Abstract
Obesity, in postmenopausal women, has been associated to a higher breast cancer incidence and worst prognosis. Some studies suggested a decrease in aromatase inhibitors (AI) efficacy in obese postmenopausal breast cancer patients, although estradiol levels were not measured. The purpose of the present study was to verify if estradiol levels are measurable in postmenopausal women under AI. If achievable, the goal is to compare the estradiol levels in lean versus obese postmenopausal women under AI treatment for non-metastatic breast cancer. Postmenopausal women were recruited in accordance to one of these four groups: lean [body mass index (BMI) of 18–25 kg/m2] under AI (n = 30), obese (BMI ≥30 kg/m2) under AI (n = 30), lean AI-naïve (n = 10), and obese AI-naïve (n = 10). Lean and obese women were matched according to their age. Estradiol levels were measured in plasma using an ELISA. The Wilcoxon signed-rank test was used to assess the significance of the differences between the groups. Estradiol levels in postmenopausal women under AI varied from 0 to 94.65 pg/ml with a median value of 0.98 pg/ml. Obese AI-naïve women had higher estradiol levels than lean AI-naïve women (p = 0.03). There was no difference in estradiol levels between lean and obese women under AI (p = 0.76). Despite very low plasma levels, it is possible to measure the estradiol levels in postmenopausal women under AI treatment. Our results suggest that the known impact of obesity on recurrence risk in women under AI treatment may not be due to incomplete aromatase inhibition. Further works are needed to examine closely the aromatase-independent pathways that are linking obesity to breast cancer risk and recurrence.
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Siegel R, Ward E, Brawley O, Jemal A (2011) Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 61(4):212–236. doi:10.3322/caac.20121
Anderson WF, Katki HA, Rosenberg PS (2011) Incidence of breast cancer in the United States: current and future trends. J Natl Cancer Inst 103(18):1397–1402. doi:10.1093/jnci/djr257
Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, Erban JK, Farrar WB, Forero A, Giordano SH, Goldstein LJ, Gradishar WJ, Hayes DF, Hudis CA, Ljung BM, Mankoff DA, Marcom PK, Mayer IA, McCormick B, Pierce LJ, Reed EC, Sachdev J, Smith ML, Somlo G, Ward JH, Wolff AC, Zellars R (2011) NCCN clinical practice guidelines in oncology: breast cancer, V.2.2011 edn. National Comprehensive Cancer Network (NCCN), Fort Washington
Miller WR (2006) Aromatase and the breast: regulation and clinical aspects. Maturitas 54(4):335–341. doi:10.1016/j.maturitas.2006.04.020
International Association for the Study of Obesity (2012) http://www.iaso.org/. Accessed 28 June 2012
Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371(9612):569–578. doi:10.1016/S0140-6736(08)60269-X
Montazeri A, Sadighi J, Farzadi F, Maftoon F, Vahdaninia M, Ansari M, Sajadian A, Ebrahimi M, Haghighat S, Harirchi I (2008) Weight, height, body mass index and risk of breast cancer in postmenopausal women: a case-control study. BMC Cancer 8:278. doi:10.1186/1471-2407-8-278
Brown KA, Simpson ER (2010) Obesity and breast cancer: progress to understanding the relationship. Cancer Res 70(1):4–7. doi:10.1158/0008-5472.CAN-09-2257
Enger SM, Greif JM, Polikoff J, Press M (2004) Body weight correlates with mortality in early-stage breast cancer. Arch Surg 139(9):954–958. doi:10.1001/archsurg.139.9.954 (discussion 958–960)
Maccio A, Madeddu C, Mantovani G (2009) Adipose tissue as target organ in the treatment of hormone-dependent breast cancer: new therapeutic perspectives. Obes Rev 10(6):660–670. doi:10.1111/j.1467-789X.2009.00592.x
Geisler J, Haynes B, Ekse D, Dowsett M, Lonning PE (2007) Total body aromatization in postmenopausal breast cancer patients is strongly correlated to plasma leptin levels. J Steroid Biochem Mol Biol 104(1–2):27–34. doi:10.1016/j.jsbmb.2006.09.040
Miller WR, Anderson TJ, Evans DB, Krause A, Hampton G, Dixon JM (2003) An integrated view of aromatase and its inhibition. J Steroid Biochem Mol Biol 86(3–5):413–421
Sestak I, Distler W, Forbes JF, Dowsett M, Howell A, Cuzick J (2010) Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol 28(21):3411–3415. doi:10.1200/JCO.2009.27.2021
Ware JE, Jr. SF-36® Health Survey Update. http://www.sf-36.org/tools/sf36.shtml. Accessed 27 Aug 2012
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483
Hilditch JR, Lewis J, Peter A, van Maris B, Ross A, Franssen E, Guyatt GH, Norton PG, Dunn E (1996) A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas 24(3):161–175
Radtke JV, Terhorst L, Cohen SM (2011) The menopause-specific quality of Life Questionnaire: psychometric evaluation among breast cancer survivors. Menopause 18(3):289–295. doi:10.1097/gme.0b013e3181ef975a
Park MH, Falconer C, Viner RM, Kinra S (2012) The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev. doi:10.1111/j.1467-789X.2012.01015.x
Morimoto LM, White E, Chen Z, Chlebowski RT, Hays J, Kuller L, Lopez AM, Manson J, Margolis KL, Muti PC, Stefanick ML, McTiernan A (2002) Obesity, body size, and risk of postmenopausal breast cancer: the women’s health initiative (United States). Cancer Causes Control 13(8):741–751
Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D (2007) Cancer incidence and mortality in relation to body mass index in the million women study: cohort study. BMJ 335(7630):1134. doi:10.1136/bmj.39367.495995.AE
Loi S, Milne RL, Friedlander ML, McCredie MR, Giles GG, Hopper JL, Phillips KA (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14(7):1686–1691. doi:10.1158/1055-9965.EPI-05-0042
Protani M, Coory M, Martin JH (2010) Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 123(3):627–635. doi:10.1007/s10549-010-0990-0
Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP (2003) Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst 95(19):1467–1476
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348(17):1625–1638. doi:10.1056/NEJMoa021423
Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 14(8):2009–2014. doi:10.1158/1055-9965.EPI-05-0106
Majed B, Moreau T, Senouci K, Salmon RJ, Fourquet A, Asselain B (2008) Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 111(2):329–342. doi:10.1007/s10549-007-9785-3
Petrelli JM, Calle EE, Rodriguez C, Thun MJ (2002) Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 13(4):325–332
Ewertz M, Jensen MB, Gunnarsdottir KA, Hojris I, Jakobsen EH, Nielsen D, Stenbygaard LE, Tange UB, Cold S (2011) Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29(1):25–31. doi:10.1200/JCO.2010.29.7614
Lorincz AM, Sukumar S (2006) Molecular links between obesity and breast cancer. Endocr Relat Cancer 13(2):279–292. doi:10.1677/erc.1.00729
Hursting SD, Berger NA (2010) Energy balance, host-related factors, and cancer progression. J Clin Oncol 28(26):4058–4065. doi:10.1200/JCO.2010.27.9935
Formica V, Tesauro M, Cardillo C, Roselli M (2012) Insulinemia and the risk of breast cancer and its relapse. Diabetes Obes Metab. doi:10.1111/j.1463-1326.2012.01614.x
Milazzo G, Giorgino F, Damante G, Sung C, Stampfer MR, Vigneri R, Goldfine ID, Belfiore A (1992) Insulin receptor expression and function in human breast cancer cell lines. Cancer Res 52(14):3924–3930
Subbaramaiah K, Morris PG, Zhou XK, Morrow M, Du B, Giri D, Kopelovich L, Hudis CA, Dannenberg AJ (2012) Increased levels of COX-2 and prostaglandin E2 contribute to elevated aromatase expression in inflamed breast tissue of obese women. Cancer Discov 2(4):356–365. doi:10.1158/2159-8290.CD-11-0241
Terry MB, Gammon MD, Zhang FF, Tawfik H, Teitelbaum SL, Britton JA, Subbaramaiah K, Dannenberg AJ, Neugut AI (2004) Association of frequency and duration of aspirin use and hormone receptor status with breast cancer risk. JAMA 291(20):2433–2440. doi:10.1001/jama.291.20.2433
Rose DP, Gilhooly EM, Nixon DW (2002) Adverse effects of obesity on breast cancer prognosis, and the biological actions of leptin (review). Int J Oncol 21(6):1285–1292
Revillion F, Charlier M, Lhotellier V, Hornez L, Giard S, Baranzelli MC, Djiane J, Peyrat JP (2006) Messenger RNA expression of leptin and leptin receptors and their prognostic value in 322 human primary breast cancers. Clin Cancer Res 12(7 Pt 1):2088–2094. doi:10.1158/1078-0432.CCR-05-1904
Bulun SE, Chen D, Moy I, Brooks DC, Zhao H (2011) Aromatase, breast cancer and obesity: a complex interaction. Trends Endocrinol Metab 23(2):83–89. doi:10.1016/j.tem.2011.10.003
Schmid P, Possinger K, Bohm R, Chaudri H, Verbeek A, Grosse Y, Luftner D, Petrides PE, Sezer O, Wischnewsky M (2000) Body mass index as predictive parameter for response and time to progression (TTP) in advanced breast cancer patients treated with letrozole or megestrol acetate. Proc Am Soc Clin Oncol 19:103a (abstr 398)
Pfeiler G, Konigsberg R, Fesl C, Mlineritsch B, Stoeger H, Singer CF, Postlberger S, Steger GG, Seifert M, Dubsky P, Taucher S, Samonigg H, Bjelic-Radisic V, Greil R, Marth C, Gnant M (2011) Impact of body mass index on the efficacy of endocrine therapy in premenopausal patients with breast cancer: an analysis of the prospective ABCSG-12 trial. J Clin Oncol 29(19):2653–2659. doi:10.1200/JCO.2010.33.2585
Michaud L, Buzdar A, Rubin S, Steinberg M, Yin H, Aaronson L, Nabholtz J (2002) The efficacy of anastrozole is not dependent upon body mass index (BMI) in postmenopausal women with advanced breast cancer (BC). Proc Am Soc Clin Oncol 21:55a (abstr 219)
Pfeiler G, Stöger H, Singer C, Seifert M, Jakesz R, Dubsky P, Samonigg H, Greil R, Menzel C, Heck D, Gnant M (2010) Impact of body mass index (BMI) on the efficacy of endocrine therapy in postmenopausal breast cancer patients—an analysis of the ABCSG 6 and 6a Trial. San Antonio Breast Cancer Conf abstract PD-09-05
Folkerd EJ, Dixon JM, Renshaw L, A’Hern RP, Dowsett M (2012) Suppression of plasma estrogen levels by letrozole and anastrozole is related to body mass index in patients with breast cancer. J Clin Oncol 30(24):2977–2980. doi:10.1200/JCO.2012.42.0273
Lonning PE, Geisler J (2008) Aromatase inhibitors: assessment of biochemical efficacy measured by total body aromatase inhibition and tissue estrogen suppression. J Steroid Biochem Mol Biol 108(3–5):196–202. doi:10.1016/j.jsbmb.2007.09.017
Geisler J, Detre S, Berntsen H, Ottestad L, Lindtjorn B, Dowsett M, Einstein Lonning P (2001) Influence of neoadjuvant anastrozole (Arimidex) on intratumoral estrogen levels and proliferation markers in patients with locally advanced breast cancer. Clin Cancer Res 7(5):1230–1236
Santen RJ, Song RX, Zhang Z, Kumar R, Jeng MH, Masamura A, Lawrence J Jr, Berstein L, Yue W (2005) Long-term estradiol deprivation in breast cancer cells up-regulates growth factor signaling and enhances estrogen sensitivity. Endocr Relat Cancer 12(Suppl 1):S61–S73. doi:10.1677/erc.1.01018
Acknowledgments
C.D. is a Junior Investigator of the Canadian Research Society (2011-700657). J.L. is a Clinical Research Scholar from the Fonds de Recherche du Québec—Santé (FRQS). This study was supported by an unrestricted grant from Pfizer Canada.
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Caroline Diorio and Julie Lemieux contributed equally to this study.
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Diorio, C., Lemieux, J., Provencher, L. et al. Aromatase inhibitors in obese breast cancer patients are not associated with increased plasma estradiol levels. Breast Cancer Res Treat 136, 573–579 (2012). https://doi.org/10.1007/s10549-012-2278-z
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DOI: https://doi.org/10.1007/s10549-012-2278-z