Abstract
The typical high fat, low fibre diet of the industrialised West, particularly when associated with inadequate exercise, is likely to advance the onset of puberty. This will manifest in girls as an earlier menarche, earlier onset of breast development, and an earlier growth spurt. Both earlier menarche and adult tallness are markers of increased risk to breast cancer. Earlier menarche in the West is usually associated with earlier onset of hyperinsulinaemia, and multiple case-control studies report that hyperinsulinaemia too is a marker of increased breast cancer risk.
Although the Western diet is linked both to earlier menarche and also to earlier hyperinsulinaemia, the mechanism involved is not necessarily the same. While menarche is likely to be triggered by a threshold level of fatness, manifestation of insulin resistance is genetically-determined and strongly influenced by the fatty acid profile of the diet. The putative mechanisms by which they influence mammary carcinogenesis also differ. Early menarche is reported to be associated with a raised oestradiol level persisting into early adult life. On the other hand, hyperinsulinaemia is commonly associated with abnormal aromatase activity in the ovaries. In addition, the concomitant increase in bioactive levels of insulin-like growth factor-I may synergise with oestrogen in stimulating proliferative activity in mammary epithelium.
Dietary modification and exercise regimens are proposed in families at high risk to breast cancer. The measures have been shown to reduce insulin levels in both children and adults, and serial monitoring of insulin and sex steroid levels could be used to detect a metabolic-endocrine effect.
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Clavel-Chapelon F, Launoy G, Auquïer A et al.: Reproductive factors and breast cancer risk. Effect of age at diagnosis. Ann Epidemiol 5: 315–320, 1995
MacMahon B, Trichopoulos D, Brown D et al.: Age at menarche, urine estrogens and breast cancer risk. Int J Cancer 30: 427–431, 1982
Apter F, Reinila M, Vikho R: Some endocrine characteristics of early menarche, a risk factor for breast cancer, are preserved into adulthood. Int J Cancer 44: 783–787, 1989
Stoll BA, Vatten LJ, Kvinnsland S: Does early physical maturity influence breast cancer risk? Acta Oncol 33: 171–176, 1994
Ballard-Barbash R, Schatzkin R, Carter CL, Kannel WB, Kreger BE, D'Agostino RB et al.: Body fat distribution and breast cancer in the Framingham study. J Natl Cancer Inst 82: 286–290, 1990
Berstein LM: Increased risk of breast cancer in women with central obesity: additional considerations. J Natl Cancer Inst 82: 1943–1944, 1990
Folsom AR, Kaye SA, Prineas PJ, Potter JD, Gapstur SM, Wallace RB: Increased incidence of carcinoma of the breast associated with abdominal obesity in postmenopausal women. Am J Epidemiol 131: 794–803, 1990
Schapira DV, Kumar NB, Lyman GH, Cox CE: Abdominal obesity and breast cancer risk. Ann Int Med 112: 182–186, 1990
Kodama M, Kodama T, Miura S, Yoshida M: Nutrition and breast cancer risk in Japan. Anticancer Res 11: 745–754, 1991
Bruning PF, Bonfrer JMG, Van Noord PAH, Hart AAM, De Jong Bakker M, Nooijen WJ: Insulin resistance and breast cancer risk. Int J Cancer 52: 511–516, 1992
den Tonkelaar I, Seidell JC, Collette HJ: Body fat distribution in relation to breast cancer in women participating in the DOM project. Breast Cancer Res Treat 34: 55–61, 1995
Tekden N, Kahraman H, Yucel I et al.: Insulin and C-peptide response to oral glucose in patients with breast cancer. Ann Oncol (suppl 5) 7: 24, 1996
Mati P, Liu J, Trevisan A, Menotti A: Insulin resistance as a risk factor for colon and breast cancer. Am J Epidemiol (suppl 11) 145: 25, 1997
Gamayunova VB, Bobrov YF, Tsyrlina EV et al.: Comparative study of blood insulin levels in breast and endometrial cancer. Neoplasma 44: 123–126, 1997
Ng EH, Gao F, Ji CY et al.: Risk factors for breast carcinoma in Singaporean Chinese women. Cancer 80: 725–731, 1997
Petrek JA, Peters M, Cirrincione C, Rhodes D, Bajorunas D: Is body fat topography a risk factor for breast cancer? Ann Int Med 188: 356–362, 1993
Frisch RE, McArthur JW: Menstrual cycles, fatness as a determinant of minimum weight for height necessary for their maintenance at onset. Science 185: 949–951, 1974
Storlien LH, Baur LA, Kriketos AD et al.: Dietary fats and insulin action. Diabetologia 39: 621–631, 1996
Herman-Giddens ME, Slora EJ, Wasserman RC et al.: Secondary sexual characteristics and menses in young girls seen in office practice; a study from the Pediatric Research Office Settings Network. Pediatrics 99: 505–512, 1997
Arslanian S, Suprasongsin C: Differences in the in vivo insulin secretion and sensitivity of healthy black versus white adolescents. J Pediatrics 129: 440–443, 1996
Richards RJ, Svec F, Bao W et al.: Steroid hormones during puberty; racial (black-white) differences in androstenedione and estradiol; the Bogalusa Heart Study. J Clin Endocrinol Metab 75: 624–631, 1992
Gray GE, Henderson BE, Pike MC: Changing ratio of breast cancer incidence rates with age of black females compared with white females in the United States. J Natl Cancer Inst 64: 461–463, 1980
Moison J, Meyer F, Gingras S: A nested case control analysis of the correlates of early menarche. Am J Epidemiol 132: 953–961, 1990
Maclure M, Travis LB, Willett W, MacMahon B: A prospective cohort study of nutrient intake and age at menarche. Am J Clin Nutr 34: 649–656, 1991
Merzenich H, Boeing H, Wahrendorf J: Dietary fat and sports activity as determinants for age at menarche. Am J Epidemiol 138: 217–224, 1993
Hunter D, Willett W: Diet, body size and breast cancer. Epidemiol Rev 15: 110–132, 1993
Preece MA: The trend to greater height and earlier maturation. Growth Matters 1: 3–4, 1989
Apter D, Sipila I: Development of children and adolescents; physiological, pathophysiological and therapeutic aspects. Curr Opin Obst Gynec 51: 764–773, 1993
Sharara FJ, Giudice LC: Role of growth hormone in ovarian physiology and onset of puberty. J Soc Gynec Invest 4: 2–7, 1997
Veldhuis JD, Iranmanesh A: Physiological regulation of the GH-insulin-IGF-I axis; predominant impact of age, obesity, gonadal function and sleep. Sleep 19(suppl 10): 221s-224s, 1996
Caprio S, Bronson M, Sherwin RS et al.: Co-existence of severe insulin resistance and hyperinsulinemia in preadolescent obese children. Diabetologia 39: 1489–1497, 1996
Travers SH, Jeffers BW, Bloch CA et al.: Gender and Tanner stage differences in body composition and insulin sensitivity in early pubertal children. J Clin Endocrinol Metab 80: 172–178, 1995
Kurihara M, Aoki K, Tominaga S: Cancer Mortality Statisties in the World. Univ Nagoya Press, 1984
Kato J, Tominaga S, Kuroishi T: Relationship between Westernization of dietary habits and mortality from breast and ovarian cancers in Japan. Jpn J Cancer Res 78: 349–357, 1987
Savage MO, Smith CP, Dunger DB et al.: Insulin and growth factors adaptation to normal puberty. Hormone Res 37(Suppl 3): 70–73, 1992
Gïudice LC: The insulin like growth factor system in normal and abnormal human ovarian follicle development. Am J Med 98(1A): 48s-54s, 1995
Garzo VG, Dorrington JH: Aromatase activity in human granulosa cells during follicular development and its modulation by FSH and by insulin. Am J Obstet Gynecol 148: 657–662, 1984
Erickson GF, Garzo VG, Magoffin DA: IGF-I regulates aromatase activity in human granulosa and granulosa luteal cells. J Clin Endocrinol Metab 69: 716–724, 1989
Barbieri RL, Makris A, Randall RV et al.: Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 62: 904–910, 1986
Preziosi P, Barrett-Connor E, Papez L et al.: Interrelation between plasma SHBG and plasma insulin in healthy adult women. J Clin Endocrinol Metab 76: 283–287, 1993
Westley BR, May FE: Role of IGF in steroid-modulated proliferation. J Ster Biochem Mol Biol 51: 1–9, 1994
Macaulay VM: Insulin like growth factors and cancer. Br J Cancer 65: 311–320, 1992
Bruning PF, van Doorn J, Bonfrer JMG et al.: IGFBP3 is decreased in early stage operable promenopausal breast cancer. Int J Cancer 62: 266–270, 1995
Peyrat JP, Bonnctcrre J, Hecquet B et al.: Plasma IGF-I concentration in human breast cancer. Eur J Cancer 29A: 492–497, 1993
Favoni RE, de Cupis A, Perrotta A et al.: IGF-I and IGFBP blood serum levels in women with early and late stage breast cancer. J Cancer Res Clin Oncol 121: 674–682, 1995
Clarke RB, Howell A, Anderson E: Type I IGF receptor gene expression in normal breast tissue treated with oestrogen and progesterone. Br J Cancer 75: 251–257, 1997
Kleinberg DL, Ruan W, Catanese V et al.: Non-lactogenic effects of growth hormone on growth and IGF-I messenger mRNA of rat mammary gland. Endocrinology 126: 3274–3276, 1990
Darendeliler F, Hindmarsh PC, Preece MA: Growth hormone increases rate of pubertal maturation. Acta Endocrinol 122: 414–416, 1990
Pollak M, Costantino J, Polychronakos C et al.: Effect of tamoxifen on serum IGF levels in Stage 1 breast cancer patients. J Natl Cancer Inst 82: 1693–1697, 1990
Mason HD, Martikainen H, Beard RW et al.: Direct gonadotrophic effect of growth hormone on oestradiol production by human granulosa cells in vitro. J Endocrinol 126: R1–R4, 1990
Mol JA, Henzen-Logmans SC, Hageman P et al.: Expression of the gene encoding growth hormone in the human mammary gland. J Clin Endocrinol Metab 80: 3094–3096, 1995
Stolfi R, Parisi AM, Natoli C et al.: Advanced breast cancer; response to somatostatin. Anticancer Res 10: 203–204, 1990
Reubi JC, Wasser B, Fockens JA et al.: Somatostatin receptor incidence and distribution in breast cancer using receptor autoradiography; relationship to IGF receptors. Int J Cancer 46: 416–420, 1990
Trichopoulos D: Hypothesis; does breast cancer originate in utero? Lancet 335: 939–940, 1990
Michels KB, Trichopoulos D, Robins JM et al.: Birthweight as a risk factor for breast cancer. Lancet 348: 1542–1546, 1996
Phillips DJ, Barker DJ, Hales CN et al.: Thinness at birth and insulin resistance in adult life. Diabetologia 37: 150–154, 1994
Fall CH, Pandit AM, Law CM et al.: Size and birth and plasma insulin-like growth factor 1 concentrations. Arch Dis Childhood 73: 287–293, 1995
Giudice LC: The insulin like-growth factor system in normal and abnormal human ovarian follicle development. Am J Med 98(Suppl 1A): 48–54, 1995
Despres JP: Abdominal obesity as important component of insulin resistance syndrome. Nutrition 9: 452–459, 1993
Stoll BA: Impaired ovulation and breast cancer risk. Eur J Cancer 33: 1532–1535, 1997
Cave WT: Dietary omega-3 polyunsaturated fats and breast cancer. Nutrition 12(suppl): 39s-42s, 1996
Hardin HS, Hebert JD, Bayden T et al.: Treatment of childhood syndrome X. Pediatrics 100: E51–E54, 1997
Decsi T, Molnar D, Koletzko B: Long chain polyunsaturated fatty acids in plasma lipids of obese children. Lipids 31: 350–311, 1996
Agostoni C, Riva E, Bellu R et al.: Relationships between the fatty acid status and insulinemic indexes in obese children. Prostaglandins, Leukotrienes, Essential Fatty Acids 51: 317–321, 1994
Torjesen PA, Birkeland KJ, Anderssen SA et al.: Lifestyle changes may reverse development of the insulin resistance syndrome; a randomized trial. Diabetes Care 20: 26–31, 1997
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Stoll, B.A. Western diet, early puberty, and breast cancer risk. Breast Cancer Res Treat 49, 187–193 (1998). https://doi.org/10.1023/A:1006003110909
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DOI: https://doi.org/10.1023/A:1006003110909