Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
Int J Cancer. 2021 Jul 1;149(1):42-57. doi: 10.1002/ijc.33508. Epub 2021 Feb 24.
Emerging evidence suggests that normal weight postmenopausal women with a relative excess of body fat are at increased breast cancer risk. However, little is known about the associations between obesity-related blood markers and risk of breast cancer among these individuals. In this prospective study comprising 58 629 normal weight postmenopausal women (body mass index between 18.5 kg/m and 24.9 kg/m ) who were enrolled in the UK Biobank cohort between 2006 and 2010, we examined the associations of glycated hemoglobin, triglycerides, high-density lipoprotein cholesterol, C-reactive protein (CRP), testosterone and sex hormone-binding globulin (SHBG) with risk of breast cancer. A total of 1268 postmenopausal breast cancer cases were ascertained during a median follow-up period of 7 years. Women with CRP, total testosterone and free testosterone (FT) levels in the highest quintile had increased risk of breast cancer compared to those in the lowest quintile (HR : 1.35, 95% confidence interval [CI]: 1.12-1.63, HR : 1.47, 95% CI: 1.20-1.80 and HR : 1.53, 95% CI: 1.23-1.90, respectively), whereas those with SHBG in the highest quintile had reduced risk (HR : 0.70, 95% CI: 0.56-0.88). These associations were attenuated but persisted after additional adjustment for BMI, fat mass index (whole body fat mass [kg]/height [m ]) or waist circumference and after mutual adjustment for testosterone, CRP and/or SHBG. Our study suggests that the risk of postmenopausal breast cancer among normal weight women is increased in association with relatively high levels of CRP and testosterone and with relatively low levels of SHBG.
新出现的证据表明，体脂相对过剩的正常体重绝经后妇女患乳腺癌的风险增加。然而，人们对这些人群中与肥胖相关的血液标志物与乳腺癌风险之间的关系知之甚少。在这项包括 58629 名正常体重绝经后妇女（体重指数在 18.5kg/m 和 24.9kg/m 之间）的前瞻性研究中，这些妇女于 2006 年至 2010 年期间参加了英国生物库队列研究，我们研究了糖化血红蛋白、甘油三酯、高密度脂蛋白胆固醇、C 反应蛋白（CRP）、睾酮和性激素结合球蛋白（SHBG）与乳腺癌风险的关系。在中位随访 7 年期间共确定了 1268 例绝经后乳腺癌病例。与 CRP、总睾酮和游离睾酮（FT）水平处于最低五分位数的女性相比，处于最高五分位数的女性患乳腺癌的风险增加（HR：1.35，95%置信区间 [CI]：1.12-1.63，HR：1.47，95%CI：1.20-1.80 和 HR：1.53，95%CI：1.23-1.90），而 SHBG 处于最高五分位数的女性则降低了风险（HR：0.70，95%CI：0.56-0.88）。这些关联在进一步调整 BMI、脂肪质量指数（全身脂肪量 [kg]/身高 [m]）或腰围后减弱但仍然存在，并且在相互调整睾酮、CRP 和/或 SHBG 后也仍然存在。我们的研究表明，在正常体重女性中，CRP 和睾酮水平相对较高以及 SHBG 水平相对较低与绝经后乳腺癌风险增加相关。
