Postmenopauzālā vecuma sieviešu ķermeņa masas indeksa saistība ar krūts vēža attīstību
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Latvijas Universitāte
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Darba pamatojums: Sievietēm postmenopauzē krūts vēzi un citas slimības, kas bieži vien sastopamas kopā, apvieno riska faktori – liekais svars vai aptaukošanās. Pieaugot to incidencei, krūts vēzi sievietēm postmenopauzē atklāj arvien biežāk. Šajā periodā taukaudi ir galvenais estrogēnu avots. Pie tauku masas pieauguma: 1. paaugstinātais estrogēnu (un/vai citu hormonu līmenis - insulīna, leptīna) stimulē krūts vēža attīstību; 2. ļoti mazu audzēju ir grūti sataustīt - to diagnosticē vēlīni. Ja pēcmenopauzes vecuma sievietēm krūts vēzis ir saistīts ar ĶMI, tad tā incidenci var samazināt, jo ĶMI ir viens no riska faktoriem, kuru var modificēt. Darba mērķis: noteikt ĶMI saistību ar krūts vēža attīstību pēcmenopauzes vecuma sievietēm Latvijā, iegūstot datus, par krūts vēža un veselām pacientēm, aplūkojot tos atsevišķi, salīdzinot tos savā starpā un ar datiem no līdzīgiem dažādu pasaules valstu pētījumiem. Materiāli un metodes: No 2011. gada oktobra līdz 2012. gada februārim notika gadījumu – kontroles pētījums. Ievākta informācija par: 1. LOC Krūts ķirurģijas nodaļā ārstētām krūts vēža pacientēm; 2. veselām sievietēm - veicot anonīmo anketēšanu „Medicīnas Centrā 3”. Tika atlasītas 307 pēcmenopauzes vecuma sievietes. Izmantoti dati: 1. abām grupām – vecums, krūts vēža riska faktori, ar medicīnas personāla palīdzību noteiktais svars un augums; 2. gadījumu grupai - krūts vēža diagnoze, tā raksturojums, blakusslimību anamnēze. Rezultāti: 1. Krūts vēža pacientēm bija lielāks vidējais ĶMI (p = 0,01) un biežāka tendence uz aptaukošanos – 56%. 2. Krūts vēža pacientēm vēlāk iestājās menopauze (p = 0,05). 3. Krūts audzēji bieži bija estrogēnu receptoru pozitīvi – 85%. 4. Vidējais ĶMI pacientēm ar dažādām krūts vēža klīniskajām stadijām neatšķīrās (p = 0,782). 5. Otrā tipa cukura diabēta diagnoze krūts vēža pacientēm tika konstatēta 6% gadījumu. Secinājumi: 1. Šajā pētījumā pēcmenopauzes vecuma sieviešu vidējā ĶMI pieaugums par 1,7 kg/m2, kam par pamatu bija viņu biežāka tendence uz aptaukošanos, tika saistīts ar krūts vēža attīstību. 2. Viens no iemesliem krūts vēža attīstībai bija arī vēlāks menopauzes iestāšanās vecums. 3. Pozitīvo estrogēnu receptoru ekspresijas krūts audzēju audos biežāka konstatēšana var norādīt uz to augšanas atkarību no estrogēniem. 4. Liekais svars un aptaukošanās nebija saistīti ar vēlīnu krūts vēža klīnisko stadiju diagnozes brīdī. 5. Otrā tipa cukura diabēta un krūts vēža saistībai ir nepieciešams atsevišķs pētījums. 6. Lai pierādītu liekā svara un aptaukošanās saistību ar krūts vēža attīstību pēcmenopauzes vecuma sievietēm, ir jānosaka estrogēnu vai citu hormonu līmeni asinīs. Atslēgvārdi: ĶMI, postmenopauze, krūts vēzis, estrogēni, ER, hormoni, stadija, diagnostika, terapija.
Introduction: during the post-menopausal period, breast cancer and other diseases that often occur together, are combined together by risk factors – excess weight or obesity. With the raise of its incidence, women are increasingly diagnosed with breast cancer in the post-menopausal period. At that time adipose tissues are the main source of estrogen. To the growth in the fat mass: 1. increased level of estrogen (or/and other hormones – insulin, leptin) stimulates the development of breast cancer; 2. hard to feel a very small tumor – it is being diagnosed behind time. If women’s breast cancer in post-menopausal age is associated with BMI, its incidence can be reduced, as BMI is on of the risk factors that may be modified. Aim: to determine the connection between the BMI with the development of breast cancer in women of post-menopausal age in Latvia, by acquiring data about the breast cancer itself, and about healthy patients, examining them separately, and comparing both together and with the similar data from the researches in other countries. Materials and methods: Case – control study was happening from October, 2011 till February, 2012. Was collected information about: 1. female patients diagnosed with breast cancer in LOC Breast Surgery Department; 2. healthy women – by conducting an anonymous survey at „Medical Center 3”. 307 women of post-menopausal age were selected. The data used: 1. for both groups – age, breast cancer risk factors, height and weight set with the help of medical personnel; 2. group case – breast cancer diagnosis, its characteristics, anamnesis of concomitant diseases. Results: 1. Patients diagnosed with breast cancer had higher average BMI (p = 0,01) and more frequent tendency to obesity – 56%. 2. Breast cancer patients had later entered the menopause period (p = 0,05). 3. Breast tumors were frequently estrogen receptor positive - 85%. 4. Average BMI of patients with different clinical stages of breast cancer did not differ (p = 0,782). 5. Type II diabetes in patients diagnosed with breast cancer was found in 6% of cases. Conclusions: 1. In this research, the average increase of BMI for 1,7 kg/m2 in women of post-menopausal age, which was based on their increased tendency to obesity, was linked to the development of the breast cancer. 2. A later age of entering the menopause period was also connected with the development of breast cancer. 3. Frequent statement of positive estrogen receptors in breast tumor tissues may indicate to its growth dependence on estrogen. 4. Excessive weight and obesity were not connected to the breast cancer’s late clinical stage at the time of diagnosis. 5. To determine the connection between the type II diabetes and breast cancer a separate research is needed. 6. For proving the relevance between the excessive weight and obesity with the development of breast cancer in women that has entered the post-menopausal period, one has to detect the level of estrogen, as well as other hormones. Key words: BMI, post-menopausal period, breast cancer, estrogens, ER, hormones, stage, diagnosis, therapy.
Introduction: during the post-menopausal period, breast cancer and other diseases that often occur together, are combined together by risk factors – excess weight or obesity. With the raise of its incidence, women are increasingly diagnosed with breast cancer in the post-menopausal period. At that time adipose tissues are the main source of estrogen. To the growth in the fat mass: 1. increased level of estrogen (or/and other hormones – insulin, leptin) stimulates the development of breast cancer; 2. hard to feel a very small tumor – it is being diagnosed behind time. If women’s breast cancer in post-menopausal age is associated with BMI, its incidence can be reduced, as BMI is on of the risk factors that may be modified. Aim: to determine the connection between the BMI with the development of breast cancer in women of post-menopausal age in Latvia, by acquiring data about the breast cancer itself, and about healthy patients, examining them separately, and comparing both together and with the similar data from the researches in other countries. Materials and methods: Case – control study was happening from October, 2011 till February, 2012. Was collected information about: 1. female patients diagnosed with breast cancer in LOC Breast Surgery Department; 2. healthy women – by conducting an anonymous survey at „Medical Center 3”. 307 women of post-menopausal age were selected. The data used: 1. for both groups – age, breast cancer risk factors, height and weight set with the help of medical personnel; 2. group case – breast cancer diagnosis, its characteristics, anamnesis of concomitant diseases. Results: 1. Patients diagnosed with breast cancer had higher average BMI (p = 0,01) and more frequent tendency to obesity – 56%. 2. Breast cancer patients had later entered the menopause period (p = 0,05). 3. Breast tumors were frequently estrogen receptor positive - 85%. 4. Average BMI of patients with different clinical stages of breast cancer did not differ (p = 0,782). 5. Type II diabetes in patients diagnosed with breast cancer was found in 6% of cases. Conclusions: 1. In this research, the average increase of BMI for 1,7 kg/m2 in women of post-menopausal age, which was based on their increased tendency to obesity, was linked to the development of the breast cancer. 2. A later age of entering the menopause period was also connected with the development of breast cancer. 3. Frequent statement of positive estrogen receptors in breast tumor tissues may indicate to its growth dependence on estrogen. 4. Excessive weight and obesity were not connected to the breast cancer’s late clinical stage at the time of diagnosis. 5. To determine the connection between the type II diabetes and breast cancer a separate research is needed. 6. For proving the relevance between the excessive weight and obesity with the development of breast cancer in women that has entered the post-menopausal period, one has to detect the level of estrogen, as well as other hormones. Key words: BMI, post-menopausal period, breast cancer, estrogens, ER, hormones, stage, diagnosis, therapy.