Normal and unusual days for dietary intake during the 12 months after a breast cancer diagnosis in women

Purpose

There are several reasons to report days as being unusual with regard to dietary intake, including special occasions and celebrations. For breast cancer patients during the 12 month post-surgery period, unusual days may also include days that are affected by being a cancer patient. The aim of this study was to study dietary intake on “normal” and “unusual” days, and to study what is reported in “free text fields” of a food diary.

Methods

Women (n = 456), mean age 55.5 years newly diagnosed with invasive breast cancer (stage I/II) were included in this clinical study. “Normal” and “unusual” days in general, over time and during the week and weekends were studied using repeated administration of a 7-day pre-coded food diary.

Results

The breast cancer patients reported 26% of all days as unusual. The intake of energy, most nutrients, especially alcohol and sugar, red and processed meat, and sweets, cakes, and snacks was 5–126% higher, whereas intake of fiber, fruit and berries, vegetables, and dairy products was 7–17% lower on unusual than on normal days (P < 0.001). The same pattern was seen for normal/unusual days during the weekdays, weekends and over time. Finally, 99% of the breast cancer patients used the free text fields to report additional intake with a mean energy of 1.1 MJ/day.

Conclusion

For breast cancer patients during the 12-month post-surgery period, unusual days are important drivers of total intake, especially for alcohol. The free text fields in the pre-coded food diary contributed substantially to the total intake.

Abstract GS5-02: Cardiovascular function and the effect of exercise training during adjuvant breast cancer treatment. Results from The EBBA-II trial

Background: Breast cancer survival rates have improved, but cardiovascular disease is a competing cause of death among breast cancer survivors, and treatment-induced cardio-toxicity remains a major concern. The effect of aerobic exercise on cardiovascular function during adjuvant breast cancer treatment is not yet well established.

Material & methods: The women participating in the Energy Balance and Breast Cancer Aspect (EBBA)-II trial are aged 18-75 years and diagnosed with stage I-II breast cancer. VO2max was assessed at three separate times, prior to surgery and at 6 and 12 months after, using a maximum exercise test on a treadmill (modified Balke protocol).The patients were randomized after surgery to a control group (n=188, usual care) or an intervention group (n=187) stratified by menopausal status. The 12 months exercise intervention program started 2-3 weeks after surgery and the patients received a detailed training program based on their own VO2max at baseline. They met for training sessions in groups of 10-12 women for 60 minutes twice a week during a 12 month period, and were in addition asked to perform at least 120 minutes of exercise at home (a total of 240 minutes of exercise weekly).Analyses were done on an intention-to-treat basis (NCT02240836).

Preliminary results: Breast cancer patients (n=375) with a mean age at diagnosis of 55.2 years (27.0-75.0 years) had a mean body mass index (BMI) of 25.1kg/m2, a mean VO2max before surgery of 31.5 ml•min−1•kg−1, and 57 % of the patients underwent chemotherapy (paclitaxel, epirubicin/cyclophosphamide based adjuvant chemotherapy). Comparing the intervention group to the control group, the intervention group had a decrease in VO2max of 2.7% after 6 months, but they improved their VO2max by 2.3 % at 12 months compared to before surgery (p=0.001). Breast cancer patients in the control group had a 10 % reduction in VO2max 6 months after surgery (p&lt;0.001), and a 3.8% decrease in VO2max was observed at 12 months compared to before surgery (p&lt;0.001). Among patients in the control group who received chemotherapy, a decline in VO2max by 5.3 ml•min−1•kg−1 (16.2%) (p&lt;0.001) at 6 months was observed. This reduction in VO2max at 6 months was most pronounced in patients who received paclitaxel alone, or paclitaxel in combination with epirubicin/cyclophosphamide (6.1 ml•min−1•kg−1, 18.7% decrease). In comparison, patients in the intervention group who received chemotherapy had a decline of 2.4 ml•min−1•kg−1 (7.6%) in VO2max at 6 and after 12 months VO2max was equal to before surgery. Differences in VO2max at 6 and after 12 month between groups were in favor of the intervention group (p&lt;0.05).

Conclusion: Our findings strongly support that tailored exercise training during adjuvant breast cancer treatment may counteract a decline in cardiovascular function, and in particular among those receiving chemotherapy. Our study supports incorporation of supervised clinical exercise programs into breast cancer treatment guidelines.

Final results of the trial at SABCS 2018 (the trial closes October 15, 2018) total included N=539 (NCT02240836)

Citation Format: Thune I, Husøy A, Frydenberg H, Flote VG, Fjeldheim F, Bertheussen GF, Lundgren S, Lømo J, Wist EA, McTiernan A, Schlichting E. Cardiovascular function and the effect of exercise training during adjuvant breast cancer treatment. Results from The EBBA-II trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS5-02.

Validation of repeated self-reported n-3 PUFA intake using serum phospholipid fatty acids as a biomarker in breast cancer patients during treatment

Background

The role of n-3 polyunsaturated fatty acids (PUFAs) in breast cancer is not clear and under debate. To explore this relationship it is important to have proper validated dietary assessment methods for measuring the intake of n-3 PUFAs. The aim of the current study is to validate two different methods used to assess the intake of selected n-3 PUFAs as well as food sources of long-chained n-3 PUFAs. Also, we aim to study how stable the intake of fatty acids is during breast cancer treatment.

Methods

The study-population was patients with breast cancer (Stages I-II) or ductal carcinoma in situ (DCIS-grade III) undergoing treatment (n = 49) in Norway. Dietary intake was assessed by two self-administered methods, a 256 food item food frequency questionnaire (FFQ) and a 7-day pre-coded food diary (PFD). The FFQ was administered presurgery and twelve months postsurgery, and the PFD was administered shortly after surgery (10 +/− 2 days), six and twelve months postsurgery. Fasting blood samples (presurgery, six and twelve months postsurgery) were analysed for serum phospholipid fatty acids, a biomarker for intake of n-3 PUFAs.

Results

Mean (SD) age was 54.2 (7.8) years at diagnosis, and the mean (SD) body mass index (BMI) was 24.8 (3.4) kg/m². Correlation coefficients between dietary intakes of n-3 PUFAs measured with the FFQ and the PFD ranged from 0.35 to 0.66. The correlation coefficients between the PFD and the biomarker (serum phospholipid n-3 PUFAs) as well as between the FFQ and the biomarker demonstrated stronger correlations twelve months after surgery (ρ 0.40–0.56 and 0.36–0.53, respectively) compared to around surgery (ρ 0.08–0.20 and 0.28–0.38, respectively). The same pattern was observed for intake of fatty fish. The intake of n-3 PUFAs did not change during treatment assessed by the FFQ, PFD or biomarker.

Conclusion

These results indicate that the FFQ and the PFD can be used to assess dietary intake of fish and n-3 PUFAs in breast cancer patients during breast cancer treatment. Still, the PFD shortly after surgery should be used with caution. The diet of patients undergoing breast cancer treatment was quite stable, and the intake of n-3 PUFAs did not change.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0402-6) contains supplementary material, which is available to authorized users.

Circulating microRNAs associated with prolonged overall survival in lung cancer patients treated with nivolumab

BACKGROUND

The introduction of immune check-point inhibition in non-small cell lung cancer (NSCLC) therapy represents improved prospects for the patients. The response rates to check-point inhibitors are approximately 20% in unselected NSCLC patients. Increasing levels of tumor PD-L1 expression are associated with higher response rates. However, patients with low PD-L1 levels may also have durable responses, and improved strategies for patient stratification are needed.

MATERIAL AND METHODS

In this study, we investigated circulating microRNAs aiming to identify circulating predictive biomarkers associated with increased overall survival after immune check-point treatment. Using next generation sequencing, we performed microRNA profiling in serum from NSCLC patients (n = 20) treated with nivolumab. Serum samples from 31 patients were used for validation using qPCR assays. Serum samples were collected prior to immune therapy initiation.

RESULTS

Based on multivariate regression analysis, we identified a signature of seven microRNAs (miR-215-5p, miR-411-3p, miR-493-5p, miR-494-3p, miR-495-3p, miR-548j-5p and miR-93-3p) significantly associated with overall survival (OS) > 6 months in discovery cohort (p = .0003). We further validated this in another similar set of samples (n = 31) and the model was significantly associated with overall survival (OS) > 6 months (p = .001) with sensitivity and specificity of 71% and 90%, respectively.

CONCLUSIONS

In this study of circulating microRNAs, we have identified a 7-miR signature associated with survival in nivolumab-treated NSCLC patients. This signature may lead to better treatment options for patients with NSCLC, but a validation in an independent cohort is needed to confirm the predicted potential.

Polymorphisms in the estrogen receptor alpha gene (ESR1), daily cycling estrogen and mammographic density phenotypes

Background

Single nucleotide polymorphisms (SNPs) involved in the estrogen pathway and SNPs in the estrogen receptor alpha gene (ESR1 6q25) have been linked to breast cancer development, and mammographic density is an established breast cancer risk factor. Whether there is an association between daily estradiol levels, SNPs in ESR1 and premenopausal mammographic density phenotypes is unknown.

Methods

We assessed estradiol in daily saliva samples throughout an entire menstrual cycle in 202 healthy premenopausal women in the Norwegian Energy Balance and Breast Cancer Aspects I study. DNA was genotyped using the Illumina Golden Gate platform. Mammograms were taken between days 7 and 12 of the menstrual cycle, and digitized mammographic density was assessed using a computer-assisted method (Madena). Multivariable regression models were used to study the association between SNPs in ESR1, premenopausal mammographic density phenotypes and daily cycling estradiol.

Results

We observed inverse linear associations between the minor alleles of eight measured SNPs (rs3020364, rs2474148, rs12154178, rs2347867, rs6927072, rs2982712, rs3020407, rs9322335) and percent mammographic density (p-values: 0.002–0.026), these associations were strongest in lean women (BMI, ≤23.6 kg/m^2.). The odds of above-median percent mammographic density (>28.5 %) among women with major homozygous genotypes were 3–6 times higher than those of women with minor homozygous genotypes in seven SNPs. Women with rs3020364 major homozygous genotype had an OR of 6.46 for above-median percent mammographic density (OR: 6.46; 95 % Confidence Interval 1.61, 25.94) when compared to women with the minor homozygous genotype. These associations were not observed in relation to absolute mammographic density. No associations between SNPs and daily cycling estradiol were observed. However, we suggest, based on results of borderline significance (p values: 0.025–0.079) that the level of 17β-estradiol for women with the minor genotype for rs3020364, rs24744148 and rs2982712 were lower throughout the cycle in women with low (<28.5 %) percent mammographic density and higher in women with high (>28.5 %) percent mammographic density, when compared to women with the major genotype.

Conclusion

Our results support an association between eight selected SNPs in the ESR1 gene and percent mammographic density. The results need to be confirmed in larger studies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2804-1) contains supplementary material, which is available to authorized users.

Lipoprotein subfractions by nuclear magnetic resonance are associated with tumor characteristics in breast cancer

Background

High-Density Lipoprotein (HDL)-cholesterol, has been associated with breast cancer development, but the association is under debate, and whether lipoprotein subfractions is associated with breast tumor characteristics remains unclear.

Methods

Among 56 women with newly diagnosed invasive breast cancer stage I/II, aged 35–75 years, pre-surgery overnight fasting serum concentrations of lipids were assessed, and body mass index (BMI) was measured. All breast tumors were immunohistochemically examined in the surgical specimen. Serum metabolomics of lipoprotein subfractions and their contents of cholesterol, free cholesterol, phospholipids, apolipoprotein-A1 and apolipoprotein-A2, were assessed using nuclear magnetic resonance. Principal component analysis, partial least square analysis, and uni- and multivariable linear regression models were used to study whether lipoprotein subfractions were associated with breast cancer tumor characteristics.

Results

The breast cancer patients had following means: age at diagnosis: 55.1 years; BMI: 25.1 kg/m²; total-Cholesterol: 5.74 mmol/L; HDL-Cholesterol: 1.78 mmol/L; Low-Density Lipoprotein (LDL)-Cholesterol: 3.45 mmol/L; triglycerides: 1.18 mmol/L. The mean tumor size was 16.4 mm, and the mean Ki67 hotspot index was 26.5 %. Most (93 %) of the patients had estrogen receptor (ER) positive tumors (≥1 % ER+), and 82 % had progesterone receptor (PgR) positive tumors (≥10 % PgR+). Several HDL subfraction contents were strongly associated with PgR expression: Apolipoprotein-A1 (β 0.46, CI 0.22–0.69, p < 0.001), HDL cholesterol (β 0.95, CI 0.51–1.39, p < 0.001), HDL free cholesterol (β 2.88, CI 1.28–4.48, p = 0.001), HDL phospholipids (β 0.70, CI 0.36–1.04, p < 0.001). Similar results were observed for the subfractions of HDL1-3. We observed inverse associations between HDL phospholipids and Ki67 (β -0.25, p = 0.008), and in particular between HDL1’s contents of cholesterol, phospholipids, apolipoprotein-A1, apolipoprotein-A2 and Ki67. No association was observed between lipoproteins and ER expression.

Conclusion

Our findings hypothesize associations between different lipoprotein subfractions, and PgR expression, and Ki 67 % in breast tumors. These findings may have clinical implications, but require confirmation in larger studies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12944-016-0225-4) contains supplementary material, which is available to authorized users.

Pre-diagnostic high-sensitive C-reactive protein and breast cancer risk, recurrence, and survival

Inflammation may initiate and promote breast cancer development, and be associated with elevated circulating levels of inflammation markers. A total of eight 130 initially healthy women, participated in the population-based Tromsø study (1994-2008). Pre-diagnostic high-sensitivity C-reactive protein (hs-CRP) was assessed. During 14.6 years of follow-up, a total of 192 women developed invasive breast cancer. These cases were followed for additional 7.2 years. Detailed medical records were obtained. We observed an overall positive dose-response relationship between pre-diagnostic hs-CRP and breast cancer risk (hazard ratio (HR) = 1.06, 95 % CI 1.01-1.11). Postmenopausal women with above median levels of hs-CRP (>1.2 mg/l) had a 1.42 (95 % CI 1.01-2.00) higher breast cancer risk compared to postmenopausal women with hs-CRP below median. Postmenopausal women, who were hormone replacement therapy non-users, and were in the middle tertile (0.8-1.9 mg/l), or highest tertile of hs-CRP (>1.9 mg/l), had a 2.31 (95 % CI 1.31-4.03) and 2.08 (95 % CI 1.16-3.76) higher breast cancer risk, respectively, compared with women in the lowest tertile. For each unit increase in pre-diagnostic hs-CRP levels (mg/l), we observed an 18 % increase in disease-free interval (95 % CI 0.70-0.97), and a 22 % reduction in overall mortality (95 % CI 0.62-0.98). Our study supports a positive association between pre-diagnostic hs-CRP and breast cancer risk. In contrast, increased pre-diagnostic hs-CRP was associated with improved overall mortality, but our findings are based on a small sample size, and should be interpreted with caution.

Alcohol consumption, endogenous estrogen and mammographic density among premenopausal women

Introduction

Alcohol consumption may promote aromatization of androgens to estrogens, which may partly explain the observations linking alcohol consumption to higher breast cancer risk. Whether alcohol consumption is associated with endogenous estrogen levels, and mammographic density phenotypes in premenopausal women remains unclear.

Methods

Alcohol consumption was collected by self-report and interview, using semi quantitative food frequency questionnaires, and a food diary during seven days of a menstrual cycle among 202 premenopausal women, participating in the Energy Balance and Breast Cancer Aspects (EBBA) study I. Estrogen was assessed in serum and daily in saliva across an entire menstrual cycle. Computer-assisted mammographic density (Madena) was obtained from digitized mammograms taken between days 7–12 of the menstrual cycle. Multivariable regression models were used to investigate the associations between alcohol consumption, endogenous estrogen and mammographic density phenotypes.

Results

Current alcohol consumption was positively associated with endogenous estrogen, and absolute mammographic density. We observed 18 % higher mean salivary 17β-estradiol levels throughout the menstrual cycle, among women who consumed more than 10 g of alcohol per day compared to women who consumed less than 10 g of alcohol per day (p = 0.034). Long-term and past-year alcohol consumption was positively associated with mammographic density. We observed a positive association between alcohol consumption (past year) and absolute mammographic density; high alcohol consumers (≥7 drinks/week) had a mean absolute mammographic density of 46.17 cm² (95 % confidence interval (CI) 39.39, 52.95), while low alcohol consumers (<1 drink/week) had a mean absolute mammographic density of 31.26 cm² (95 % CI 25.89, 36.64) (p-trend 0.001). After adjustments, high consumers of alcohol (≥7 drinks/week), had 5.08 (95 % CI 1.82, 14.20) times higher odds of having absolute mammographic density above median (>32.4 cm²), compared to low (<1 drink/week) alcohol consumers.

Conclusion

Alcohol consumption was positively associated with daily endogenous estrogen levels and mammographic density in premenopausal women. These associations could point to an important area of breast cancer prevention.

Electronic supplementary material

The online version of this article (doi:10.1186/s13058-015-0620-1) contains supplementary material, which is available to authorized users.

Abstract P6-08-37: Cardiorespiratory fitness (VO2max) before, during and after adjuvant treatment in breast cancer patients

Background: Breast cancer treatment may result in reduced exercise capacity that may in turn lead to reduced maximum oxygen consumption (VO2max). However, whether physical exercise can counteract any observed decline in VO2max in breast cancer patients undergoing adjuvant breast cancer treatment, is less known.

Material & methods: The women participating in the Norwegian Energy Balance and Breast Cancer Aspect (EBBA)-II pilot study, were aged 35-75 years and diagnosed with stage I-II breast cancer. Performing a maximum exercise test on a treadmill (modified Balke protocol), VO2max was assessed at four times; preoperative, 6, 12 and 24 months postoperative. The patients were randomized postoperative to a control group (n=31) or an intervention group (n=29) stratified by menopausal status. The 12 months exercise intervention program consisted of group-based exercise, 60 minutes twice a week and a minimum of 60 minutes of individual exercise. Regression models were used to study the associations between treatment regime and VO2max.

Results: Breast cancer patients (n=60) with a mean age at diagnosis of 55.3 years (38.0-69.0 years), had a mean body mass index of 25.1 kg/m2, and a mean preoperative VO2max of 32.4 ml/min/kg. Comparing the intervention group to the control group, the intervention group maintained VO2max throughout the treatment period, and improved their VO2max with 7.8 % from 12 to 24 months postoperative (p=0.117), while the control group had a 15% reduction in VO2max 6 months after surgery (p&lt;0.001), which improved 14 % at 12 months and additionally 6 % at 24 months postoperative (p=0.025). Among those patients receiving chemotherapy (60%), and being in the control group, a decline in VO2max of 22.9 % (p&lt;0.001) at 6 months postoperative was observed. In comparison, patients in the intervention group who received chemotherapy had a 4.5 % reduction in VO2max at 6 months postoperative (p = 0.159). Thereafter, in the control group, VO2max improved with 21.6 % at 12 months postoperative (p=0.006), while in the intervention group VO2max improved with 13.4 % 24 months postoperative (p=0.038). Patients in the intervention group who did not receive any chemotherapy increased their VO2max by 6% 6 months postoperative (p=0.174), while patients in the control group who did not receive any chemotherapy had a reduction in VO2max of 2.1 % at 6 month postoperative (p=0.630).

Conclusion: Our findings suggest that systematic physical training may counteract a decline in VO2max in breast cancer patients receiving adjuvant treatment, including chemotherapy, and is of clinical interest, but needs to be replicated in larger studies.

Citation Format: Hanne Frydenberg, Tora J Bettum, Trygve Lofterød, Elisabeth Edvardsen, Vidar G Flote, Sissi E Finstad, Gro F Bertheussen, Ellen Schlichting, Anne McTiernan, Inger Thune. Cardiorespiratory fitness (VO2max) before, during and after adjuvant treatment in breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-37.

High-density lipoprotein-cholesterol, daily estradiol and progesterone, and mammographic density phenotypes in premenopausal women

High-density lipoprotein-cholesterol (HDL-C) may influence the proliferation of breast tumor cells, but it is unclear whether low HDL-C levels, alone or in combination with cyclic estrogen and progesterone, are associated with mammographic density, a strong predictor of breast cancer development. Fasting morning serum concentrations of HDL-C were assessed in 202 premenopausal women, 25 to 35 years of age, participating in the Norwegian Energy Balance and Breast Cancer Aspects (EBBA) I study. Estrogen and progesterone were measured both in serum, and daily in saliva, throughout an entire menstrual cycle. Absolute and percent mammographic density was assessed by a computer-assisted method (Madena), from digitized mammograms (days 7-12). Multivariable models were used to study the associations between HDL-C, estrogen and progesterone, and mammographic density phenotypes. We observed a positive association between HDL-C and percent mammographic density after adjustments (P = 0.030). When combining HDL-C, estradiol, and progesterone, we observed among women with low HDL-C (<1.39 mmol/L), a linear association between salivary 17β-estradiol, progesterone, and percent and absolute mammographic density. Furthermore, in women with low HDL-C, each one SD increase of salivary mid-menstrual 17β-estradiol was associated with an OR of 4.12 (95% confidence intervals; CI, 1.30-13.0) of having above-median percent (28.5%), and an OR of 2.5 (95% CI, 1.13-5.50) of having above-median absolute mammographic density (32.4 cm(2)). On the basis of plausible biologic mechanisms linking HDL-C to breast cancer development, our findings suggest a role of HDL-C, alone or in combination with estrogen, in breast cancer development. However, our small hypothesis generating study requires confirmation in larger studies.

Gene variations in oestrogen pathways, CYP19A1, daily 17β-estradiol and mammographic density phenotypes in premenopausal women

INTRODUCTION

High mammographic density is an established breast cancer risk factor, and circulating oestrogen influences oestrogen-regulating gene expression in breast cancer development. However, less is known about the interrelationships of common variants in the CYP19A1 gene, daily levels of oestrogens, mammographic density phenotypes and body mass index (BMI) in premenopausal women.

METHODS

Based on plausible biological mechanisms related to the oestrogen pathway, we investigated the association of single nucleotide polymorphisms (SNPs) in CYP19A1, 17β-estradiol and mammographic density in 202 premenopausal women. DNA was genotyped using the Illumina Golden Gate platform. Daily salivary 17β-estradiol concentrations were measured throughout an entire menstrual cycle. Mammographic density phenotypes were assessed using a computer-assisted method (Madena). We determined associations using multivariable linear and logistic regression models.

RESULTS

The minor alleles of rs749292 were positively (P = 0.026), and the minor alleles of rs7172156 were inversely (P = 0.002) associated with daily 17β-estradiol. We observed an 87% lower level of daily 17β-estradiol throughout a menstrual cycle in heavier women (BMI >23.6 kg/m(2)) of rs7172156 with minor genotype aa compared with major genotype AA. Furthermore, the rs749292 minor alleles were inversely associated with absolute mammographic density (P = 0.032). Lean women with rs749292 minor alleles had 70 to 80% lower risk for high absolute mammographic density (>32.4 cm(2)); Aa: odds ratio (OR) = 0.23 (95% CI 0.07 to 0.75). Lean women with rs7172156 minor homozygous genotype had OR 5.45 for high absolute mammographic density (aa: OR = 5.45 (95% CI 1.13 to 26.3)).

CONCLUSION

Our findings suggest that two SNPs in CYP19A1, rs749292 and rs7172156, are associated with both daily oestrogen levels and mammographic density phenotypes. BMI may modify these associations, but larger studies are needed.

Abstract 1362: Dyslipidemia, excess weight and high mammographic density are associated with high levels of daily estrogen and progesterone

Background: Dyslipidemia, excess weight, and high mammographic density have independently been associated with breast cancer development. However, little is known regarding the combined effect of dyslipidemia, excess weight and mammographic density on cyclic variation in estrogen and progesterone.

Material and Methods: 202 premenopausal women (25-35 years) participated in the Norwegian EBBA-I study including clinical examinations, and fasting blood sampling. Computer-assisted percent mammographic density (Madena) was obtained from digitized mammograms taken at day 7-12 of menstrual cycle. Daily saliva samples were collected across an entire menstrual cycle, and concentrations of 17β-estradiol and progesterone were measured at the Reproductive Ecology Laboratory, Harvard University, USA. Uni and multivariable linear and logistic regression models were used to study the combined association of high-density lipoprotein cholesterol (HDL-C), body mass index (BMI) and mammographic density with daily concentrations of 17β-estradiol and progesterone.

Results: Among women with mean age of 30.7 years, mean percent mammographic density 29.8 %, mean BMI 24.4 kg/m2, mean total cholesterol 4.45 mmol/l, and mean HDL-C 1.54 mmol/l, we observed overall mean salivary 17β-estradiol 16.2 pmol/l and progesterone 129.3 pmol/l. We used median split and women characterized by lower than median HDL-C (≤ 1.51 mmol/l), higher than median BMI (&gt; 23.6 kg/m2), and higher than median percent mammographic density (&gt; 28.5 %) (unfavorable profile), had higher concentrations of both 17β-estradiol (p = 0.005) and progesterone (p = 0.016) across the entire menstrual cycle, compared with women characterized by higher HDL-C(&gt; 1.51 mmol/l), lower BMI (≤ 23.6 kg/m2) and lower percent mammographic density (≤ 28.5 %) (favorable profile). Comparing the profiles, women with an unfavorable profile had 46 % higher overall mean 17β-estradiol (17β-estradiol; 22.2 versus 15.9 pmol/l) and 48% higher overall mean progesterone (progesterone; 187.5 versus 126.1pmol/l). These factors also showed strong associations with differences in AUC (area under curve) of these sex steroid hormones across the entire menstrual cycle, reflecting cumulative exposure. Women characterized by unfavorable profile had 48 % higher AUC estradiol compared with women having favorable profile (AUCe, 387, 95 % confidence interval (CI) 244 - 531 versus 262, 95% CI 244 - 281). Furthermore, women with unfavorable profile had 47 % higher AUC progesterone than women with favorable profile (AUCp, 1929, 95 % CI 1125 - 2733 versus 1309, 95% CI 1211 -1408).

Conclusion: A combination of low HDL-C, excess weight, and high percent mammographic density, was strongly associated with higher daily levels of 17β-estradiol and progesterone, and could in part explain the association of these factors with increased risk of breast cancer development.

Citation Format: Vidar G. Flote, Hanne Frydenberg, Giske Ursin, Anita Iversen, Morten W. Fagerland, Peter T. Ellison, Erik A. Wist, Thore Egeland, Anne-Sofie Furberg, Inger Thune. Dyslipidemia, excess weight and high mammographic density are associated with high levels of daily estrogen and progesterone. . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1362. doi:10.1158/1538-7445.AM2013-1362

Abstract P3-01-01: Insulin, Insulin-like Growth Factor-1 and cycling estrogen predict premenopausal mammographic density

Background: Mammographic density, a strong biomarker for breast cancer risk, represents epithelial and stromal proliferation. Insulin and insulin-like growth factor (IGF)-1 are suggested to influence cellular proliferation, while estrogen is a key factor in breast cancer development. However, whether the effects of these hormones among premenopausal women are mediated through mammographic density is less known.

Material and Methods: Fasting serum insulin, IGF-1, and IGF binding protein (IGFBP)-3 were assessed among 202 healthy premenopausal women (Norwegian Energy Balance and Breast cancer Aspects study-I (EBBA-I). Daily salivary levels of 17β-estradiol throughout an entire menstrual cycle were measured at the reproductive Ecology Laboratory, Harvard University, USA. Computer-assisted mammographic density (Madena) was obtained from digitized mammograms taken at day 7–12 of the menstrual cycle. Uni- and multivariable regression models were used to study the associations between hormones and premenopausal percent mammographic density.

Results: Among women with a mean age of 30,7 years, a mean premenopausal percent mammographic density of 29.8 % was observed. Throughout the menstrual cycle when comparing women with a high percent mammographic density (≥28.5%) to women with a low percent mammographic density (&lt;28.5%), we observed insulin, IGF-1 and IGFBP-3 independently and in combination with cycling 17β-estradiol to predict premenopausal percent mammographic density. We observed among women with either serum insulin ≥89 pmol/, IGF-1 ≥24 nmol/l, IGFBP-3 ≥ 100 nmol/l, having a high (≥28.5%) versus a low (&lt;28.5%) percent mammographic density was associated with an increase in overall average 17β-estradiol of 4.0 %, 10.9 % and 14.9%, respectively. Moreover, we observed a higher adjusted Odds Ratio (OR) for having a high percent mammographic density for each standard deviation (SD) increase in overall average 17β -estradiol, insulin, IGF-1 and IGFBP-3: 17β-estradiol, 1.55 (1.06–2.27); insulin, 1.62 (0.76–3.48), IGF-1, 1.90 (1.10–3.27); IGFBP-3, 1.88 (1.05–3.37) (adjusted for age, body mass index-BMI kg/m2)).

Conclusion: Our study supports that insulin, IGF-1 and IGFBP-3 independently, and in combination with cycling estrogen, predicts premenopausal mammographic density. These hormones may be important biomarkers in breast cancer control and clinical practice.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-01-01.

[Patients with cluster headache in a neurological department]

BACKGROUND

Cluster headache is a devastating disorder which needs intensive drug treatment in the cluster periods.

MATERIAL AND METHODS

All patients hospitalised for cluster headache (n = 37) at the Department of Neurology, Haukeland University Hospital 1988-1998 were studied. Data were retrieved from patient files and all patients were asked to fill in a postal questionnaire, which were returned by 27 (73%).

RESULTS

Median age was 47 years, range 22-78 years. 28 patients were male. Ten of the patients had chronic cluster headache, all men. 20 out of 27 patients who answered the questionnaire used sumatriptan for acute attacks, 15 of them as subcutaneous injection. 17 patients had tried oxygen inhalation during an attack. Ten of the patients had tried prednisone as prophylactic treatment during a cluster, half of them with effect. Only two patients had tried verapamil and four had tried lithium. None of the patients had ever used valproate as drug prophylaxis. 18 of the patients smoked more than five cigarettes per day.

INTERPRETATION

The treatment of cluster headache patients is at present suboptimal, both regarding symptomatic and prophylactic drugs.