Homeostasis model assessment to detect insulin resistance and identify patients at high risk of breast cancer development: National Cancer Institute of Naples experience

Immacolata Capasso, Emanuela Esposito, Francesca Pentimalli, Maurizio Montella, Anna Crispo, Nicola Maurea, Massimiliano D'Aiuto, Alfredo Fucito, Maria Grimaldi, Ernesta Cavalcanti, Giuseppe Esposito, Giuseppe Brillante, Sergio Lodato, Tonino Pedicini, Giuseppe D'Aiuto, Gennaro Ciliberto, Antonio Giordano

Research output: Contribution to journalArticle

19 Citations (Scopus)

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 languageEnglish
Article number14
JournalJournal of Experimental and Clinical Cancer Research
Volume32
Issue number1
DOIs
Publication statusPublished - 2013

Fingerprint

National Cancer Institute (U.S.)
Insulin Resistance
Homeostasis
Breast Neoplasms
Fasting
Insulin
Carcinogenesis
Breast
Glucose
Abdominal Fat
Hyperinsulinism
Waist Circumference
Primary Prevention
Menopause
Neoplasms
Cell Survival
Reference Values
Body Mass Index
Obesity
Fats

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 journalArticle

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. / Homeostasis model assessment to detect insulin resistance and identify patients at high risk of breast cancer development : National Cancer Institute of Naples experience. In: Journal of Experimental and Clinical Cancer Research. 2013 ; Vol. 32, No. 1.
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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.",
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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

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