title: NSAID use reduces breast cancer recurrence in overweight and obese women: role of prostaglandin-aromatase interactions.
abstract: Obesity is associated with a worse breast cancer prognosis and elevated levels of inflammation, including greater cyclooxygenase-2 (COX-2) expression and activity in adipose-infiltrating macrophages. The product of this enzyme, the proinflammatory eicosanoid prostaglandin E2 (PGE2), stimulates adipose tissue aromatase expression and subsequent estrogen production, which could promote breast cancer progression. This study demonstrates that daily use of a nonsteroidal anti-inflammatory drug (NSAID), which inhibits COX-2 activity, is associated with reduced estrogen receptor α (ERα)-positive breast cancer recurrence in obese and overweight women. Retrospective review of data from ERα-positive patients with an average body mass index of >30 revealed that NSAID users had a 52% lower recurrence rate and a 28-month delay in time to recurrence. To examine the mechanisms that may be mediating this effect, we conducted in vitro studies that utilized sera from obese and normal-weight patients with breast cancer. Exposure to sera from obese patients stimulated greater macrophage COX-2 expression and PGE2 production. This was correlated with enhanced preadipocyte aromatase expression following incubation in conditioned media (CM) collected from the obese-patient, sera-exposed macrophages, an effect neutralized by COX-2 inhibition with celecoxib. In addition, CM from macrophage/preadipocyte cocultures exposed to sera from obese patients stimulated greater breast cancer cell ERα activity, proliferation, and migration compared with sera from normal-weight patients, and these differences were eliminated or reduced by the addition of an aromatase inhibitor during CM generation. Prospective studies designed to examine the clinical benefit of NSAID use in obese patients with breast cancer are warranted.
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas.
authors.forename: Laura W
authors.initials: LW
authors.lastname: Bowers
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas.
authors.forename: Ilane X F
authors.initials: IX
authors.lastname: Maximo
authors.affiliation: Division of Hematology and Medical Oncology, University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Brenner
authors.affiliation: The START Center for Cancer Care, San Antonio, Texas.
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Beeram
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Hursting
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas.
authors.forename: Ramona S
authors.initials: RS
authors.lastname: Price
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Rajeshwar R
authors.initials: RR
authors.lastname: Tekmal
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Jolly
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas. degraffenried@austin.utexas.edu.
authors.forename: Linda A
authors.initials: LA
authors.lastname: deGraffenried
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D001141:Aromatase / Q000378:metabolism*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000517:prevention & control*; D048708:Cell Growth Processes / Q000187:drug effects; D002465:Cell Movement / Q000187:drug effects; D051546:Cyclooxygenase 2 / Q000378:metabolism; D015232:Dinoprostone / Q000378:metabolism*; D018572:Disease-Free Survival; D047628:Estrogen Receptor alpha / Q000378:metabolism; D005260:Female; D006801:Humans; D008264:Macrophages / Q000201:enzymology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009765:Obesity / Q000150:complications / Q000378:metabolism*; D050177:Overweight / Q000150:complications / Q000378:metabolism*; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; C506487:ESR1 protein, human; D047628:Estrogen Receptor alpha; D001141:Aromatase; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D015232:Dinoprostone