Research Article
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Using hormonotherapy in breast cancer and its relationship with metabolic syndrome

Year 2024, Volume: 6 Issue: 1, 80 - 86, 15.01.2024
https://doi.org/10.38053/acmj.1387556

Abstract

Aims: This study aims to investigate whether the use of hormonotherapy pharmaceuticals causes metabolic syndrome-like symptoms in patients diagnosed with breast cancer and to compare the long-term effects of the drugs.
Methods: This retrospective file analysis was conducted on breast cancer patients who presented to the Radiation Oncology clinic between January 2019 and April 2022. Files of 75 patients diagnosed with breast cancer, postmenopausal, and without any previous chronic diseases such as diabetes or hypertension were included in the study. Patients who were started on medications with different active ingredients (tamoxifen citrate, letrozole or anastrazole) in the adjuvant period were examined in 3 groups. Waist circumference thickness, body weight, blood pressure, and blood biochemical tests (blood glucose, lipid levels) were measured before and 6 months after the start of the drugs, and the values were compared retrospectively.
Results: Of the 75 patients included in the study, the average age of patients using tamoxifen was 59.6; The average age of patients using letrozole was 59.12 years and the average age of patients using anastrozole was 63.56 years. There was an increase in fasting blood sugar (p:0.014) and waist circumference (p:0.009) in the tamoxifen group. There was an increase in fasting blood sugar, weight, waist circumference, blood pressure and lipid levels in the letrozole and anastrazole arms (p<0.0001 for all). Furthermore, comorbidities such as diabetes mellitus and hypertension that developed after using drugs were ascertained.
Conclusion: We think that there is a significant association between hormonotherapy medicines used in breast cancer and metabolic syndrome. While we found increases in blood lipids, FBG, body weight, and waist circumference in most of the patients, we observed that these increases were significantly higher in the groups using aromatase inhibitors. These patients should be examined in detail before starting hormone therapy. Diet, active lifestyle, and sports should be recommended.

Ethical Statement

Ethics committee approval of Ankara Training and Research Hospital (E. Board-E-22-1067) dated 07.09.2022 and No. E-93471371-514.99 was taken.

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References

  • Jacques F, Isabelle S, Rajesh D, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-E386
  • Wani B, Aziz SA, Ganaie MA, Mir MH. Metabolic syndrome and breast cancer risk. Indian J Med Paediatr Oncol. 2017;38(04):434-439.
  • Balkau B, Valensi P, Eschwege E, Slama G. A review of the metabolic syndrome. Diabetes Metabolism. 2007;33(6):405-413.
  • Ray A, Fıcek M. Immunomodulatory effects of antiestrogenic drugs. Acta Pharm. 2012;62(2):141-155
  • Kang C, LeRoith D, Gallagher EJ. Diabetes, obesity, and breast cancer. Endocrinol. 2018;159(11):3801-3812. doi: 10.1210/en. 2018-00574
  • Wright N, Akinyemiju T, Subhedar P, Rida P, Aneja R. Targeting risk factors for reducing the racially disparate burden in breast cancer. Front Biosci. 2019;11(1):136-160. doi: 10.2741/s531
  • Ming Xie, Yan Zhong, Yide Yang, Fang Shen, Yue Nie. Extended adjuvant endocrine therapy for women with hormone receptor-positive early breast cancer: a meta-analysis with trial sequential analysis of randomized controlled trials. Front Oncol. 2022;12:1039320. doi:10.3389/fonc.2022.1039320
  • Battisti NML, Smith IE. Preventing late recurrence in hormone receptor-positive early breast cancer: a review. Eur J Cancer. 2022;172:53-64. doi: 10.1016/j.ejca.2022.05.028
  • Zackariah C, James K, Janne B, Robert W, Melissa B. Extended duration of adjuvant aromatase inhibitor in breast cancer: a meta-analysis of randomized controlled trials. Gland Surg. 2018;7(5):449-457. doi: 10.21037/gs.2018.08.03
  • Pasanisi P, Berrino F, De Petris M, Elisabetta V, Antonio M, Salvatore P. Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer. 2006;119(1):236-238.
  • Vona DL, Howard MM, Rose DP. Adiposity, type 2 diabetes and the metabolic syndrome in breast cancer. Obes Rev. 2007;8(5):395-408.
  • Agnoli C, Berrino F, Abagnato CA, et al. Metabolic syndrome and postmenopausal breast cancer in the ORDET cohort: a nested case-conrtol study. Nutr Metab Cardiovasc Dis. 2010;20(1):41-47.
  • Kuhl H. Breast cancer risk in the WHI study: the problem of obesity. Maturitas. 2005;51(1):83-97.
  • Esposito K, Chiodini P, Colao A, Lenzi A, Giugliano D. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care. 2012;35(11):2402-2411.
  • Mendonca FM, de Sousa FR, Barbosa AL, et al. Metabolic syndrome and risk of cancer: which link? Metabolism. 2015;64(2):182-189. doi:10.1016/j.metabol.2014.10.008
  • Metabolik Sendrom Araştırma Grubu. METSAR sonuçları. XX.Ulusal Kardiyoloji Kongresi. Antalya, 2004.
  • Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-2752.
  • Sinagra D, Amato C, Scarpilta AM, et al. Metabolic syndrome and breast cancer risk. Natl Cancer Inst. 2004;96:1152-1160.
  • Johansson H, Gandini S, Guerrieri GA, et al. Effect of fenretinide and low dose tamoxifen on insulin sensitivity in premenopausal women at high ris for breast cancer. Cancer Res. 2008;68(22):9512-9518.
  • Bordeleau L, Lipscombe L, Lubinski J, et al. Diabetes and breast cancer among women with BRCA1 and BRCA2 mutations. Cancer. 2011;17:1812-1818.
  • Yazıcı G, Sayın M. Role of aromatase inhibitors in glucose intolerance of obese men. Med Hypotheses. 2008;71(4):612-613. doi:10.1016/j.mehy.2008.05.012
  • La Merrill M, Baston DS, Denison MS. Mouse breast cancer model-dependent changes in metabolic syndrome-associated phenotypes caused by maternal dioxin exposure and dietary fat. Am J Physiol Endocrinol Metab. 2009;296(1):203-210.
  • Furberg AS, Veierod MB, Wilsgaard T, et al. Serum highdensity lipoprotein, cholesterol, metabolic profile, and breast cancer risk. Natl Cancer Inst. 2004;96(15):1152-1160.
  • Sarıcı F, Sunar V, Aksoy S. The frequency and determinants of metabolic syndrome in operated patients with stage I-III breast cancer. Int J Hematol Oncol. 2022;33(3):001-010.
  • Maiti B, Kundranda MN, Spiro TP, Daw HA. The association of metabolic syndrome with triple-negative breast cancer. Breast Cancer Res Treat. 2010;121(2):479-483.
  • Kozan Ö, Oguz A, Abaci A, et al. Prevalence of the metabolic syndrome among Turkish adults. Eur J Clin Nutr. 2007;61(4):548-553.
  • Lippman SM, Hong WK. Cancer Prevention, Cecil Medicine International Edition. Ed. Goldman L, Ausiello D. Philadelphia, Saunders Elsevier. 2008;1367-1370.
  • Capasso I, Esposito E, Pentimalli F, Anna C, Maurizio M, Maria G. Metabolic syndrome affects breast cancer risk in postmenopausal women. National Cancer Institude of Naples experience. Cancer Biol Ther. 2010;10(12):1240-1243.
  • Liu LN, Miaskowski C, Wang JS, Shin-Cheh C, Mei-Ling C. Accuracy of body mass index to determine obesity in women with breast cancer: an observational study of TaiWanese sample. Int J Nurs Stud. 2010;47(8):994-1000.

Meme kanserinde hormonoterapi kullanımı ve metabolik sendrom arasındaki ilişki

Year 2024, Volume: 6 Issue: 1, 80 - 86, 15.01.2024
https://doi.org/10.38053/acmj.1387556

Abstract

ÖZET
Amaçlar: Meme kanseri tanısı almış hastalarda, hormonoterapi ilaçlarının kullanılmasıyla metabolik sendrom benzeri bulgulara neden olup olmadığını araştırmak ve uzun dönemde ilaçların etkilerini karşılaştırmak.
Yöntemler : Bu retrospektif dosya analizi Ocak 2019 ile Nisan 2022 tarihleri arasında Radyasyon Onkolojisi kliniğine başvuran meme kanseri hastalarında gerçekleştirildi. Meme kanseri tanısı alan, postmenopozal dönemde olan ve önceden diyabet, hipertansiyon gibi herhangi bir kronik hastalığı bulunmayan 75 hastanın dosyaları çalışmaya dahil edildi. Adjuvan dönemde farklı etken maddeli ilaç (tamoksifen sitrat, letrozol veya anastrazol) başlanan hastalar 3 grupta incelendi. İlaçlara başlanmadan önce ve ilaç başlandıktan 6 ay sonra bel çevresi kalınlığı, vücut ağırlığı, kan basıncı ve kan biyokimyasal testleri (açlık kan şekeri, lipid düzeyleri) ölçüldü ve değerler geriye dönük olarak karşılaştırıldı.
Bulgular : Çalışmaya dahil edilen 75 hastadan tamoksifen kullanan hastaların yaş ortalaması 59.6; letrozol kullanan hastaların yaş ortalaması 59.12 yıl ve anastrozol kullanan hastaların yaş ortalaması 63.56 yıldı. Tamoksifen kullanan grupta açlık kan şekeri (p:0.014) ve bel çevresinde kalınlık artışı vardı (p:0.009). Letrozol ve anastrazol kollarında ise açlık kan şekeri, kilo, bel çevresi kalınlığı, tansiyon ve lipit düzeylerinde artış vardı (hepsinde p:0.0001). Ayrıca ilaçlar başlandıktan sonra gelişen diyabet,hipertansiyon gibi ek hastalıklar belirlendi.
Sonuç: Meme kanserinde kullanılan hormonoterapi ilaçlar ile metabolik sendrom arasında ciddi bir bağlantı olduğunu düşünüyoruz. Hastaların çoğunda kan lipit, AKŞ, kilo, bel çevresi artışları saptarken, özellikle aromataz inhibitörü kullanan gruplarda bu artışların anlamlı derecede daha fazla olduğunu gözlemledik. Bu hastaların hormonoterapi başlamadan önce ayrıntılı tetkik edilmesi gerekiyor. Hastalara diyet (şeker ve yağ kısıtlaması), aktif hayat ve spor önerilmelidir. Ayrıca ilaçlara bağlı gelişen ek hastalıkların erken dönemde tanısının konup, gerekli ilaçların başlanması uygun olacaktır.

References

  • Jacques F, Isabelle S, Rajesh D, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-E386
  • Wani B, Aziz SA, Ganaie MA, Mir MH. Metabolic syndrome and breast cancer risk. Indian J Med Paediatr Oncol. 2017;38(04):434-439.
  • Balkau B, Valensi P, Eschwege E, Slama G. A review of the metabolic syndrome. Diabetes Metabolism. 2007;33(6):405-413.
  • Ray A, Fıcek M. Immunomodulatory effects of antiestrogenic drugs. Acta Pharm. 2012;62(2):141-155
  • Kang C, LeRoith D, Gallagher EJ. Diabetes, obesity, and breast cancer. Endocrinol. 2018;159(11):3801-3812. doi: 10.1210/en. 2018-00574
  • Wright N, Akinyemiju T, Subhedar P, Rida P, Aneja R. Targeting risk factors for reducing the racially disparate burden in breast cancer. Front Biosci. 2019;11(1):136-160. doi: 10.2741/s531
  • Ming Xie, Yan Zhong, Yide Yang, Fang Shen, Yue Nie. Extended adjuvant endocrine therapy for women with hormone receptor-positive early breast cancer: a meta-analysis with trial sequential analysis of randomized controlled trials. Front Oncol. 2022;12:1039320. doi:10.3389/fonc.2022.1039320
  • Battisti NML, Smith IE. Preventing late recurrence in hormone receptor-positive early breast cancer: a review. Eur J Cancer. 2022;172:53-64. doi: 10.1016/j.ejca.2022.05.028
  • Zackariah C, James K, Janne B, Robert W, Melissa B. Extended duration of adjuvant aromatase inhibitor in breast cancer: a meta-analysis of randomized controlled trials. Gland Surg. 2018;7(5):449-457. doi: 10.21037/gs.2018.08.03
  • Pasanisi P, Berrino F, De Petris M, Elisabetta V, Antonio M, Salvatore P. Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer. 2006;119(1):236-238.
  • Vona DL, Howard MM, Rose DP. Adiposity, type 2 diabetes and the metabolic syndrome in breast cancer. Obes Rev. 2007;8(5):395-408.
  • Agnoli C, Berrino F, Abagnato CA, et al. Metabolic syndrome and postmenopausal breast cancer in the ORDET cohort: a nested case-conrtol study. Nutr Metab Cardiovasc Dis. 2010;20(1):41-47.
  • Kuhl H. Breast cancer risk in the WHI study: the problem of obesity. Maturitas. 2005;51(1):83-97.
  • Esposito K, Chiodini P, Colao A, Lenzi A, Giugliano D. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care. 2012;35(11):2402-2411.
  • Mendonca FM, de Sousa FR, Barbosa AL, et al. Metabolic syndrome and risk of cancer: which link? Metabolism. 2015;64(2):182-189. doi:10.1016/j.metabol.2014.10.008
  • Metabolik Sendrom Araştırma Grubu. METSAR sonuçları. XX.Ulusal Kardiyoloji Kongresi. Antalya, 2004.
  • Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-2752.
  • Sinagra D, Amato C, Scarpilta AM, et al. Metabolic syndrome and breast cancer risk. Natl Cancer Inst. 2004;96:1152-1160.
  • Johansson H, Gandini S, Guerrieri GA, et al. Effect of fenretinide and low dose tamoxifen on insulin sensitivity in premenopausal women at high ris for breast cancer. Cancer Res. 2008;68(22):9512-9518.
  • Bordeleau L, Lipscombe L, Lubinski J, et al. Diabetes and breast cancer among women with BRCA1 and BRCA2 mutations. Cancer. 2011;17:1812-1818.
  • Yazıcı G, Sayın M. Role of aromatase inhibitors in glucose intolerance of obese men. Med Hypotheses. 2008;71(4):612-613. doi:10.1016/j.mehy.2008.05.012
  • La Merrill M, Baston DS, Denison MS. Mouse breast cancer model-dependent changes in metabolic syndrome-associated phenotypes caused by maternal dioxin exposure and dietary fat. Am J Physiol Endocrinol Metab. 2009;296(1):203-210.
  • Furberg AS, Veierod MB, Wilsgaard T, et al. Serum highdensity lipoprotein, cholesterol, metabolic profile, and breast cancer risk. Natl Cancer Inst. 2004;96(15):1152-1160.
  • Sarıcı F, Sunar V, Aksoy S. The frequency and determinants of metabolic syndrome in operated patients with stage I-III breast cancer. Int J Hematol Oncol. 2022;33(3):001-010.
  • Maiti B, Kundranda MN, Spiro TP, Daw HA. The association of metabolic syndrome with triple-negative breast cancer. Breast Cancer Res Treat. 2010;121(2):479-483.
  • Kozan Ö, Oguz A, Abaci A, et al. Prevalence of the metabolic syndrome among Turkish adults. Eur J Clin Nutr. 2007;61(4):548-553.
  • Lippman SM, Hong WK. Cancer Prevention, Cecil Medicine International Edition. Ed. Goldman L, Ausiello D. Philadelphia, Saunders Elsevier. 2008;1367-1370.
  • Capasso I, Esposito E, Pentimalli F, Anna C, Maurizio M, Maria G. Metabolic syndrome affects breast cancer risk in postmenopausal women. National Cancer Institude of Naples experience. Cancer Biol Ther. 2010;10(12):1240-1243.
  • Liu LN, Miaskowski C, Wang JS, Shin-Cheh C, Mei-Ling C. Accuracy of body mass index to determine obesity in women with breast cancer: an observational study of TaiWanese sample. Int J Nurs Stud. 2010;47(8):994-1000.

Details

Primary Language English
Subjects Radiation Therapy
Journal Section Research Articles
Authors

Meral SAYIN 0000-0002-1211-1723

Publication Date January 15, 2024
Submission Date November 7, 2023
Acceptance Date December 27, 2023
Published in Issue Year 2024 Volume: 6 Issue: 1

Cite

AMA SAYIN M. Using hormonotherapy in breast cancer and its relationship with metabolic syndrome. Anatolian Curr Med J / ACMJ / acmj. January 2024;6(1):80-86. doi:10.38053/acmj.1387556

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