernesta; Esposito, Giuseppe; Brillante, Giuseppe; Lodato, Sergio; Pedicini, Tonino; D'Aiuto, Giuseppe; Ciliberto, Gennaro; Giordano, Antonio.
In: Journal of Experimental and Clinical Cancer Research, Vol. 32, No. 1, 14, 2013.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Homeostasis model assessment to detect insulin resistance and identify patients at high risk of breast cancer development
T2 - National Cancer Institute of Naples experience
AU - Capasso, Immacolata
AU - Esposito, Emanuela
AU - Pentimalli, Francesca
AU - Montella, Maurizio
AU - Crispo, Anna
AU - Maurea, Nicola
AU - D'Aiuto, Massimiliano
AU - Fucito, Alfredo
AU - Grimaldi, Maria
AU - Cavalcanti, Ernesta
AU - Esposito, Giuseppe
AU - Brillante, Giuseppe
AU - Lodato, Sergio
AU - Pedicini, Tonino
AU - D'Aiuto, Giuseppe
AU - Ciliberto, Gennaro
AU - Giordano, Antonio
PY - 2013
Y1 - 2013
N2 - Background: Metabolic Syndrome (MS) has been correlated to breast carcinogenesis. MS is common in the general population (34%) and increases with age and body mass index. Although the link between obesity, MS and hormone related cancer incidence is now widely recognized, the molecular mechanisms at the basis of such increase are still poorly characterized. A crucial role is supposed to be played by the altered insulin signalling, occurring in obese patients, which fuels cancer cell growth, proliferation and survival. Therefore we focused specifically on insulin resistance to investigate clinically the potential role of insulin in breast carcinogenesis. Methods. 975 patients were enrolled and the association between MS, insulin resistance, and breast cancer was evaluated. Women were stratified by age and menopausal status. Insulin resistance was measured through the Homeostasis Model Assessment score (HOMA-IR). The cut off value to define insulin resistance was HOMA-IR ≥ 2.50. Results: Higher prevalence of MS (35%) was found among postmenopausal women with breast cancer compared to postmenopausal healthy women (19%) [OR 2.16]. A broad range of BMI spanning 19-48 Kg/m§ssup§2§esup§ was calculated. Both cases and controls were characterized by BMI ≥ 25 Kg/m§ssup§2§esup§ (58% of cases compared to 61% of controls). Waist circumference >88 cm was measured in 53% of cases - OR 1.58- (95% CI 0.8-2.8) and in 46% of controls. Hyperinsulinemia was detected in 7% of cases - OR 2.14 (95% CI 1.78-2.99) and only in 3% of controls. HOMA-IR score was elevated in 49% of cases compared to 34% of controls [OR 1.86], suggesting that insulin resistance can nearly double the risk of breast cancer development. Interestingly 61% of women operated for breast cancer (cases) with HOMA-IR ≥ 2.5 presented subclinical insulin resistance with fasting plasma glucose levels and fasting plasma insulin levels in the normal range. Both android fat distribution and insulin resistance correlated to MS in the subgroup of postmenopausal women affected by breast cancer. Conclusions: Our results further support the hypothesis that MS, in particular insulin resistance and abdominal fat, can be considered as risk factors for developing breast cancer after menopause. We suggest that HOMA-IR, rather than fasting plasma glucose and fasting plasma insulin levels alone, could be a valuable tool to identify patients with subclinical insulin resistance, which could be relevant for primary prevention and for high risk patient screening.
AB - Background: Metabolic Syndrome (MS) has been correlated to breast carcinogenesis. MS is common in the general population (34%) and increases with age and body mass index. Although the link between obesity, MS and hormone related cancer incidence is now widely recognized, the molecular mechanisms at the basis of such increase are still poorly characterized. A crucial role is supposed to be played by the altered insulin signalling, occurring in obese patients, which fuels cancer cell growth, proliferation and survival. Therefore we focused specifically on insulin resistance to investigate clinically the potential role of insulin in breast carcinogenesis. Methods. 975 patients were enrolled and the association between MS, insulin resistance, and breast cancer was evaluated. Women were stratified by age and menopausal status. Insulin resistance was measured through the Homeostasis Model Assessment score (HOMA-IR). The cut off value to define insulin resistance was HOMA-IR ≥ 2.50. Results: Higher prevalence of MS (35%) was found among postmenopausal women with breast cancer compared to postmenopausal healthy women (19%) [OR 2.16]. A broad range of BMI spanning 19-48 Kg/m§ssup§2§esup§ was calculated. Both cases and controls were characterized by BMI ≥ 25 Kg/m§ssup§2§esup§ (58% of cases compared to 61% of controls). Waist circumference >88 cm was measured in 53% of cases - OR 1.58- (95% CI 0.8-2.8) and in 46% of controls. Hyperinsulinemia was detected in 7% of cases - OR 2.14 (95% CI 1.78-2.99) and only in 3% of controls. HOMA-IR score was elevated in 49% of cases compared to 34% of controls [OR 1.86], suggesting that insulin resistance can nearly double the risk of breast cancer development. Interestingly 61% of women operated for breast cancer (cases) with HOMA-IR ≥ 2.5 presented subclinical insulin resistance with fasting plasma glucose levels and fasting plasma insulin levels in the normal range. Both android fat distribution and insulin resistance correlated to MS in the subgroup of postmenopausal women affected by breast cancer. Conclusions: Our results further support the hypothesis that MS, in particular insulin resistance and abdominal fat, can be considered as risk factors for developing breast cancer after menopause. We suggest that HOMA-IR, rather than fasting plasma glucose and fasting plasma insulin levels alone, could be a valuable tool to identify patients with subclinical insulin resistance, which could be relevant for primary prevention and for high risk patient screening.
KW - Breast cancer
KW - HOMA-IR
KW - Insulin resistance
KW - Metabolic syndrome
KW - Postmenopausal
UR - http://www.scopus.com/inward/record.url?scp=84874930452&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874930452&partnerID=8YFLogxK
U2 - 10.1186/1756-9966-32-14
DO - 10.1186/1756-9966-32-14
M3 - Article
C2 - 23497533
AN - SCOPUS:84874930452
VL - 32
JO - Journal of Experimental and Clinical Cancer Research
JF - Journal of Experimental and Clinical Cancer Research
SN - 0392-9078
IS - 1
M1 - 14
ER -