There is a hypothesis that hyperinsulinemia or insulin resistance may be a mediator for breast cancer risk factors. On the other hand, some, but not all, of the well-known risk factors of breast cancer have been associated with serum estrogen concentrations. We assessed the relationships of potential breast cancer risk factors to indicators of insulin resistance, fasting plasma insulin concentration and homeostasis model assessment insulin resistance (HOMA-R), in 88 postmenopausal Japanese women. We also examined whether insulin resistance would explain the association of breast cancer risk factors with serum estradiol and sex hormone-binding globulin (SHBG). Information on potential breast cancer risk factors, such as demographic characteristics, smoking and drinking habits, diet, exercise, menstrual and reproductive factors, was obtained by self-administered health questionnaire including a validated semiquantitative food frequency questionnaire. 1) Positive association between serum estradiol and breast cancer risk has been confirmed in postmenopausal women.2, 3) The known breast cancer risk factors such as age at menarche, nulliparity, and obesity may be mediated by an estrogen mechanism. Therefore, the relationships between estrogen profile and some of the breast cancer risk factors have been investigated, but the results are inconsistent. [4][5][6][7][8] Recent epidemiological studies showed that high serum C-peptide, a peripheral marker of insulin secretion, or plasma fasting insulin level was significantly associated with risk of breast cancer.9, 10) Insulin promotes the growth of rat mammary carcinoma cells.11) Hyperinsulinemia may be a significant risk factor for breast cancer. Obesity, a well-known risk factor of postmenopausal breast cancer was accompanied by hyperinsulinemia. 12, 13) Dietary fat, a suspected breast cancer risk factor, was associated with blood insulin concentration. 13,14) Fat intake modified the binding of insulin receptors and the rate of insulin-stimulated glucose transport.15) These observations led to the hypothesis that hyperinsulinemia or insulin resistance rather than estrogen profile may be a link between breast cancer risk factors and breast cancer. 16,17) According to this hypothesis, the previously reported positive association between estradiol concentration and breast cancer risk factors, such as obesity and fat intake, may be explained by the influence of hyperinsulinemia on serum estrogen concentrations.18) Therefore, we evaluated the relationships between insulin resistance and potential breast cancer risk factors in postmenopausal women and examined whether insulin resistance confounds any observed relations between estrogen status and potential breast cancer risk factors.
MATERIALS AND METHODSWe focused on women who were postmenopausal, defined as cessation of menses for 12 or more months, among the participants in the health check-up program provided by a general hospital in Gifu.19) A total of 103 postmenopausal women agreed to participate in the present study a...