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Adipositas und Karzinogenese des Mammakarzinoms

Obesity and tumorigenesis of breast cancer

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Adipositas und Übergewichtigkeit sind als Tumorrisikofaktoren anzusehen. Epidemiologische Studien bestätigen eine konsistente, positive Risikkoverknüpfung von Adipositas und Brustkrebs bei postmenopausalen Frauen. Zudem ist von einer schlechteren Prognose nach Mammakarzinom im Zusammenhang mit Fettleibigkeit sowohl in der Prä- und Postmenopause auszugehen. Dargestellt weden die molekularbiologischen Zusammenhänge zwischen Adipositas und Karzinogenese des Mammakarzinoms. Die wichtigsten Hypothesen zur Tumorgenese gehen davon aus, dass bei Fettleibigkeit in der Postmenopause eine vermehrte periphere Östrogensynthese vorliegt, sodass in Folge erhöhter Östrogenwerte ein kontinuierlicher proliferativer Stimulus auf hormonabhängige Gewebestrukturen ausgeübt wird. Weiterhin ist anzunehmen, dass die Adipositas zum metabolischen Syndrom führt, wodurch vermehrt Insulin und IGF („insulin-like growth factor“) als mitogene Substanzen im Blutkreislauf zirkulieren. Die jüngste Hypothese zur Tumorgenese spricht insbesondere der autokrinen, parakrinen und endokrinen Funktion der Adipozyten eine zentrale Aufgabe bei der Kanzerogenisierung des Brustgewebes zu. Da die Adipositas einen veränderbaren Risikofaktor darstellt, müssen zukünftige Therapiekonzepte auch diätetische Maßnahmen zur Gewichtsreduktion beinhalten.

Abstract

Conditions of obesity and overweight are known to be risk factors for breast cancer. Most epidemiological studies have shown that obese women are at increased risk of developing postmenopausal breast cancer. It has also been suggested that a higher body mass index is associated with a poorer prognosis after tumor diagnosis in premenopausal as well as postmenopausal women. This article reviews the hypotheses which attempt to provide a molecular basis for a causal link between obesity and the risk of breast cancer. In particular the effects of the metabolic syndrome and insulin resistance, peripheral estrogen aromatization and the direct effect of adipokines are discussed. Furthermore clinical implications for therapy are mentioned.

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  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    W. Distler, K. Kast & U. Canzler

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  1. W. Distler
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  2. K. Kast
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  3. U. Canzler
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Correspondence to W. Distler.

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Distler, W., Kast, K. & Canzler, U. Adipositas und Karzinogenese des Mammakarzinoms. Gynäkologe 43, 552–558 (2010). https://doi.org/10.1007/s00129-010-2528-2

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