Abstract
Objective: To investigate the association between metabolic syndrome and breast cancer and to elucidate the potential mechanism underlying this association.Patients and Methods: Based on baseline data drawn from 21 hospitals in 11 provinces of China, we performed a case–control study among 1,127 women (595 cases and 532 controls), divided into premenopausal, and postmenopausal subgroups. Student's t test, Pearson's χ2 test, and logistic regression analyses were performed to ascertain the association between breast cancer and metabolic syndrome, including all of its components. In addition, we attempted to clarify the potential role of adiponectin in this association.Results: Among the components of metabolic syndrome, abnormal waist circumference was the component that markedly increased breast cancer risk in premenopausal women (OR 1.447, 95% CI 1.043–2.006). Metabolic syndrome with clusters of special risk factors showed an association with breast cancer risk. Among all these components of metabolic syndrome, the hypertriglyceridemic-waist (HW) phenotype significantly increased breast cancer risk (OR 1.56, 95% CI 1.02–2.39), regardless of menopausal status, rendering it a strong predictor of breast cancer. Total adiponectin levels and high-molecular-weight adiponectin were reversely associated with metabolic syndrome. In addition, total adiponectin levels among breast cancer patients were much lower than among controls (p = 0.005) only in the HW phenotype subgroup. Furthermore, the HW phenotype was associated with increased risk of estrogen receptor/progesterone receptor-positive (ER+/PR+) breast cancer, with a 95% (OR = 1.95, 95% CI:1.21–3.13) increase. However, there was no significant association between the HW phenotype and both ER+/PR– and ER–/PR– subtypes. These results suggested that low adiponectin levels may be a mechanism that explains the association between the HW phenotype and breast cancer risk.Conclusion: Metabolic syndrome with special cluster factors is related to breast cancer risk; in particular, the HW phenotype can be regarded as a strong predictor of breast cancer. As an important factor involved in fat metabolism, adiponectin may strongly predict metabolic syndrome, especially the HW phenotype and breast cancer. Further research into this mechanism and epidemiological studies are needed. This study provides new evidence for the role of a healthy lifestyle in preventing breast cancer.
Highlights
Breast cancer is known as the most prevalent cancer among women worldwide and has been the leading cause of female cancer deaths globally [1, 2]
What’s more, we have found that when considering the influence of metabolic abnormality on the occurrence of breast cancer, the adiponectin showed a significant association with breast cancer only in the HW phenotype population
Consistent with what we found in our previous study, namely, that general obesity, as indicated by body mass index (BMI), was associated with the ER+/PR+ subtype, whereas central obesity, as indicated by waist/hip ratio, was more specific for the ER–/PR– subtype [61], We revealed that HW phenotype was an independent risk factor for the ER+/PR+ subtype
Summary
Breast cancer is known as the most prevalent cancer among women worldwide and has been the leading cause of female cancer deaths globally [1, 2]. In China, breast cancer is the most commonly diagnosed cancer and the sixth leading cause of cancer deaths among women, with an age-standardized rate (ASR) of 22.1 cases and 5.4 cases per 100,000 women, respectively, according to data from the GLOBOCAN 2012 [2, 3]. In addition to the known risk factors associated with breast cancer, such as breastfeeding and number of childbirths, the westernization of traditional lifestyles has contributed substantially to this difference and is drawing more and more attention [4,5,6]. Urbanization and the shift to a Westernized lifestyle have led to a substantial increase in a series of non-communicable chronic diseases, such as diabetes, obesity, metabolic syndrome, and cancers [10, 11]. Metabolic syndrome is defined as the coexistence of several risk factors for cardiovascular diseases, diabetes, and certain cancers, such as endometrial cancer, prostate cancer, colorectal cancer, and breast cancer [16]
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