Picon-Ruiz Manuel, Morata-Tarifa Cynthia, Valle-Goffin Janeiro J, Friedman Eitan R, Slingerland Joyce M
Postdoctoral Associate, Braman Family Breast Cancer Institute at Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL.
Resident in Internal Medicine, Department of Medicine, University of Miami, Miami, FL.
CA Cancer J Clin. 2017 Sep;67(5):378-397. doi: 10.3322/caac.21405. Epub 2017 Aug 1.
Answer questions and earn CME/CNE Recent decades have seen an unprecedented rise in obesity, and the health impact thereof is increasingly evident. In 2014, worldwide, more than 1.9 billion adults were overweight (body mass index [BMI], 25-29.9 kg/m ), and of these, over 600 million were obese (BMI ≥30 kg/m ). Although the association between obesity and the risk of diabetes and coronary artery disease is widely known, the impact of obesity on cancer incidence, morbidity, and mortality is not fully appreciated. Obesity is associated both with a higher risk of developing breast cancer, particularly in postmenopausal women, and with worse disease outcome for women of all ages. The first part of this review summarizes the relationships between obesity and breast cancer development and outcomes in premenopausal and postmenopausal women and in those with hormone receptor-positive and -negative disease. The second part of this review addresses hypothesized molecular mechanistic insights that may underlie the effects of obesity to increase local and circulating proinflammatory cytokines, promote tumor angiogenesis and stimulate the most malignant cancer stem cell population to drive cancer growth, invasion, and metastasis. Finally, a review of observational studies demonstrates that increased physical activity is associated with lower breast cancer risk and better outcomes. The effects of recent lifestyle interventions to decrease sex steroids, insulin/insulin-like growth factor-1 pathway activation, and inflammatory biomarkers associated with worse breast cancer outcomes in obesity also are discussed. Although many observational studies indicate that exercise with weight loss is associated with improved breast cancer outcome, further prospective studies are needed to determine whether weight reduction will lead to improved patient outcomes. It is hoped that several ongoing lifestyle intervention trials, which are reviewed herein, will support the systematic incorporation of weight loss intervention strategies into care for patients with breast cancer. CA Cancer J Clin 2017;67:378-397. © 2017 American Cancer Society.
回答问题并获取CME/CNE 近几十年来，肥胖现象以前所未有的速度增长，其对健康的影响也日益明显。2014年，全球有超过19亿成年人超重（体重指数[BMI]为25 - 29.9kg/m²），其中超过6亿人肥胖（BMI≥30kg/m²）。尽管肥胖与糖尿病和冠状动脉疾病风险之间的关联广为人知，但肥胖对癌症发病率、发病率和死亡率的影响尚未得到充分认识。肥胖不仅与患乳腺癌的风险较高有关，尤其是在绝经后女性中，而且与各年龄段女性的疾病预后较差有关。本综述的第一部分总结了肥胖与绝经前和绝经后女性以及激素受体阳性和阴性疾病患者的乳腺癌发生和预后之间的关系。本综述的第二部分探讨了假设的分子机制见解，这些见解可能是肥胖增加局部和循环促炎细胞因子、促进肿瘤血管生成并刺激最恶性的癌症干细胞群体以推动癌症生长、侵袭和转移的作用基础。最后，对观察性研究的综述表明，增加体育活动与较低的乳腺癌风险和更好的预后相关。还讨论了近期生活方式干预对降低性激素、胰岛素/胰岛素样生长因子-1通路激活以及与肥胖中较差乳腺癌预后相关的炎症生物标志物的影响。尽管许多观察性研究表明，减肥运动与改善乳腺癌预后相关，但仍需要进一步的前瞻性研究来确定体重减轻是否会导致患者预后改善。希望本文综述的几项正在进行的生活方式干预试验将支持将减肥干预策略系统地纳入乳腺癌患者的护理中。《CA：临床医师癌症杂志》2017年；67：378 - 397。©2017美国癌症协会
