Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype

Abstract

Purpose

To investigate the association between metabolic syndrome (MetS) and risk of breast cancer mortality by menopausal status, obesity, and subtype.

Methods

Data from 94,555 women free of cancer at baseline in the National Institute of Health-American Association of Retired Persons Diet and Health Study cohort (NIH-AARP) were used to investigate the prospective associations of baseline MetS and components with risk of breast cancer mortality using Cox proportional hazard regression models adjusted for baseline behavioral and demographic covariates.

Results

During a mean follow-up duration of 14 years, 607 women in the cohort died of breast cancer. Overall, MetS was associated with a 73% increased risk of breast cancer mortality (HR 1.73; 95% CI 1.09–2.75); the association remained significant among post-menopausal women overall (HR 2.07, 95% CI 1.32, 3.25), and among those with overweight/obesity (HR 1.15, 95% CI 0.81, 1.64). MetS was associated with increased risk of breast cancer mortality for ER+/PR+ (HR 1.28, 95% CI 0.52, 3.16) and lower risk for ER−/PR− (HR 0.44, 95% CI 0.11, 1.75) subtypes; however, the associations were not statistically significant. Of the individual MetS components, high waist circumference (HR 1.32, 95% CI 1.03, 1.70), high cholesterol (HR 1.24, 95% CI 1.05, 1.46), and hypertension (HR 1.24, 95% CI 1.05, 1.46) were independently associated with increased risk of breast cancer mortality.

Conclusions

MetS was associated with increased risk of breast cancer mortality, especially among post-menopausal women. Further studies with larger sample sizes are needed to definitively determine the extent to which these associations vary by breast cancer subtype.

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Fig. 1

Data availability

The NIH-AARP dataset is publicly available for research investigations upon submission and approval of a research proposal. Details can be found at https://www.nihaarpstars.com.

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Acknowledgements

We thank the participants in the NIH-AARP Diet and Health Study for their cooperation, and David Campbell and Jane Wang at Information management Services (Silver Spring, MD) for data support.

Funding

TA was funded by Grant K01TW010271 by the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

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Authors

Contributions

TA conceived and designed the study and oversaw statistical analysis and manuscript writing. DTD, KO, TA, and DB contributed to statistical analysis, drafting of the results, and critical review of the manuscript. All authors substantially contributed to the manuscript.

Corresponding author

Correspondence to Tomi Akinyemiju.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The Special Studies Institutional Review Board (IRB) of the U.S. National Cancer Institute approved the NIH-AARP Diet and Health Study (Protocol Number: OH95CN025).

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Dibaba, D.T., Ogunsina, K., Braithwaite, D. et al. Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype. Breast Cancer Res Treat 174, 209–218 (2019). https://doi.org/10.1007/s10549-018-5056-8

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Keywords

  • Metabolic syndrome
  • Breast cancer mortality
  • Menopause
  • Obesity
  • Hormone-receptor subtypes