Obesity and Breast Cancer

A. Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. Breast cancer (malignant breast neoplasm) is a cancer that starts in the tissues of the breast either from the inner lining of milk ducts (Ductal carcinoma) or the lobules (Lobular carcinoma) that supply the ducts with milk. there is also rare cases that breast cancer starts in other areas of the breast. In 2010, over 250,000 new cases of breast cancer were expected to be diagnosed in women in the U.S. alone and the risk of getting invasive breast cancer during life time of a women is 1/8.

C. How do calculate your BMI index
BMI= weight (kg)/ height (m2)

D. How Obesity associates with Breast Cancer
1. In a study of "Hormonal mechanisms underlying the relationship between obesity and breast cancer" by Perks CM, Holly JM. (Source from School of Clinical Sciences, University of Bristol, Research & Learning Building, Southmead Hospital, Bristol BS10 5NB, UK.,Copyright © 2011 Elsevier Inc. All rights reserved), posted in PubMed, researchers indicated in abstract that This review focuses on the influence of obesity on breast cancer development and progression and describes the hormonal factors that may underlie the observations, with particular emphasis on the roles of estrogen, insulin/insulin-like growth factor axis, and adipokines.

2. According to the study of "Obesity, weight change, fasting insulin, proinsulin, C-peptide, and insulin-like growth factor-1 levels in women with and without breast cancer: the Rancho Bernardo Study" by Jernström H, Barrett-Connor E. (Source from Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, USA., J Womens Health Gend Based Med. 1999 Dec;8(10):1265-72.), researchers indicated in abstract that The risk of breast cancer was significantly increased in women who had gained weight or used ERT. This increased risk was not associated with circulating levels of IGF-1, fasting insulin, proinsulin, or C-peptide.

3. According to" Breast cancer risk in the WHI study: the problem of obesity" by Kuhl H. (Source from Department of Gynecology and Obstetrics, J. W. Goethe University of Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany. h.kuhl@em.uni-frankfurt.de, Maturitas. 2005 May 16;51(1):83-97.), posted in PubMed, researchers stated in abstract that Obese women are at high risk to develop a metabolic syndrome including insulin resistance and hyperinsulinemia. In postmenopausal women, elevated insulin levels are not only associated with an increased risk for cardiovascular disease, but also for breast cancer. This might explain the effects observed in both arms of the WHI study: HRT with relative low doses of estrogens may improve insulin resistance and, hence, reduce the elevated breast cancer risk in obese patients.

4. According to tha study of "Polymorphisms in three obesity-related genes (LEP, LEPR, and PON1) and breast cancer risk: a meta-analysis" by Liu C, Liu L.(Source from Department of Clinical Laboratory, Taizhou Municipal Hospital, Taizhou, 318000, China, liuchibo@126.com., Tumour Biol. 2011 Sep 2. [Epub ahead of print]), posted in PubMed, researchers concluded that . The present meta-analysis suggested that LEPR Q223R polymorphism might be implicated in the development of breast cancer in East Asians; PON1 L55M might increase breast cancer risk. However, given the limited sample size, the findings warrant further investigation.

5. In the study of "Obesity and breast cancer: progress to understanding the relationship" by Brown KA, Simpson ER. (Source from Prince Henry's Institute, Monash Medical Centre, Department of Physiology, Monash University, Clayton, Melbourne, Victoria, Australia, Cancer Res. 2010 Jan 1;70(1):4-7. Epub 2009 Dec 22.), posted in PubMed, researchers found that the regulation of aromatase expression in the breast by AMPK and CRTC2, in response to the altered adipokine milieu associated with obesity, provides an important link between obesity and breast cancer risk.

6. Etc.

E. Treatments of Obesity and Breast Cancer
1. According to the study of "Pre-operative gynecologic evaluation of bariatric surgery patients: improving cancer detection in a high-risk population" by Winfree LE, Henretta MS, Hallowell PT, Modesitt SC. (Source from Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA, USA.,J Am Coll Surg. 2010 Aug;211(2):256-62., Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved), posted in PubMed, researchers found that Given the massive increases in morbid obesity and bariatric surgery in women, surgeons could serve a vital role in educating patients about both gynecologic and nongynecologic malignancy risks. With appropriate referral for cancer screening, patient outcomes could improve.

2. In a study of " Alcohol consumption, obesity, estrogen treatment and breast cancer" by Hong J, Holcomb VB, Dang F, Porampornpilas K, Núñez NP. (Source from The University of Texas at Austin, College of Natural Sciences, School of Human Ecology, Department of Nutritional Science, 1 University Station A2703, PAI 5.14, Austin, Texas 78712, USA., Anticancer Res. 2010 Jan;30(1):1-8), posted in PubMed, researchers found that Alcohol intake resulted in insulin sensitivity and increased tumor growth in obese mice. Exogenous estrogen alone inhibited tumor growth. The combination of estrogen and alcohol overcame the inhibitory effects of estrogen on tumor growth in obese mice. Alcohol consumption increased the circulating estrogen and leptin levels. In conclusion, alcohol and estrogen treatment can modify mammary tumor growth, possibly through the regulation of estrogen and leptin, especially in obese mice.

3. According to the "Impact of obesity on diagnosis and treatment of breast cancer" by Deglise C, Bouchardy C, Burri M, Usel M, Neyroud-Caspar I, Vlastos G, Chappuis PO, Ceschi M, Ess S, Castiglione M, Rapiti E, Verkooijen HM. (Source from Geneva Cancer Registry, Institute of Social and Preventive Medicine, Geneva University, 55 Boulevard de la Cluse, 1205, Geneva, Switzerland, Breast Cancer Res Treat. 2010 Feb;120(1):185-93. Epub 2009 Jul 14), researchers found that Obese women were less likely to have undergone ultrasound (OR(adj) 0.5, [0.3-0.9]) and MRI (OR(adj) 0.3, [0.1-0.6]) and were at increased risk of prolonged hospital stay (OR(adj) 4.7, [2.0-10.9]). This study finds important diagnostic and therapeutic differences between obese and lean women, which may impair survival of obese women with breast cancer. Specific strategies are needed to optimize the care of obese women with or at risk of breast cancer.

4. Etc.
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