Role of physical activity and metabolic syndrome in determining the risk of postmenopausal breast cancer: a systematic review

Physical activity (PA) and metabolic syndrome (MetS) have emerged as crucial factors in facilitating the incidence of postmenopausal (PM) breast cancer (BC). The association of PA, MetS and its components with PM BC was explored in this study. PRISMA guideline was followed and online databases were searched comprehensively to find relevant cohort and case-control studies until 18 February 2021 using keywords such as “physical activity”, “metabolic syndrome” and “breast cancer”. Eligible studies evaluating BC in postmenopausal women with a clear definition and measure of PA, MetS and its individual components were selected. A total of twenty-three articles related to PA and fifteen articles for MetS met the eligibility criteria and were assessed thoroughly. PA and MetS were significantly associated with PM BC. There was evidence of dose-response effect of PA and Mets on PM BC. Obesity, diabetes and dyslipidaemia were independently associated with PM BC and posed an increased risk on PM BC whereas the association of HPTN with PM BC was not prominent. Consistent and sustained long term PA throughout one’s lifetime was observed to decrease PM BC risk whereas increasing number of MetS components increased the risk of PM BC. Routine screening for PM women with ≥2 MetS components and obese or overweight women with any of the MetS components may be beneficial in early BC detection. Lifestyle modifications with emphasis on long term PA would be beneficial to public health in preventing and improving MetS outcomes as well as a primary prevention of sporadic PM BC.

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Minireview: Obesity and Breast Cancer: A Tale of Inflammation and Dysregulated Metabolism

Molecular Endocrinology ◽

10.1210/me.2013-1011 ◽

2013 ◽

Vol 27 (5) ◽

pp. 715-725 ◽

Cited By ~ 51

Author(s):

Evan R. Simpson ◽

Kristy A. Brown

Keyword(s):

Breast Cancer ◽

Metabolic Syndrome ◽

Postmenopausal Breast Cancer ◽

Breast Tumors ◽

The Other ◽

Cellular Mechanisms ◽

Related Factors ◽

The Metabolic Syndrome ◽

Increased Risk ◽

The One

Abstract In addition to the spectrum of conditions known collectively as the Metabolic Syndrome, obesity is now recognized to be associated with increased risk of several cancers including colon, endometrial, and breast cancer. Obesity and carcinogenesis share 2 characteristics in common. On the one hand, they involve inflammatory pathways, and on the other hand, they involve dysregulated metabolism. In this review we focus on postmenopausal breast cancer and discuss the metabolic and cellular mechanisms whereby obesity and breast cancer are related. Because a majority of postmenopausal breast tumors are estrogen responsive, we include a discussion of the action of obesity-related factors on estrogen formation within the breast.

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Effect of Exercise on Metabolic Syndrome Variables in Breast Cancer Survivors

International Journal of Endocrinology ◽

10.1155/2013/168797 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 20

Author(s):

Gwendolyn A. Thomas ◽

Marty Alvarez-Reeves ◽

Lingeng Lu ◽

Herbert Yu ◽

Melinda L. Irwin

Keyword(s):

Breast Cancer ◽

Metabolic Syndrome ◽

Cancer Survivors ◽

Aerobic Exercise ◽

Usual Care ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Exercise Adherence ◽

Postmenopausal Breast Cancer ◽

Increased Risk

Objective. Breast cancer survivors are highly sedentary, overweight, or obese, which puts them at increased risk for comorbid chronic disease. We examined the prevalence of, and changes in, metabolic syndrome following 6 months of an aerobic exercise versus usual care intervention in a sample of sedentary postmenopausal breast cancer survivors.Design and Methods. 65 participants were randomized to an aerobic exercise intervention (EX) (n=35) mean BMI 30.8 (±5.9) kg/m2or usual care (UC) (n=30) mean BMI 29.4 (±7.4) kg/m2. Metabolic syndrome prevalence was determined, as well as change in criteria and overall metabolic syndrome.Results. At baseline, 55.4% of total women met the criteria for metabolic syndrome. There was no statistically significant change in metabolic syndrome when comparing EX and UC. However, adhering to the exercise intervention (at least 120 mins/week of exercise) resulted in a significant (P=.009) decrease in metabolic syndromez-score from baseline to 6 months (-0.76±0.36) when compared to those who did not adhere (0.80±0.42).Conclusions. Due to a higher prevalence of metabolic syndrome in breast cancer survivors, lifestyle interventions are needed to prevent chronic diseases associated with obesity. Increasing exercise adherence is a necessary target for further research in obese breast cancer survivors.

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Pattern and prevalence of metabolic syndrome in obese adolescents aged 10-18 years: a community based study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20202145 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1344

Author(s):

K. Jothilakshmi ◽

Vadivel Vinoth ◽

Suvetha Kannappan

Keyword(s):

Metabolic Syndrome ◽

Strong Association ◽

Cross Sectional Study ◽

Cardiovascular Morbidity ◽

Age Group ◽

Obese Children ◽

Lifestyle Modifications ◽

Cross Sectional ◽

Increased Risk

Background: The prevalence and magnitude of childhood obesity is increasing in pediatric age group. Incidence of metabolic syndrome is high among obese children and adolescents leading to increased risk of cardiovascular morbidity in long term. For this reason, recognition of metabolic syndrome in obese children is of great importance.Methods: This study was a cross-sectional study carried out among children aged 10-18 years from both urban and rural schools in Coimbatore. Children were screened, sample for metabolic studies collected after consent and analyzed.Results: Total 1582 children in the age group of 10-18 years were screened. 300 children were recruited. Among the studied group, 19.3% were overweight, 30.7% were obese. Metabolic syndrome was present in 55.1% of obese and overweight children. Hyperinsulinemia was present in 30% of obese children.Conclusions: This study done in adolescent school children showed a strong association between obesity and early onset of metabolic syndrome. Early intervention with lifestyle modifications is strongly recommended to prevent long term cardiovascular morbidity.

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Improving risk assessment of obesity-associated breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.1544 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 1544-1544

Author(s):

Neil M. Iyengar ◽

Ayca Gucalp ◽

Xi K. Zhou ◽

Hanhan Wang ◽

Dilip D. Giri ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Body Fat ◽

Menopausal Status ◽

Postmenopausal Breast Cancer ◽

Categorical Variables ◽

Continuous Variables ◽

Exact Test ◽

Increased Risk ◽

Adipocyte Hypertrophy

1544 Background: Elevated body mass index (BMI) is associated with increased risk of estrogen receptor (ER)-positive postmenopausal breast cancer. The risk is also elevated in women with a normal BMI but excess body fat. These risks may be driven by breast white adipose tissue inflammation (WATi), which is associated with elevated aromatase levels and systemic metabolic dysfunction (e.g. hyperinsulinemia). We hypothesized that body fat assessment is superior to BMI for detecting the pathophysiology that promotes obesity-related breast cancer, particularly among normal BMI women. Methods: Non-tumorous breast tissue was collected from women undergoing mastectomy for breast cancer treatment or prevention. Breast WATi was detected by the presence of crown-like structures in the breast, which are composed of a dead/dying adipocyte surrounded by CD68+ macrophages. Body composition was measured prior to mastectomy via dual energy X-ray absorptiometry. Exercise behavior was also assessed prior to surgery using the Godin Leisure Time Exercise Questionnaire. Associations among categorical variables were examined using Χ2 or Fisher’s exact test. Relationships between continuous variables were examined using the Spearman correlation. Results: From April 5, 2016 to August 31, 2018, 100 patients were enrolled; median age 49 (range 29 to 82) years. Breast WATi was present in 56/100 (56%) women and was associated with elevated BMI and body fat levels, breast adipocyte hypertrophy, postmenopausal status, metabolic syndrome and decreased physical activity (P < 0.05). Among 39 women with normal BMI, breast WATi was present in 14 (36%) and was associated with elevated body fat levels, breast adipocyte hypertrophy, dyslipidemia, and decreased physical activity (P < 0.05). There was no statistically significant association between BMI and breast WATi in the normal BMI group. Menopausal status and total fat mass had greater sensitivity and specificity for the detection of breast WATi compared to a BMI-based model (AUC 0.843 vs. 0.779, respectively). Conclusions: Measurement of body fat is superior to BMI for predicting breast inflammation, which has been shown to promote obesity-related breast cancer.

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Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases

BMJ ◽

10.1136/bmj.m3873 ◽

2020 ◽

pp. m3873 ◽

Cited By ~ 2

Author(s):

Yana Vinogradova ◽

Carol Coupland ◽

Julia Hippisley-Cox

Keyword(s):

Breast Cancer ◽

General Practice ◽

Hormone Replacement Therapy ◽

Index Date ◽

Hormone Replacement ◽

Case Control ◽

Case Control Studies ◽

Increased Risk ◽

Nested Case Control

Abstract Objective To assess the risks of breast cancer associated with different types and durations of hormone replacement therapy (HRT). Design Two nested case-control studies. Setting UK general practices contributing to QResearch or Clinical Practice Research Datalink (CPRD), linked to hospital, mortality, social deprivation, and cancer registry (QResearch only) data. Participants 98 611 women aged 50-79 with a primary diagnosis of breast cancer between 1998 and 2018, matched by age, general practice, and index date to 457 498 female controls. Main outcome measures Breast cancer diagnosis from general practice, mortality, hospital, or cancer registry records. Odds ratios for HRT types, adjusted for personal characteristics, smoking status, alcohol consumption, comorbidities, family history, and other prescribed drugs. Separate results from QResearch or CPRD were combined. Results Overall, 33 703 (34%) women with a diagnosis of breast cancer and 134 391 (31%) controls had used HRT prior to one year before the index date. Compared with never use, in recent users (<5 years) with long term use (≥5 years), oestrogen only therapy and combined oestrogen and progestogen therapy were both associated with increased risks of breast cancer (adjusted odds ratio 1.15 (95% confidence interval 1.09 to 1.21) and 1.79 (1.73 to 1.85), respectively). For combined progestogens, the increased risk was highest for norethisterone (1.88, 1.79 to 1.99) and lowest for dydrogesterone (1.24, 1.03 to 1.48). Past long term use of oestrogen only therapy and past short term (<5 years) use of oestrogen-progestogen were not associated with increased risk. The risk associated with past long term oestrogen-progestogen use, however, remained increased (1.16, 1.11 to 1.21). In recent oestrogen only users, between three (in younger women) and eight (in older women) extra cases per 10 000 women years would be expected, and in oestrogen-progestogen users between nine and 36 extra cases per 10 000 women years. For past oestrogen-progestogen users, the results would suggest between two and eight extra cases per 10 000 women years. Conclusion This study has produced new generalisable estimates of the increased risks of breast cancer associated with use of different hormone replacement preparations in the UK. The levels of risks varied between types of HRT, with higher risks for combined treatments and for longer duration of use.

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Physical activity and cancer risk

Proceedings of The Nutrition Society ◽

10.1079/pns200076 ◽

2001 ◽

Vol 60 (1) ◽

pp. 107-113 ◽

Cited By ~ 44

Author(s):

Adrianne E. Hardman

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Colon Cancer ◽

Physical Inactivity ◽

Modifiable Risk Factors ◽

Case Control Studies ◽

Body Fatness ◽

Physically Active ◽

Increased Risk ◽

Repeated Exercise

Evidence is accumulating that high levels of physical activity are associated with a reduced risk of some cancers. This evidence is most consistent for colon cancer, which is reduced by 40–50 % among the most active individuals, compared with the least active. The effect is evident in men and women, and appears to be independent of important confounding factors. However, there may be important interactions with body fatness; a high BMI has been reported to be associated with an increased risk of colon cancer in sedentary men but not in physically-active men. Whilst the evidence on breast cancer is less consistent, case–control studies typically suggest a reduction of 25–30 % among the most active women, although several studies have found no effect. Potential mechanisms include systemic influences and others relevant only to site-specific cancers. One unifying hypothesis is that physical inactivity reduces insulin sensitivity, leading to a growth-promotional environment which may facilitate neoplasia. The non-specific immune system may be improved by physical activity, possibly through the summative effects of repeated exercise bouts. Regular exercise, even at a recreational level, probably reduces exposure to oestrogen and thus decreases the risk of breast cancer. Increased colonic peristalsis, and thus reduced bowel transit time, might partly explain the lower risk of colon cancer in active people. Physical activity emerges as one of the few modifiable risk factors for some cancers and, as such, justifies further study.

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Effects of a 1-Year Physical Activity Intervention on Markers of Hemostasis among Breast Cancer Survivors: A Randomized Controlled Trial

TH Open ◽

10.1055/s-0040-1721782 ◽

2021 ◽

Vol 05 (01) ◽

pp. e14-e23

Author(s):

Siv Kjølsrud Bøhn ◽

Inger Thune ◽

Vidar Gordon Flote ◽

Hanne Frydenberg ◽

Gro Falkenér Bertheussen ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Postmenopausal Women ◽

Cancer Patients ◽

Physical Activity Intervention ◽

Intervention Group ◽

Factor Vii ◽

Breast Cancer Patients ◽

Hemostatic Factors

Abstract Introduction Physical activity may reduce the development of breast cancer. Whereas hypercoagulability has been linked to adverse outcomes in breast cancer patients, the effects of physical activity on their hemostatic factors are unknown. The study aimed to assess whether long-term (1 year) physical activity can affect hemostatic factors in breast cancer patients. Methods Fifty-five women (35–75 years) with invasive breast cancer stage I/II were randomized to a physical activity intervention (n = 29) lasting 1 year or to a control group (n = 26), and analyzed as intention to treat. Fibrinogen, factor VII antigen, tissue factor pathway inhibitor, and von Willebrand factor (VWF) antigen as well as prothrombin fragment 1 + 2, the endogenous thrombin potential and D-dimer, were measured in plasma before intervention (baseline), and then after 6 and 12 months. Results Maximal oxygen uptake (measure of cardiorespiratory fitness) decreased the first 6 months among the controls, but remained stable in the intervention group. We found no significant differences between the two study groups regarding any of the hemostatic factors, except a significantly higher increase in factor VII antigen in the intervention group. The effect of the intervention on VWF was, however, significantly affected by menopausal stage, and a significant effect of the intervention was found on VWF among postmenopausal women, even after adjustment for dietary intake. Conclusion Long-term physical activity had no effect on the majority of the hemostatic factors measured, but led to increased plasma concentrations of factor VII antigen and prevented an increase in VWF concentration after breast cancer treatment in postmenopausal women. The clinical impact of these findings for risk of vascular thrombosis warrants further studies.

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Changes in Metabolic Syndrome Status and Breast Cancer Risk: A Nationwide Cohort Study

Cancers ◽

10.3390/cancers13051177 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1177

Author(s):

In Young Choi ◽

Sohyun Chun ◽

Dong Wook Shin ◽

Kyungdo Han ◽

Keun Hye Jeon ◽

...

Keyword(s):

Breast Cancer ◽

Metabolic Syndrome ◽

Proportional Hazards ◽

Screening Program ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Increased Risk ◽

Health Screening Program ◽

Design And Methods

Objective: To our knowledge, no studies have yet looked at how the risk of developing breast cancer (BC) varies with changes in metabolic syndrome (MetS) status. This study aimed to investigate the association between changes in MetS and subsequent BC occurrence. Research Design and Methods: We enrolled 930,055 postmenopausal women aged 40–74 years who participated in a biennial National Health Screening Program in 2009–2010 and 2011–2012. Participants were categorized into four groups according to change in MetS status during the two-year interval screening: sustained non-MetS, transition to MetS, transition to non-MetS, and sustained MetS. We calculated multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for BC incidence using the Cox proportional hazards models. Results: At baseline, MetS was associated with a significantly increased risk of BC (aHR 1.11, 95% CI 1.06–1.17) and so were all of its components. The risk of BC increased as the number of the components increased (aHR 1.46, 95% CI 1.26–1.61 for women with all five components). Compared to the sustained non-MetS group, the aHR (95% CI) for BC was 1.11 (1.04–1.19) in the transition to MetS group, 1.05 (0.96–1.14) in the transition to non-MetS group, and 1.18 (1.12–1.25) in the sustained MetS group. Conclusions: Significantly increased BC risk was observed in the sustained MetS and transition to MetS groups. These findings are clinically meaningful in that efforts to recover from MetS may lead to reduced risk of BC.

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Symposium report: breast cancer in India—trends, environmental exposures and clinical implications

Cancer Causes & Control ◽

10.1007/s10552-021-01428-y ◽

2021 ◽

Vol 32 (6) ◽

pp. 567-575

Author(s):

Jasmine A. McDonald ◽

Roshni Rao ◽

Marley Gibbons ◽

Rajiv Janardhanan ◽

Surinder Jaswal ◽

...

Keyword(s):

Breast Cancer ◽

Scientific Evidence ◽

Treatment Options ◽

Environmental Exposures ◽

Population Based ◽

Clinical Implications ◽

Think Tank ◽

Case Control Studies ◽

Short Term

Abstract Purpose Incidence of breast cancer (BC), particularly in young women, are rising in India. Without population-based mammography screening, rising rates cannot be attributed to screening. Investigations are needed to understand the potential drivers of this trend. Methods An international team of experts convened to discuss the trends, environmental exposures, and clinical implications associated with BC in India and outlined recommendations for its management. Results Panels were structured across three major BC themes (n = 10 presentations). The symposium concluded with a semi-structured Think Tank designed to elicit short-term and long-term goals that could address the challenges of BC in India. Conclusion There was consensus that the prevalence of late-stage BC and the high BC mortality rates are associated with the practice of detection, which is primarily through clinical and self-breast exams, as opposed to mammography. Triple-Negative BC (TNBC) was extensively discussed, including TNBC etiology and potential risk factors, the limited treatment options, and if reported TNBC rates are supported by rigorous scientific evidence. The Think Tank session yielded long-term and short-term goals to further BC reduction in India and included more regional etiological studies on environmental exposures using existing India-based cohorts and case–control studies, standardization for molecular subtyping of BC cases, and improving the public’s awareness of breast health.

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The effect of long-term poor sleep quality on risk of back-related disability and the modifying role of physical activity

Scientific Reports ◽

10.1038/s41598-021-94845-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eivind Schjelderup Skarpsno ◽

Tom Ivar Lund Nilsen ◽

Paul Jarle Mork

Keyword(s):

Physical Activity ◽

Back Pain ◽

Sleep Quality ◽

Sleep Problems ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Physical Activity Guidelines ◽

Adjusted Risk ◽

Increased Risk

AbstractSleep problems and regular leisure time physical activity (LTPA) are interrelated and have contrasting effects on risk of back pain. However, no studies have investigated the influence of long-term poor sleep quality on risk of back-related disability, or if LTPA modifies this association. The study comprised data on 8601 people who participated in three consecutive surveys over ~ 22 years, and who reported no chronic back pain at the two first surveys. Adjusted risk ratios (RRs) for back-related disability were calculated at the last survey, associated with the joint effect of changes in sleep quality between the two first surveys and meeting physical activity guidelines at the second survey. Compared to people with long-term good sleep, people with long-term poor sleep had nearly twice the risk of back-related disability (RR 1.92, 95% CI 1.48–2.49). There was no statistical interaction between sleep and LTPA but people who reported long-term poor sleep and meeting the physical activity guidelines had 35% lower risk of back-related disability compared to people with same level of sleep problems, but who not met the guidelines. These findings suggest that long-term poor sleep quality contributes to a substantially increased risk of chronic and disabling back pain irrespective of LTPA.

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