Stoll B A
Oncology Department, St. Thomas' Hospital, London, UK.
Int J Obes Relat Metab Disord. 1996 May;20(5):389-92.
The high incidence of breast cancer in Western women has been linked to nutritional factors such as high-fat/low-fibre diet, obesity and timing of weight gain. A mechanism is postulated through which the Western diet could act in conjunction with inadequate exercise and excessive weight gain at the time of a major change in hormonal balance. All these factors favour the manifestation of insulin resistance, and the concomitants of hyperinsulinaemia might then synergise with oestrogen in promoting the development of breast cancer. The mechanism is compatible with the 'breast tissue age' model of mammary carcinogenesis. The concomitants of hyperinsulinaemia could also influence the growth of established disease subsequent to its promotion, and it is suggested that the hypothesis be tested by an adjuvant randomised trial of a high-fibre/low-fat diet in patients following primary surgery for early breast cancer. It has been suggested that the development of insulin resistance may link the Western lifestyle not only to an increased risk of hypertension and arteriosclerosis, but also to increased breast cancer risk. Large abdominal fat deposits in women are frequently a marker of the presence of insulin resistance and are generally associated with an increased level of bio-available oestrogen. There is evidence that predominantly abdominal distribution of fat in women may be a marker of increased breast cancer risk from puberty onwards. Abdominal obesity may however be hidden, and it is more reliably demonstrated by imaging techniques such as CAT or MRI scans, than by anthropometric measurements such as increased waist-to-hip ratio.
西方女性乳腺癌的高发病率与高脂肪/低纤维饮食、肥胖以及体重增加的时间等营养因素有关。有人提出了一种机制，通过这种机制，西方饮食可能与运动不足以及在激素平衡发生重大变化时体重过度增加共同起作用。所有这些因素都有利于胰岛素抵抗的表现，然后高胰岛素血症的伴随症状可能与雌激素协同作用，促进乳腺癌的发展。该机制与乳腺癌发生的“乳腺组织年龄”模型相符。高胰岛素血症的伴随症状也可能在促进疾病发生后影响已确诊疾病的发展，有人建议通过对早期乳腺癌初次手术后的患者进行高纤维/低脂肪饮食的辅助随机试验来检验这一假设。有人提出，胰岛素抵抗的发展可能不仅将西方生活方式与高血压和动脉硬化风险增加联系起来，还与乳腺癌风险增加联系起来。女性腹部大量脂肪堆积常常是胰岛素抵抗存在的标志，并且通常与生物可利用雌激素水平升高有关。有证据表明，从青春期开始，女性腹部脂肪占主导的分布可能是乳腺癌风险增加的标志。然而，腹部肥胖可能是隐藏的，通过计算机断层扫描（CAT）或磁共振成像（MRI）扫描等成像技术比通过腰臀比增加等人的测量方法更能可靠地显示出来。
