title: Markers of insulin resistance and sex steroid hormone activity in relation to breast cancer risk: a prospective analysis of abdominal adiposity, sebum production, and hirsutism (Italy).
abstract: OBJECTIVE
  Insulin resistance and increased levels of serum steroids have been hypothesized to be relevant etiological factors for breast cancer. Measurements of markers of insulin resistance and elevated serum steroids may identify women at high risk for breast cancer. The present study analyzed the association of breast cancer with markers of insulin resistance and elevated serum sex steroids, abdominal adiposity, increase in sebum production and hirsutism in a case-control study nested in a prospective cohort study.
  
  
  METHODS
  Between 1987 and 1992, 10,786 women (aged 35-69) were recruited in a prospective study on breast cancer in Italy, the ORDET study. Women with a history of cancer and on hormone therapy were excluded at baseline. At recruitment, abdominal adiposity was calculated from the ratio of waist-to-hip circumferences. Sebum production was measured on the forehead under standardized conditions using a sebumeter. Nine androgen-sensitive body areas were evaluated for hirsutism and a total hirsutism score was computed. After an average of 5.5 years of follow-up, 144 breast cancer cases were identified among the participants of the cohort. For each breast cancer case, four matched controls were randomly chosen from members of the cohort who did not develop breast cancer during the follow-up period.
  
  
  RESULTS
  Waist-to-hip ratio was associated with breast cancer in premenopausal women: age and body mass index (BMI) adjusted relative risk (RR) for the highest tertile of waist-to-hip ratio was 2.2 [95% confidence interval (CI) 1.04-4.75], p for trend 0.03. In the analysis conducted within strata of BMI, the effect of waist-to-hip ratio was confined to the group of thinner women: RR for the highest tertile of waist-to-hip ratio was 3.4 (95% CI 1.2-9.5). Sebum production and hirsutism were associated with breast cancer among postmenopausal women. Age and BMI adjusted RRs for the upper tertiles were 2.2 (95% CI 1.1-4.6), p for trend 0.01, and 2.3 (95% CI 1.1-4.9), p for trend 0.03, for sebum and hirsutism, respectively.
  
  
  CONCLUSIONS
  These results add evidence for a role of hormones and metabolic alterations in breast cancer etiology and for different relations of these risk factors with breast cancer in premenopausal and postmenopausal women.
authors.affiliation: Divisione di Epidemiologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. muti@buffalo.edu
authors.forename: P
authors.initials: P
authors.lastname: Muti
authors.forename: M
authors.initials: M
authors.lastname: Stanulla
authors.forename: A
authors.initials: A
authors.lastname: Micheli
authors.forename: V
authors.initials: V
authors.lastname: Krogh
authors.forename: J L
authors.initials: JL
authors.lastname: Freudenheim
authors.forename: J
authors.initials: J
authors.lastname: Yang
authors.forename: H J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: M
authors.initials: M
authors.lastname: Trevisan
authors.forename: F
authors.initials: F
authors.lastname: Berrino
mesh_terms: D000005:Abdomen; D000273:Adipose Tissue; D000328:Adult; D000368:Aged; D015415:Biomarkers; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D012739:Gonadal Steroid Hormones / Q000502:physiology*; D006628:Hirsutism / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007333:Insulin Resistance; D007558:Italy; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012629:Sebum / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D012739:Gonadal Steroid Hormones