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Breast Cancer in Tunisia: Association of Body Mass Index with Histopathological Aspects of Tumors

  • Bouguerra, Hichem (Laboratoire de Genetique, Immunologie et Pathologies Humaines, Departement de Biologie, Faculte des Sciences de Tunis, CAMPUS, Universite Tunis-El Manar) ;
  • Guissouma, Hajer (Laboratoire de Genetique, Immunologie et Pathologies Humaines, Departement de Biologie, Faculte des Sciences de Tunis, CAMPUS, Universite Tunis-El Manar) ;
  • Labidi, Soumaya (Service de carcinologie medicale, Hopital Abderrahman Mami) ;
  • Stambouli, Nejla (Laboratoire de Genetique, Immunologie et Pathologies Humaines, Departement de Biologie, Faculte des Sciences de Tunis, CAMPUS, Universite Tunis-El Manar) ;
  • Marrakchi, Raja (Laboratoire de Genetique, Immunologie et Pathologies Humaines, Departement de Biologie, Faculte des Sciences de Tunis, CAMPUS, Universite Tunis-El Manar) ;
  • Chouaib, Salem (INSERM UMR753, Institut Gustave Roussy) ;
  • Elgaaied, Amel Ben Ammar (Laboratoire de Genetique, Immunologie et Pathologies Humaines, Departement de Biologie, Faculte des Sciences de Tunis, CAMPUS, Universite Tunis-El Manar) ;
  • Boussen, Hammouda (Service de carcinologie medicale, Hopital Abderrahman Mami) ;
  • Gati, Asma (Laboratoire de Genetique, Immunologie et Pathologies Humaines, Departement de Biologie, Faculte des Sciences de Tunis, CAMPUS, Universite Tunis-El Manar)
  • Published : 2014.08.30

Abstract

Background: Previous studies have suggested a link between obesity and breast cancer (BC). However, there is no universal consensus, especially in population based studies. Because only few studies have been conducted on African women, we aimed here to assess the relationship between BMI at time of diagnosis and the BC histopathological features among Tunisian patients according to menopausal status using a hospital-based prospective cohort study. Materials and Methods: Clinical and pathological data were collected from 262 patients stratified on four groups according to their BMI. The relationship between BMI and histopathological features at diagnosis was analysed using univariate and multivariate analysis. Receiver-operating characteristic (ROC) curves were used to evaluate the performance of BMI in predicting of high tumor grade, in comparison to ki-67 index of proliferation. Results: Obesity was correlated with larger tumors, advanced grade and with ER-PR-Her2+ BC subtype. An association of BMI with tumor size and tumor grade was observed in both premenopausal and postmenopausal women. Additionally, a significant association between BMI and ER+, ER+PR+Her2+ and ER-PR-Her2+ status was revealed for premenopausal patients, while only ER+PR+Her2+ was associated with BMI for postmenopausal women. Finally, our results showed that compared to Ki67 proliferation index, BMI is a useful prognostic marker of high grade BC tumors. Conclusions: These data are the first to show that in Tunisia obese women suffering from BC have significantly larger tumors and advanced tumor grade and that higher BMI might influence tumor characteristics and behavior.

Keywords

References

  1. Adebamowo CA, Ogundiran TO, Adenipekun AA, et al (2003). Obesity and height in urban Nigerian women with breast cancer. Ann Epidemiol, 13, 455-61. https://doi.org/10.1016/S1047-2797(02)00426-X
  2. Amadou A, Ferrari P, Muwonge R, et al (2013). Overweight, obesity and risk of premenopausal breast cancer according to ethnicity: a systematic review and dose-response metaanalysis. Obes Rev, 14, 665-78. https://doi.org/10.1111/obr.12028
  3. Belardi V, Gallagher EJ, Novosyadlyy R, et al (2013). Insulin and IGFs in obesity-related breast cancer. J Mammary Gland Biol Neoplasia, 18, 277-89. https://doi.org/10.1007/s10911-013-9303-7
  4. Belfki H, Ben Ali S, Aounallah-Skhiri H, et al (2013). Prevalence and determinants of the metabolic syndrome among Tunisian adults: results of the Transition and Health Impact in North Africa (TAHINA) project. Public Health Nutr, 16, 582-90. https://doi.org/10.1017/S1368980012003291
  5. Biglia N, Peano E, Sgandurra P, et al (2013). Body mass index (BMI) and breast cancer: impact on tumor histopathologic features, cancer subtypes and recurrence rate in pre and postmenopausal women. Gynecol Endocrinol, 29, 263-7. https://doi.org/10.3109/09513590.2012.736559
  6. Catalan V, Gomez-Ambrosi J, Rodriguez A, et al (2013). Adipose tissue immunity and cancer. Front Physiol, 4, 275.
  7. Chouchane L, Boussen H, and Sastry KS (2013). Breast cancer in Arab populations: molecular characteristics and disease management implications. Lancet Oncol, 14, 417-24. https://doi.org/10.1016/S1470-2045(13)70165-7
  8. De Pergola G, and Silvestris F (2013). Obesity as a major risk factor for cancer. J Obes, 2013, 291546.
  9. Deurenberg P, Deurenberg-Yap M, and Guricci S (2002). Asians are different from caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev, 3, 141-6. https://doi.org/10.1046/j.1467-789X.2002.00065.x
  10. Ewertz M, Jensen MB, Gunnarsdottir KA, et al (2011). Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol, 29, 25-31. https://doi.org/10.1200/JCO.2010.29.7614
  11. Ferguson RD, Gallagher EJ, Scheinman EJ, et al (2013). The epidemiology and molecular mechanisms linking obesity, diabetes, and cancer. Vitam Horm, 93, 51-98. https://doi.org/10.1016/B978-0-12-416673-8.00010-1
  12. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
  13. Grossmann ME, Ray A, Nkhata KJ, et al (2010). Obesity and breast cancer: status of leptin and adiponectin in pathological processes. Cancer Metastasis Rev, 29, 641-53. https://doi.org/10.1007/s10555-010-9252-1
  14. Hajian-Tilaki KO, Gholizadehpasha AR, Bozorgzadeh S, et al (2011). Body mass index and waist circumference are predictor biomarkers of breast cancer risk in Iranian women. Med Oncol, 28, 1296-301. https://doi.org/10.1007/s12032-010-9629-6
  15. Hanahan D, Weinberg RA (2011). Hallmarks of cancer: the next generation. Cell, 144, 646-674. https://doi.org/10.1016/j.cell.2011.02.013
  16. Harvey AE, Lashinger LM, and Hursting SD (2011). The growing challenge of obesity and cancer: an inflammatory issue. Ann N Y Acad Sci, 1229, 45-52. https://doi.org/10.1111/j.1749-6632.2011.06096.x
  17. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  18. Kaviani A, Neishaboury M, Mohammadzadeh N, et al (2013). Effects of obesity on presentation of breast cancer, lymph node metastasis and patient survival: a retrospective review. Asian Pac J Cancer Prev, 14, 2225-9. https://doi.org/10.7314/APJCP.2013.14.4.2225
  19. Keskin O, Aksoy S, Babacan T, et al (2013). Impact of the obesity on lymph node status in operable breast cancer patients. J BUON, 18, 824-30.
  20. Khan S, Shukla S, Sinha S, et al (2013). Role of adipokines and cytokines in obesity-associated breast cancer: therapeutic targets. Cytokine Growth Factor Rev, 24, 503-13. https://doi.org/10.1016/j.cytogfr.2013.10.001
  21. Kilickap S, Kaya Y, Yucel B, et al (2014). Higher Ki67 expression is associates with unfavorable prognostic factors and shorter survival in breast cancer. Asian Pac J Cancer Prev, 15, 1381-5. https://doi.org/10.7314/APJCP.2014.15.3.1381
  22. Labidi SI, Mrad K, Mezlini A, et al (2008). Inflammatory breast cancer in Tunisia in the era of multimodality therapy. Ann Oncol, 19, 473-80.
  23. Maatoug J, Harrabi I, Hmad S, et al (2013). Advising obese adults about diet and physical activity in Sousse, Tunisia. ISRN Obes, 2013, 498527.
  24. Majeed W, Aslam B, Javed I, et al (2014). Breast cancer: major risk factors and recent developments in treatment. Asian Pac J Cancer Prev, 15, 3353-8. https://doi.org/10.7314/APJCP.2014.15.8.3353
  25. Minicozzi P, Berrino F, Sebastiani F, et al (2013). High fasting blood glucose and obesity significantly and independently increase risk of breast cancer death in hormone receptorpositive disease. Eur J Cancer, 49, 3881-8. https://doi.org/10.1016/j.ejca.2013.08.004
  26. Missaoui N, Jaidene L, Abdelkrim SB, et al (2011). Breast cancer in Tunisia: clinical and pathological findings. Asian Pac J Cancer Prev, 12, 169-72.
  27. Missaoui N, Landolsi H, Jaidaine L, et al (2012). Breast cancer in central Tunisia: an earlier age at diagnosis and incidence increase over a 15-year period. Breast J, 18, 289-91. https://doi.org/10.1111/j.1524-4741.2012.01242.x
  28. Ogundiran TO, Huo D, Adenipekun A, et al (2012). Body fat distribution and breast cancer risk: findings from the Nigerian breast cancer study. Cancer Causes Control, 23, 565-74. https://doi.org/10.1007/s10552-012-9916-y
  29. Okobia MN, Bunker CH, Zmuda JM, et al (2006). Anthropometry and breast cancer risk in Nigerian women. Breast J, 12, 462-6. https://doi.org/10.1111/j.1075-122X.2006.00304.x
  30. Porter GA, Inglis KM, Wood LA, et al (2006). Effect of obesity on presentation of breast cancer. Ann Surg Oncol, 13, 327-32. https://doi.org/10.1245/ASO.2006.03.049
  31. Renehan AG, Tyson M, Egger M, et al (2008). Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet, 371, 569-78. https://doi.org/10.1016/S0140-6736(08)60269-X
  32. Ronco AL, De Stefani E, Deneo-Pellegrini H, et al (2012). Diabetes, overweight and risk of postmenopausal breast cancer: a case-control study in Uruguay. Asian Pac J Cancer Prev, 13, 139-46. https://doi.org/10.7314/APJCP.2012.13.1.139
  33. Sangrajrang S, Chaiwerawattana A, Ploysawang P, et al (2013). Obesity, diet and physical inactivity and risk of breast cancer in Thai women. Asian Pac J Cancer Prev, 14, 7023-7. https://doi.org/10.7314/APJCP.2013.14.11.7023
  34. Santillan-Benitez JG, Mendieta-Zeron H, Gomez-Olivan LM, et al (2013). The tetrad BMI, leptin, leptin/adiponectin (L/A) ratio and CA 15-3 are reliable biomarkers of breast cancer. J Clin Lab Anal, 27, 12-20. https://doi.org/10.1002/jcla.21555
  35. Singh AK, Pandey A, Tewari M, et al (2011). Obesity augmented breast cancer risk: a potential risk factor for Indian women. J Surg Oncol, 103, 217-22. https://doi.org/10.1002/jso.21768
  36. Turkoz FP, Solak M, Petekkaya I, et al (2013). Association between common risk factors and molecular subtypes in breast cancer patients. Breast, 22, 344-50. https://doi.org/10.1016/j.breast.2012.08.005
  37. Xing MY, Xu SZ, and Shen P (2014). Effect of low-fat diet on breast cancer survival: a meta-analysis. Asian Pac J Cancer Prev, 15, 1141-4. https://doi.org/10.7314/APJCP.2014.15.3.1141
  38. Yaw YH, Shariff ZM, Kandiah M, et al (2014). Diet and physical activity in relation to weight change among breast cancer patients. Asian Pac J Cancer Prev, 15, 39-44. https://doi.org/10.7314/APJCP.2014.15.1.39
  39. Zhu K, Caulfield J, Hunter S, et al (2005). Body mass index and breast cancer risk in African American women. Ann Epidemiol, 15, 123-8. https://doi.org/10.1016/j.annepidem.2004.05.011

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