title: Metabolic syndrome-breast cancer link varies by intrinsic molecular subtype.
abstract: BACKGROUND
  Metabolic syndrome (MS) has been shown to increase the risk of breast cancer. Existing data suggest that the strength of metabolic syndrome-breast cancer link varies by intrinsic molecular subtype, but results from worldwide literature are controversial. Primary endpoint of the study was to assess whether MS is a predictor of specific breast cancer (BC) subtype. Secondary endpoint was to determine whether components of MS can individually increase the risk of specific breast cancer subtype.
  
  
  METHODS
  Anthropometric and metabolic variables were correlated to breast cancer specific subgroups, retrospectively. Statistical significance was considered when p ≤ 0.05 and 95% CI.
  
  
  RESULTS
  Data analysis suggests that MS per se represents a modifiable risk factor for BC in postmenopausal [OR 6.28 (95% CI 2.79-14.11) p < 0.00001]. MS per se prevalence is higher among Luminal breast cancers in postmenopausal [OR 1.37 (95% CI 1.07-2.80) p = 0.03]. Body Mass Index (BMI) alone is associated to Luminal A subtype breast cancer risk [OR 1.12 (95% CI 0.96-2.196 p = 0.2]. Waist Circumference > 88 cm has been shown to be specifically and statistically significant associated to HER-2+ breast cancer subtypes in postmenopausal [OR 2.72 (95% CI 1.69- 10.72) p = 0.01], whilst in Luminal B it was only marginally statistical associated [OR 2.21 (95% CI 0.77-2.60) p = 0.1]. Insulin resistance showed statistical significant association to HER-2+ and Luminal B tumors [OR 2.11 (95% CI 1.66-6.69) p = 0.05] and [OR 2.33 (95% CI 1.2-4.2) p = 0.006], respectively. Hence, it has emerged that BMI is weakly associated to Luminal A breast cancers in this case series, whereas visceral obesity and insulin resistance are likely to be linked to more aggressive breast cancer subtypes.
  
  
  CONCLUSIONS
  New molecular biomarkers unveiling metabolic syndrome related breast carcinogenesis need to be detected to further stratify breast cancer risk by subtypes.
authors.affiliation: Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Immacolata
authors.initials: I
authors.lastname: Capasso
authors.affiliation: Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Esposito
authors.affiliation: Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Michelino
authors.initials: M
authors.lastname: de Laurentiis
authors.affiliation: Division of Cardiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maurea
authors.affiliation: Division of Medicine Laboratory and Clinical Pathology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Ernesta
authors.initials: E
authors.lastname: Cavalcanti
authors.affiliation: Division of Pathology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Botti
authors.affiliation: Department of Radiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Petrillo
authors.affiliation: Division of Epidemiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Montella
authors.affiliation: Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: D'Aiuto
authors.affiliation: Division of Cardiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Coppola
authors.affiliation: Division of Epidemiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Crispo
authors.affiliation: Division of Epidemiology, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Grimaldi
authors.affiliation: Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Frasci
authors.affiliation: Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Fucito
authors.affiliation: Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Ciliberto
authors.affiliation: Department of Breast Surgery and Cancer Prevention, "Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale - IRCCS - Italia", Via Mariano Semmola, 80131 Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Aiuto
keywords: BMI; Breast cancer; Insulin-resistance; Metabolic syndrome; Molecular subtype; Waist circumference