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Body composition and breast cancer risk and treatment: mechanisms and impact

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Abstract

Purpose

The purpose of this review is to clarify the association of body composition with breast cancer risk and treatment, including physiological mechanisms, and to elucidate strategies for overcoming unfavorable body composition changes that relate to breast cancer progression.

Methods

We have summarized updated knowledge regarding the mechanism of the negative association of altered body composition with breast cancer risk and treatment. We also review strategies for reversing unfavorable body composition based on the latest clinical trial results.

Results

Body composition changes in patients with breast cancer typically occur during menopause or as a result of chemotherapy or endocrine therapy. Dysfunction of visceral adipose tissue (VAT) in the setting of obesity underlies insulin resistance and chronic inflammation, which can lead to breast cancer development and progression. Insulin resistance and chronic inflammation are also observed in patients with breast cancer who have sarcopenia or sarcopenic obesity. Nutritional support and a personalized exercise program are the fundamental interventions for reversing unfavorable body composition. Other interventions that have been explored in specific situations include metformin, testosterone, emerging agents that directly target the adipocyte microenvironment, and bariatric surgery.

Conclusions

A better understanding of the biology of body composition phenotypes is key to determining the best intervention program for patients with breast cancer.

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Acknowledgements

We thank Ms. Sunita Patterson in the Research Medical Library, MD Anderson Cancer Center, and Ms. Shraddha Subramanian in the Center for Metabolic and Degenerative Diseases, The University of Texas Health Science Center at Houston, for editorial assistance.

Funding

This work was supported by the Morgan Welch Inflammatory Breast Cancer Research Program, a State of Texas Rare and Aggressive Breast Cancer Research Program grant, National Institutes of Health/National Cancer Institute award 1R01CA205043-01A1 (to NTU), and a Harry E. Bovay, Jr. Foundation gift (to MGK).

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Authors and Affiliations

  1. Section of Translational Breast Cancer Research, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, TX, 77030, USA

    Toshiaki Iwase, Xiaoping Wang, Tushaar Vishal Shrimanker & Naoto T. Ueno

  2. Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Toshiaki Iwase, Xiaoping Wang, Tushaar Vishal Shrimanker & Naoto T. Ueno

  3. Center for Metabolic and Degenerative Diseases, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX, 77030, USA

    Mikhail G. Kolonin

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  1. Toshiaki Iwase
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Correspondence to Naoto T. Ueno.

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Iwase, T., Wang, X., Shrimanker, T.V. et al. Body composition and breast cancer risk and treatment: mechanisms and impact. Breast Cancer Res Treat 186, 273–283 (2021). https://doi.org/10.1007/s10549-020-06092-5

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