The Association between Obesity and Premenopausal Breast Cancer According to Intrinsic Subtypes – a Systematic Review

Abstract

Introduction Obesity is a well-established risk factor for postmenopausal hormone-receptor positive breast cancer. The relationship between premenopausal breast cancer intrinsic subtypes and obesity is not completely elucidated; therefore, this systematic review was conducted to give an overview about the existing evidence.

Methods This review followed the PRISMA Statement for Systematic Reviews and Meta-analyses. Full electronic search was conducted in PubMed and Orbis for articles published in English between January 2008 and June 2018. The literature search was performed in June 2018 using search strings that combined the Medical Subject Headings (MeSH terms) keywords and/or text words in any field were used: “body mass index” (BMI) OR obesity OR overweight AND premenopausal breast cancer.

Results 391 articles were found to be eligible, of which ultimately 21 were included comprising a total of 55 580 breast cancer patients. 45% were case-control studies, 35% were single cohort studies, 15% were cohort studies, two were cross-sectional studies, one was a multicenter-study and one was a pooled analysis. The evidence shows a tendency for an increased risk for the more aggressive triple negative breast cancer subtype in obese premenopausal women and a decreased risk for less aggressive tumor subtypes such as the luminal A subtype. The evidence is limited by small sample sizes for triple negative and HER2-positive subtypes in severely obese patients.

Conclusion Higher BMI might influence aggressive tumor characteristics among premenopausal women and has divergent impacts on the risk of different breast cancer subtypes. Further research is needed to confirm these results and to evaluate potential pathophysiologic mechanisms for the relationship between obesity and aggressive premenopausal breast cancer subtypes.

Zusammenfassung

Einleitung Übergewicht ist ein bekannter Risikofaktor für postmenopausalen hormonrezeptorpositiven Brustkrebs. Der Zusammenhang zwischen prämenopausalen intrinsischen Mammakarzinom-Subtypen und Übergewicht ist aber noch nicht ganz geklärt. Es wurde daher eine systematische Literaturrecherche durchgeführt, um einen Überblick der existierenden Evidenz zu bekommen.

Methoden Diese Literaturrecherche wurde gemäß den PRISMA-Vorgaben zu systematischen Übersichten und Metaanalysen durchgeführt. In den Datenbanken PubMed und Orbis wurde eine elektronische Suche nach englischsprachigen Artikeln, die zwischen Januar 2008 und Juni 2018 veröffentlicht wurden, durchgeführt. Die Literaturrecherche wurde im Juni 2018 vorgenommen unter Verwendung einer Kombination von MeSH (Medical Subject Headings) Suchbegriffen und „und/oder“ Worten in allen Feldern wie folgt: „body mass index“ (BMI) OR „obesity“ OR „overweight“ AND „premenopausal breast cancer“.

Ergebnisse Insgesamt fanden sich 391 geeignete Publikationen, von denen schließlich 21 Studien, die insgesamt 55 580 Brustkrebspatientinnen einschlossen, ausgewählt wurden. Von den ausgewählten Studien waren 45% Fallkontrollstudien, 35% einfache Kohortenstudien und 15% Kohortenstudien. Es waren auch 2 Querschnittsstudien, eine multizentrische Studie und eine gepoolte Analyse darunter. Die durch die Recherche gewonnene Evidenz zeigt, dass adipöse prämenopausale Frauen ein tendenziell höheres Risiko für aggressivere triple-negative Brustkrebs-Subtypen und ein geringeres Risiko für weniger aggressive Subtypen wie Luminal-A-Tumoren aufweisen. Die kleine Fallzahl an stark adipösen Patientinnen mit triple-negativen und HER2-positiven Subtypen schränkt jedoch die Aussagekraft der Evidenz ein.

Schlussfolgerung Ein höherer BMI könnte einen Einfluss auf aggressive Tumoreigenschaften bei prämenopausalen Frauen haben und hat unterschiedliche Auswirkungen auf das Risiko für verschiedene Brustkrebs-Subtypen. Es werden weitere Studien benötigt, um diese Ergebnisse zu bestätigen und die möglichen pathophysiologischen Mechanismen für die Beziehung zwischen Adipositas und aggressiven prämenopausalen Brustkrebs-Subtypen zu ermitteln.

Key words

hormone receptor - premenopause - breast neoplasms - receptors - obesity - risk factors

Schlüsselwörter

Hormonrezeptor - Prämenopause - Brusttumoren - Rezeptoren - Adipositas - Risikofaktoren

Publikationsverlauf

Eingereicht: 16. Oktober 2019
Eingereicht: 06. April 2020

Angenommen: 27. April 2020

Artikel online veröffentlicht:
17. Juni 2020

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