Page 28 - Deleware Medical Journal - September/October 2019
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Diabetes
A total of 221 out of 1,644 patients
carried a diagnosis of diabetes mellitus
(164 Caucasian and 57 AA). AA patients are more likely to have diabetes than Caucasian (chi square p=0.0002). Patients with diabetes have worse breast cancer- diabetes (log-rank Mantel Cox, p=0.014). There is no difference in breast cancer survival in patients with diabetes by race (p=0.2664).
Obesity
A total of 688 out of 1,644 patients were found to be obese (522 Caucasian and 166 AA). AA patients are more likely to be obese than Caucasian (chi square p=0.0001). There are no differences in breast cancer- patients (log-rank Mantel Cox p=0.2718). There is no difference in breast cancer survival in patients with obesity by race (log-rank Mantel Cox p=0.2005).
Metabolic Syndrome
AA patients are more likely to have
hypertension, diabetes, and obesity) (chi square p=0.0001). Patients with metabolic syndrome have worse survival (log-rank Mantel Cox p=0.02). However, despite the higher incidence of metabolic syndrome
in AA patients, there was no difference in patients with metabolic syndrome vs. AA patients (log-rank Mantel Cox p=0.6091).
DISCUSSION
AA patients living in Delaware have
a decreased survival rate across all breast cancer types.1 The etiology of
the decreased survival is still unknown. After performing a retrospective chart review, we have determined patients with hypertension, diabetes or metabolic syndrome have worse breast cancer- higher incidence of metabolic syndrome in AA patients, there was no difference among the cohort of patients with metabolic syndrome based on race.
Underlying etiology of many of these comorbidities is obesity. Investigating
the link between obesity and cancer is
factor.6 In a study performed by Cho et al., 5,668 patients who underwent curative surgery for breast cancer were evaluated for effect of BMI on disease-free survival and overall survival.6 This study further unfavorable factor for overall survival and patients with BMI <25 had improved disease-free and overall survival.6 Additionally, survival rates were worsened by the presence of metabolic syndrome.6
In our study, although the incidence
of obesity was higher in AA patients, there was no difference noted in breast
races or between obese and non-obese patients. Waist-to-hip ratio (WHR) is
an alternative method of evaluating obesity that may impact this outcome. Capers et al. evaluated the importance
of body shape in European American (EA) women compared to AA women
to predict disease association.7 552 patients underwent evaluation of body shapes, body fat distribution, and body composition using digital photography, android-gynoid ratio (AGR), and dual energy X-ray absorptiometry.7 AA higher BMI, AGR, mean total body fat, mean trunk fat, and mean leg fat with fat distribution compared to EA patients.7 Although patients of different races may have equivalent BMI, their fat distribution
in a different manner.2,7 The AMBER Consortium examined the variability in the literature when using BMI vs. WHR in regard to obesity and breast cancer
in pre- and postmenopausal women.3 Ultimately it was found that AA women are impacted by general and central obesity based on their menopausal and hormone receptor subtype. When using BMI, higher recent BMI was associated
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Del Med J | September/October 2019 | Vol. 91 | No. 5
