Li Yun Rose, Ro Vicky, Tchou Julia C
Department of Endocrine and Oncologic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, 19104.
Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, 94143.
Curr Surg Rep. 2018 Mar;6(3). doi: 10.1007/s40137-018-0204-y. Epub 2018 Feb 24.
Obesity contributes to an estimated forty-percent, or 630,000 cases, of malignant neoplasms diagnosed in the United States[1] and higher body mass index (BMI) has been associated with at least seventeen types of solid tumors, including 9% of all breast cancer cases. In this review, we discuss the impact of obesity and consequences of obesity, including the metabolic syndrome and type 2 diabetes mellitus, on breast cancer risk and recurrence. Recent work has identified multiple molecular mechanisms that may underlie the association between obesity and breast cancer. In particular, insulin resistance, increased inflammatory cytokines, leptin signaling, and adipokine signaling have been shown to affect breast cancer risk and outcomes. While obesity is associated with higher breast cancer incidences and worse breast cancer outcomes, several risk reduction methods have been shown to attenuate these risks. Both metformin and statins have been shown to improve disease free survival and overall survival compared to non-users. Metformin also has been associated with lower risk of breast cancer incidence. Furthermore, increased physical activity and weight loss have been shown to decrease risk of breast cancer, especially in post-menopausal women. These studies have emphasized the potential impact that lifestyle changes can have on breast cancer risk and outcomes, and demonstrate the need for randomized control trials to evaluate the roles of metformin and statins for the treatment and chemoprevention of breast cancer.
在美国，肥胖导致了约40%（即63万例）的恶性肿瘤确诊病例[1]，较高的体重指数（BMI）与至少17种实体瘤有关，其中包括9%的乳腺癌病例。在本综述中，我们讨论肥胖及其后果（包括代谢综合征和2型糖尿病）对乳腺癌风险和复发的影响。最近的研究确定了多种可能是肥胖与乳腺癌之间关联基础的分子机制。特别是，胰岛素抵抗、炎症细胞因子增加、瘦素信号传导和脂肪因子信号传导已被证明会影响乳腺癌风险和预后。虽然肥胖与较高的乳腺癌发病率和较差的乳腺癌预后相关，但已证明几种降低风险的方法可以减轻这些风险。与未使用者相比，二甲双胍和他汀类药物都已被证明可改善无病生存期和总生存期。二甲双胍还与较低的乳腺癌发病风险相关。此外，增加体育活动和减轻体重已被证明可降低乳腺癌风险，尤其是在绝经后女性中。这些研究强调了生活方式改变对乳腺癌风险和预后可能产生的潜在影响，并表明需要进行随机对照试验来评估二甲双胍和他汀类药物在乳腺癌治疗和化学预防中的作用。
