Relationship Of Breast Cancer And Molecular Subtypes With Menopausal Status And Body Mass Index

Abstract

Relationship Of Breast Cancer And Molecular Subtypes With Menopausal Status And Body Mass Index ABSTRACT Objectives: To determine the relationship between body mass index (BMI) and breast cancer subtypes according to menopausal status. Methods: Medical records of 802 patients who were followed up with the diagnosis of breast cancer in XXX Training and Research Hospital were retrospectively reviewed. The patients were divided into two groups according to menopausal status as premenopausal and postmenopausal. The groups were further categorized into subgroups as normal weight, overweight, and obese according to the BMI. For breast cancer subtype analysis, the St. Gallen classification was used. The effect of BMI on breast cancer subtypes according to menopausal status was analyzed. Results: Of the 802 patients, 44.8% (n=359) were premenopausal and 55.2% (n=443) were postmenopausal. When the patients were categorized according to the BMI, the rate of overweight and obese patients in the premenopausal group was 60.1% while this value was 82.1% in the postmenopausal group. It was observed that the number of overweight and obese patients was statistically significantly higher in the postmenopausal group. However, no statistically significant correlation was found in the analyses performed between BMI and breast cancer immunohistochemical subtypes in either group. Conclusions: The findings of this study support that obesity causes an increased risk of breast cancer in the postmenopausal period, independent of breast cancer immunohistochemical subtypes. The relationship between obesity and breast cancer should be evaluated together with risk factors, such as family history, ethnicity, and use of hormone replacement therapy since their roles have been more clearly defined in the etiology of breast cancer than obesity. Key Words: Body mass index, Breast cancer, Menopausal status, Molecular subtypes

Keywords

• Body mass index
• Breast cancer
• Menopausal status
• Molecular subtypes

Meme Kanseri ve Moleküler Alt Tiplerinin Menopoz Durumu ve Vücut Kitle İndeksi İle İlişkisi

Öz

ÖZ Amaç: Bu çalışmanın amacı vücut kitle indeksinin menopozal duruma göre meme kanseri subtipleri ile olan ilişkisinin belirlenmesidir. Yöntem: Sağlık Bilimleri Üniversitesi, XXX Eğitim ve Araştırma Hastanesinde meme kanseri tanısı ile takip edilen 802 hastanın dosyaları geriye dönük tarandı ve demografik, klinik ve patolojik karakteristikleri kaydedildi. Hastalar, menopozal duruma göre premenopozal ve postmenopozal olmak üzere iki gruba ayrıldı. Gruplar vücut kitle indeksi verilerine göre normal kilolu, aşırı kilolu ve obez olarak alt gruplara kategorize edildi. Meme kanseri subtip analizi için St. Gallen klasifikasyonu kullanıldı. Menopozal duruma göre vücut kitle indeksinin meme kanseri subtipleri üzerindeki etkisi analiz edildi. Bulgular: 802 hastanın %44,8’i (n: 359) premenopozal, %55,2’si (n: 443) ise postmenopozal idi. Hastalar vücut kitle indeksi verilerine göre kategorize edildiğinde premenopozal grupta aşırı kilolu ve obez hasta oranı %60,1 olup bu değer postmenopozal grupta %82,1 olarak izlendi. Aşırı kilolu ve obez hasta sayısının postmenopozal grupta istatistiksel olarak anlamlı şekilde daha fazla olduğu izlendi. Ne premenopozal ne de postmenopozal grupta vücut kitle indeksi ile meme kanseri immünhistokimyasal subtipleri arasında yapılan analizlerde istatistiksel olarak anlamlı bir korelasyon izlenmedi. Sonuçlar: Bu çalışmanın bulguları, obezitenin meme kanseri immünhistokimyasal subtiplerinden bağımsız olarak postmenopozal dönemde meme kanseri riskinde artışa neden olduğunu desteklemektedir. Obezite ve meme kanseri ilişkisi, meme kanseri etyolojisindeki rolleri obeziteye göre daha net olarak belirlenmiş olan aile öyküsü, etnisite ve hormon replasman tedavisi kullanımı gibi risk faktörleriyle birlikte değerlendirilmelidir. Anahtar Sözcükler: Vücut kitle indeksi, Meme kanseri, Menopozal durum, Moleküler subtipler

Anahtar Kelimeler

• Vücut kitle indeksi
• Meme kanseri
• Menopozal durum
• Moleküler subtipler

References

1. 1- World Health Organization. WHO fact sheet on overweight and obesity. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . (erişim tarihi: 2020.04.01)
2. 2- Millikan RC, Newman B, Tse CK, Moorman PG, Conway K, Dressler LG, Smith LV, Labbok MH, Geradts J, Bensen JT, Jackson S, Nyante S, Livasy C, Carey L, Earp HS, Perou CM. Epidemiology of basal-like breast cancer. Breast Cancer Res Treat. 2008; 109(1):123-39.
3. 3- Eichholzer M, Huang DJ, Modlasiak A, Schmid SM, Schötzau A, Rohrmann S, Güth U. Impact of body mass index on prognostically relevant breast cancer tumor characteristics. Breast Care (Basel). 2013; 8(3):192-198.
4. 4- Thomas HV, Key TJ, Allen DS, Moore JW, Dowsett M, Fentiman IS, Wang DY. Re: Reversal of relation between body mass and endogenous estrogen concentrations with menopausal status. J Natl Cancer Inst. 1997; 5;89(5):396-8.
5. 5- Henderson BE, Ross RK, Judd HL, Krailo MD, Pike MC. Do regular ovulatory cycles increase breast cancer risk? Cancer. 1985; 1;56(5):1206-8.
6. 6- Li H, Sun X, Miller E, Wang Q, Tao P, Liu L, Zhao Y, Wang M, Qi Y, Li J. BMI, reproductive factors, and breast cancer molecular subtypes: a case-control study andmeta-analysis. J Epidemiol 2017; 27(4):143–151
7. 7- Pierobon M, Frankenfeld CL. Obesity as a risk factor for triple-negative breast cancers: A systematic review and meta-analysis. Breast Cancer Res Treat 2013; 137:307-314.
8. 8- Biglia N, Peano E, Sgandurra P, Moggio G, Pecchio S, Maggiorotto F, Sismondi P. Body mass index (BMI) and breast cancer: impact on tumor histopathologic features, cancer subtypes and recurrence rate in pre and postmenopausal women. Gynecol Endocrinol. 2013; 29(3):263-267.

9. 9- Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010; 28(16):2784-2795.
10. 10- Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, Thürlimann B, Senn HJ; Panel Members. Tailoring therapies--improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol. 2015; 26(8):1533-46.
11. 11- World Health Organisation/Europe. Body mass index - BMI. http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi (erişim tarihi: 2020.05.11).
12. 12- Steele CB, Thomas CC, Henley SJ, Massetti GM, Galuska DA, Agurs-Collins T, Puckett M, Richardson LC. Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity - United States, 2005-2014. MMWR Morb Mortal Wkly Rep 2017; 66:1052.
13. 13- Kyrgiou M, Kalliala I, Markozannes G, Gunter MJ, Paraskevaidis E, Gabra H, Martin-Hirsch P, Tsilidis KK. Adiposity and cancer at major anatomical sites: umbrella review of the literature. BMJ 2017; 356:j477.
14. 14- Fang X, Wei J, He X, Lian J, Han D, An P, Zhou T, Liu S, Wang F, Min J. Quantitative association between body mass index and the risk of cancer: A global Meta-analysis of prospective cohort studies. Int J Cancer 2018; 1,143(7):1595-1603.
15. 15- Renehan AG, Zwahlen M, Egger M. Adiposity and cancer risk: new mechanistic insights from epidemiology. Nat Rev Cancer. 2015;15(8):484–98.
16. 16- Park J, Morley TS, Kim M, Clegg DJ, Scherer PE. Obesity and cancer– mechanisms underlying tumour progression and recurrence. Nat Rev Endocrinol. 2014;10(8):455–65.
17. 17- Lahmann PH, Hoffmann K, Allen N, et al. Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC). Int J Cancer 2004; 111:762.
18. 18- Alsaker MD, Janszky I, Opdahl S, Vatten LJ, Romundstad PR. Weight change in adulthood and risk of postmenopausal breast cancer: the HUNT study of Norway. Br J Cancer 2013; 109:1310.
19. 19- Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. International Agency for Research on Cancer Handbook Working Group. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med 2016; 375:794.
20. 20- Widschwendter P, Friedl TW, Schwentner L, et al. The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial. Breast Cancer Res. 2015; 17(1):129.
21. 21- Suzuki R, Orsini N, Saji S, et al: Body weight and incidence of breast cancer defined by estrogen and progesterone receptor status: A meta-analysis. Int J Cancer 2009; 124:698-712.
22. 22- Suzuki R, Orsini N, Saji S, Key TJ, Wolk A. The role of body mass index in the relative risk of developing premenopausal versus postmenopausal breast cancer. Proc Soc Exp Biol Med 1997; 216(1):28–43.
23. 23- Gunter MJ, Hoover DR, Yu H, et al. Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 2009; 101:48.
24. 24- Petrelli JM, Calle EE, Rodriguez C, Thun MJ. Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 2002;13:325–32.
25. 25- Yang XR, Chang-Claude J, Goode EL,et al. Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the Breast Cancer Association Consortium studies. J Natl Cancer Inst 2011;103(3):250e63.
26. 26- Chen L, Li CI, Tang MT, Porter P, Hill DA, Wiggins CL, Cook LS. Reproductive factors and risk of luminal, HER2-overexpressing and triple negative breast cancer among multiethnic women. Cancer Epidemiol Biomarkers Prev. 2016: 25(9): 1297– 1304.
27. 27- Howlader N, Altekruse SF, Li CI, Chen VW, Clarke CA, Ries LA, Cronin KA. US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst. 2014; 106(5):dju055.
28. 28- Wacker M, Risendal B, Westerlind K, Lezotte D, Byers T. Ethnicity, body size, and estrogen levels in postmenopausal Hispanic and non-Hispanic white women. J Womens Health 2009;18(4):487-91.
29. 29- Huo D, Ikpatt F, Khramtsov A, Dangou JM, Nanda R, Dignam J, Zhang B, Grushko T, Zhang C, Oluwasola O, Malaka D, Malami S, Odetunde A, Adeoye AO, Iyare F, Falusi A, Perou CM, Olopade OI. Population differences in breast cancer: survey in indigenous African women reveals over- representation of triple-negative breast cancer. J Clin Oncol 2009; 27: 4515–4521.
30. 30- Olopade OI, Grushko TA, Nanda R, Huo D. Advances in breast cancer: pathways to personalized medicine. Clin Cancer Res 2008; 14: 7988–7999.
31. 31- Wang J, Yang DL, Chen ZZ, Gou BF. Associations of body mass index with cancer incidence among populations, genders, and menopausal status: A systematic review and meta-analysis. Cancer Epidemiol. 2016; 42:1-8.
32. 32- Amadou A, Ferrari P, Muwonge R, Moskal A, Biessy C, Romieu I, Hainaut P. Overweight, obesity and risk of premenopausal breast cancer according to ethnicity: a systematic review and dose-response meta-analysis. Obes Rev. 2013;14(8):665-78.