Insulin resistance contributes to racial disparities in breast cancer prognosis in US women Journal Article


Authors: Gallagher, E. J.; Fei, K.; Feldman, S. M.; Port, E.; Friedman, N. B.; Boolbol, S. K.; Killelea, B.; Pilewskie, M.; Choi, L.; King, T.; Nayak, A.; Franco, R.; Cruz, D.; Antoniou, I. M.; LeRoith, D.; Bickell, N. A.
Article Title: Insulin resistance contributes to racial disparities in breast cancer prognosis in US women
Abstract: Background: Racial disparities in breast cancer survival between Black and White women persist across all stages of breast cancer. The metabolic syndrome (MetS) of insulin resistance disproportionately affects more Black than White women. It has not been discerned if insulin resistance mediates the link between race and poor prognosis in breast cancer. We aimed to determine whether insulin resistance mediates in part the association between race and breast cancer prognosis, and if insulin receptor (IR) and insulin-like growth factor receptor (IGF-1R) expression differs between tumors from Black and White women. Methods: We conducted a cross-sectional, multi-center study across ten hospitals. Self-identified Black women and White women with newly diagnosed invasive breast cancer were recruited. The primary outcome was to determine if insulin resistance, which was calculated using the homeostatic model assessment of insulin resistance (HOMA-IR), mediated the effect of race on prognosis using the multivariate linear mediation model. Demographic data, anthropometric measurements, and fasting blood were collected. Poor prognosis was defined as a Nottingham Prognostic Index (NPI) > 4.4. Breast cancer pathology specimens were evaluated for IR and IGF-1R expression by immunohistochemistry (IHC). Results: Five hundred fifteen women were recruited (83% White, 17% Black). The MetS was more prevalent in Black women than in White women (40% vs 20%, p < 0.0001). HOMA-IR was higher in Black women than in White women (1.9 ± 1.2 vs 1.3 ± 1.4, p = 0.0005). Poor breast cancer prognosis was more prevalent in Black women than in White women (28% vs 15%. p = 0.004). HOMA-IR was positively associated with NPI score (r = 0.1, p = 0.02). The mediation model, adjusted for age, revealed that HOMA-IR significantly mediated the association between Black race and poor prognosis (β = 0.04, 95% CI 0.005-0.009, p = 0.002). IR expression was higher in tumors from Black women than in those from White women (79% vs 52%, p = 0.004), and greater IR/IGF-1R ratio was also associated with higher NPI score (IR/IGF-1R > 1: 4.2 ± 0.8 vs IR/IGF-1R = 1: 3.9 ± 0.8 vs IR/IGF-1R < 1: 3.5 ± 1.0, p < 0.0001). Conclusions: In this multi-center, cross-sectional study of US women with newly diagnosed invasive breast cancer, insulin resistance is one factor mediating part of the association between race and poor prognosis in breast cancer. © 2020 The Author(s).
Keywords: breast cancer; insulin resistance; cross-sectional study; insulin receptor; disparities; prognosis; insulin-like growth factor receptor
Journal Title: Breast Cancer Research
Volume: 22
ISSN: 1465-5411
Publisher: Biomed Central Ltd  
Date Published: 2020-05-12
Start Page: 40
Language: English
DOI: 10.1186/s13058-020-01281-y
PUBMED: 32393319
PROVIDER: scopus
PMCID: PMC7216707
DOI/URL:
Notes: Article -- Source: Scopus
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  1. Tari King
    176 King