Breast cancer is now the most common cancer among women with an estimated 1.38 million new cancer cases diagnosed in 2008 (23% of all cancers) (1), and only in the United States 211,731 women were diagnosed with breast cancer in 2009. Incidence rates vary between different regions, but there are higher in developed regions. Although, breast cancer stills the most frequent cause of cancer death in women in both developing and developed regions, mortality from breast cancer has been declining in developed countries over the last two decades due to the advancement in treatment and diagnostic procedures. However, today more favorable result of breast cancer maybe not only to cure and save lives, but also to save or rebuild their breasts to maintain the body image and self-esteem. As a result, breast conservation surgery can be another choice to response with patient physical and emotional need to recreate the shape of the breast following a breast cancer surgery.
Considering breast reconstructive surgery, several types of procedures are available using implant, tissue flap, or a combination of both. According to operation using flap techniques, healthy blood vessels are needed for the tissue’s blood supply, so flap procedures are not usually offered to women risk with vascular problems.
On the other hand, from researches many risk factors for breast cancer have been well documented and several studies have shown the association of the metabolic syndrome and its individual components with breast cancer (2-5). More recent studies have shown it to be an independent risk factor for breast cancer. It has also been associated with poorer prognosis, increased incidence, a more aggressive tumor phenotype (6-9). The contribution of various modifiable risk factors, excluding reproductive factors, to the overall breast cancer burden has been calculated by Danaei et al. (10). They conclude that 21% of all breast cancer deaths worldwide are attributable to alcohol use, overweight and obesity, and physical inactivity. This proportion was higher in high-income countries (27%), and the most important contributor was overweight and obesity.
Metabolic syndrome is identified as a multiplex risk factor for cardiovascular disease and metabolic syndrome is also known for its association with increased risk of common cancers; for some cancers, the risk differs between sexes, ethnics group, and definitions of metabolic syndrome. Overall From the meta-analysis and the systematic review presence of metabolic syndrome was associated with breast postmenopausal, endometrial, pancreatic, rectal, and colorectal cancers in women, and it was associated with liver, colorectal, and bladder cancer in men (11). The evidence indicates the increasing prevalence of metabolic syndrome. The clustering of risk factors that constitute the metabolic syndrome is found to be common in most countries of the world. In the Americas, in Europe, and in India, at least one-fourth of the adults carry the syndrome (12). Considering criteria diagnosis, a number of expert groups have developed clinical criteria for the metabolic syndrome. The most widely accepted of these have been produced by the WHO, the European Group for the Study of Insulin Resistance (EGIR), and NCEP ATP III (13). But all groups agree on the core components of the metabolic syndrome including obesity, insulin resistance, dyslipidaemia and hypertension. However, they apply the criteria differently to identify such a cluster. The risk for ASCVD accompanying the metabolic syndrome is approximately doubled compared with an absence of the syndrome (14). It also associated with a very risk for type 2 diabetes or with diabetes itself, the likelihood of developing diabetes is increased approximately 5-fold. In addition, the metabolic syndrome is often associated with other medical conditions, notably, fatty liver, cholesterol gallstones, obstructive sleep apnea, gout, depression, musculoskeletal disease, and polycystic ovarian syndrome. For the reason, metabolic syndrome undoubtedly affects a surgical result.
There are many researchers studied about effects of metabolic syndrome on surgery outcomes.
Metabolic syndrome has previously been found as a risk factor for poor outcomes for vascular surgery. For instance, metabolic syndrome associated with an increase in mortality and morbidity both early and late after coronary artery bypass grafting (15). Patients with metabolic syndrome have lower survival and cumulative patency rates of hemodialysis access patency (16), metabolic syndrome patients required more complex interventions, more systemic complications and major adverse limb events, and associated with poorer symptomatic and functional outcomes compared with control in superficial femoral artery interventions (17). From many researches, metabolic syndrome also affects the outcome of organ transplantation surgery. It is a risk factor for allograft failure after kidney transplant (18-21), and presence of metabolic syndrome developed a higher risk of cardiac allograft vasculopathy (CAV) in the heart transplant patients. Patients with more criteria of metabolic syndrome had a higher development of CAV (21). There is also a strong correlation between truncal obesity, which is a component of MS and skin graft failure (22). The MS is associated with faster bioprosthetic valve degeneration in patient underwent aortic valve replacement (23).
Moreover in other types of surgery metabolic syndrome also associated with the adverse outcomes. For examples, metabolic syndrome is an independent risk factor for the development of major complications, nonroutine discharge, and increased hospital cost among total joint arthroplasty recipients (24). Colorectal patients with metabolic syndrome had a higher rate of postoperative complication and a longer length of hospital stay than patients without metabolic syndrome (25). Metabolic syndrome is associated with increase perioperative mortality in hepatectomy (26).
As a result from the available evidence base medicine and literatures, the author set a hypothesis that metabolic syndrome may effect result of breast cancer surgery and breast reconstructive surgery. However, there is no available research study about this association. As a result, Further researches are needed to answer this question, and for the improvement of outcome in breast cancer and reconstructive surgery.
Disclosure: The authors declare no conflict of interest.
- IARC GLOBOCAN. (2008). Estimated cancer Incidence, Mortality, Prevalence and Disability-adjusted life years (DALYs) Worldwide in 2008. Available online: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx
- Osaki Y, Taniguchi S, Tahara A, et al. Metabolic syndrome and incidence of liver and breast cancers in Japan. Cancer Epidemiol 2012;36:141-7. [PubMed]
- Rosato V, Bosetti C, Talamini R, et al. Metabolic syndrome and the risk of breast cancer in postmenopausal women. Ann Oncol 2011;22:2687-92. [PubMed]
- Xue F, Michels KB. Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence. Am J Clin Nutr 2007;86:s823-35. [PubMed]
- Sinagra D, Amato C, Scarpilta AM, et al. Metabolic syndrome and breast cancer risk. Eur Rev Med Pharmacol Sci 2002;6:55-9. [PubMed]
- Gezgen G, Roach EC, Kizilarslanoglu MC, et al. Metabolic syndrome and breast cancer: an overview. J BUON 2012;17:223-9. [PubMed]
- Stebbing J, Sharma A, North B, et al. A metabolic phenotyping approach to understanding relationships between metabolic syndrome and breast tumour responses to chemotherapy. Ann Oncol 2012;23:860-6. [PubMed]
- Vona-Davis L, Howard-McNatt M, Rose DP. Adiposity, type 2 diabetes and the metabolic syndrome in breast cancer. Obes Rev 2007;8:395-408. [PubMed]
- Pasanisi P, Berrino F, De Petris M, et al. Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer 2006;119:236-8. [PubMed]
- Danaei G, Vander Hoorn S, Lopez AD, et al. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet 2005;366:1784-93. [PubMed]
- Esposito K, Chiodini P, Colao A, et al. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care 2012;35:2402-11. [PubMed]
- Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol 2008;28:629-36. [PubMed]
- National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-421. [PubMed]
- Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52. [PubMed]
- Angeloni E, Melina G, Benedetto U, et al. Metabolic syndrome affects midterm outcome after coronary artery bypass grafting. Ann Thorac Surg 2012;93:537-44. [PubMed]
- Protack CD, Jain A, Vasilas P, et al. The influence of metabolic syndrome on hemodialysis access patency. J Vasc Surg 2012;56:1656-62. [PubMed]
- Smolock CJ, Anaya-Ayala JE, Bismuth J, et al. Impact of metabolic syndrome on the outcomes of superficial femoral artery interventions. J Vasc Surg 2012;55:985-993.e1; discussion 993.
- Israni AK, Snyder JJ, Skeans MA, et al. Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant. Transpl Int 2012;25:748-57. [PubMed]
- Porrini E, Delgado P, Torres A. Metabolic syndrome, insulin resistance, and chronic allograft dysfunction. Kidney Int Suppl 2010;S42-6. [PubMed]
- Ozdemir FN, Karakan S, Akgul A, et al. Metabolic syndrome is related to long-term graft function in renal transplant recipients. Transplant Proc 2009;41:2808-10. [PubMed]
- de Vries AP, Bakker SJ, van Son WJ, et al. Metabolic syndrome is associated with impaired long-term renal allograft function; not all component criteria contribute equally. Am J Transplant 2004;4:1675-83. [PubMed]
- Sánchez-Gómez JM, Martínez-Dolz L, Sánchez-Lázaro I, et al. Influence of metabolic syndrome on development of cardiac allograft vasculopathy in the transplanted heart. Transplantation 2012;93:106-11. [PubMed]
- Penington AJ, Morrison WA. Skin graft failure is predicted by waist-hip ratio: a marker for metabolic syndrome. ANZ J Surg 2007;77:118-20. [PubMed]
- Briand M, Pibarot P, Després JP, et al. Metabolic syndrome is associated with faster degeneration of bioprosthetic valves. Circulation 2006;114:I512-7. [PubMed]
- Gonzalez Della Valle A, Chiu YL, Ma Y, et al. The metabolic syndrome in patients undergoing knee and hip arthroplasty: trends and in-hospital outcomes in the United States. J Arthroplasty 2012;27:1743-1749.e1.
- Lohsiriwat V, Pongsanguansuk W, Lertakyamanee N, et al. Impact of metabolic syndrome on the short-term outcomes of colorectal cancer surgery. Dis Colon Rectum 2010;53:186-91. [PubMed]
- Zarzavadjian Le Bian A, Costi R, Constantinides V, et al. Metabolic disorders, non-alcoholic fatty liver disease and major liver resection: an underestimated perioperative risk. J Gastrointest Surg 2012;16:2247-55. [PubMed]
- Ozyazicioglu A, Yalcinkaya S, Vural AH, et al. Effects of metabolic syndrome on early mortality and morbidity in coronary artery bypass graft patients. J Int Med Res 2010;38:202-7. [PubMed]
- Pimenta E, Passarelli O Jr, Borelli F, et al. Metabolic syndrome in patients undergoing coronary artery bypass graft: prevalence and a marker of morbidity/mortality during hospitalization and 30 days after hospital discharge. Arq Bras Cardiol 2007;88:413-7. [PubMed]