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Summary

Recently, Palmiero et al. [1] reported the results of a study aimed at assessing the prevalence of the metabolic syndrome (MetS), diagnosed according to current guidelines, in postmenopausal women with breast cancer, and determine its role as an independent risk factor. For this, 755 postmenopausal women (48 to 67 years) referred for cardiac evaluation due to their histologically confirmed breast cancer, were enrolled. Authors collected demographics such as age, height, weight, body mass index (BMI), symptom duration, detailed personal history of metabolic and cardiovascular disease, family history of metabolic and neoplastic diseases. All women underwent electrocardiographic and echocardiographic evaluation. A control group of 750 women without breast cancer (48 and 67 years) were also enrolled. ATP-III criteria was used to define those with MetS. The rate of the MetS and metabolic cardiomyopathy was significantly higher among women affected with breast cancer as compared to controls (10.1% vs. 5.4%; and 5.8% vs. 1.8%, both p < 0.05). Authors conclude that there was a significant association between the MetS and breast cancer, adding evidence to this controversial relationship; which was even tighter when restricted to women affected by metabolic cardiomyopathy. Since the prevalence of the MetS and breast cancer is increasing worldwide, there is a need for intervention such as improving physical activity and weight reduction.

Commentary

Early breast cancer diagnosis is difficult to achieve making it extremely important to evaluate risk factors. Many studies confirm the association of the MetS with breast cancer due to various mechanisms, probably this may be known since 2012 when Esposito et al [2] published a systematic review and meta-analysis regarding the MetS and higher risk of cancer, but as a limitation there was lack of statistical significance. Later in 2016, Dibaba et al [3] did find in their study that the MetS was associated with a 73% increased risk of breast cancer mortality (HR 1.73; 95% CI 1.09-2.75) which was overall more significant in postmenopausal women (HR 2.07, 95% CI 1.32, 3.25).

Throughout the menopausal transition it is known that women have a tendency of weight gain especially around the waist. Abdominal fat is an important source of androgen/estrogen that can stimulate breast epithelium cells and insulin growth factor; these are involved in oxidative stress related with carcinogenesis. Adipokines secreted from visceral adipocytes, free fatty acids and aromatase activity contribute to this process, as mentioned by Key et al. [4]. The results of the present study that is being commented are interesting because it found that the rate of the MetS and metabolic cardiomyopathy was significantly higher among women affected with breast cancer as compared to controls, which adds to the literature evidence of this controversial relationship. It is important for all women with or without family history of breast cancer to prevent the development of the MetS and increase physical activity. Women diagnosed with breast cancer suffer emotional distress that affect the functioning of the immune system as described by others [5,6]. Physical activity improves quality of life in women with breast cancer. Some studies recommend 3 months of physical activity; however, Zemlin et al. [7] have suggested a 12 month period of physical activity. Pilates is another useful activity that can be performed by breast cancer patients to improve their quality of life [8].

In conclusion as mentioned by the authors there was a significant association between the MetS and breast cancer. Since the prevalence of the MetS and breast cancer is increasing worldwide, there is a need for intervention with cost effective measures such as weight reduction and the increase of physical activity.

Danny Salazar-Pousada, MD
Instituto de Investigación e Innovación en Salud Integral
Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador

References

  1. Palmiero P, Maiello M, Cecere A, Ciccone MM. Metabolic syndrome and breast cancer: a dangerous association for postmenopausal women. Acta Biomed. 2021;92(4):e2021177.
    https://pubmed.ncbi.nlm.nih.gov/34487081/
  2. 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):2402-11.
    https://pubmed.ncbi.nlm.nih.gov/23093685/
  3. Dibaba DT, Ogunsina K, Braithwaite D, Akinyemiju T. Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype. Breast Cancer Res Treat. 2019;174(1):209-218.
    https://pubmed.ncbi.nlm.nih.gov/30465158/
  4. Key TJ, Appleby PN, Reeves GK, et al.; Endogenous Hormones Breast Cancer Collaborative Group. Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst. 2003;95(16):1218-26.
    https://pubmed.ncbi.nlm.nih.gov/12928347/
  5. Saxton JM, Scott EJ, Daley AJ, Woodroofe M, Mutrie N, Crank H, Powers HJ, Coleman RE. Effects of an exercise and hypocaloric healthy eating intervention on indices of psychological health status, hypothalamic-pituitary-adrenal axis regulation and immune function after early-stage breast cancer: a randomised controlled trial. Breast Cancer Res. 2014;16(2):R39.
    https://pubmed.ncbi.nlm.nih.gov/24731917/
  6. Schmidt T, van Mackelenbergh M, Wesch D, Mundhenke C. Physical activity influences the immune system of breast cancer patients. J Cancer Res Ther. 2017;13(3):392-398.
    https://pubmed.ncbi.nlm.nih.gov/28862198/
  7. Zemlin C, Stuhlert C, Schleicher JT, et al. Longitudinal Assessment of Physical Activity, Fitness, Body Composition, Immunological Biomarkers, and Psychological Parameters During the First Year After Diagnosis in Women With Non-Metastatic Breast Cancer: The BEGYN Study Protocol. Front Oncol. 2021;11:762709.
    https://pubmed.ncbi.nlm.nih.gov/34737966/
  8. Boing L, do Bem Fretta T, de Carvalho Souza Vieira M, Pereira GS, Moratelli J, Sperandio FF, Bergmann A, Baptista F, Dias M, de Azevedo Guimarães AC. Pilates and dance to patients with breast cancer undergoing treatment: study protocol for a randomized clinical trial – MoveMama study. Trials. 2020;21(1):35.
    https://pubmed.ncbi.nlm.nih.gov/31910872/

 


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