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Insulin, Macronutrient Intake, and Physical Activity: Are Potential Indicators of Insulin Resistance Associated with Mortality from Breast Cancer?

¹ Cancer Control Research, ² Vancouver Cancer Centre, ³ Department of Nutritional Services, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; ⁴ Cancer Prevention Research, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, Washington; and ⁵ Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada

Requests for reprints: Marilyn J. Borugian, Cancer Control Research, BC Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada. Phone: (604) 877-6006; Fax: (604) 877-1868. E-mail: mborugia{at}bccancer.bc.ca

High levels of insulin have been associated with increased risk of breast cancer, and poorer survival after diagnosis. Data and sera were collected from 603 breast cancer patients, including information on diet and physical activity, medical history, family history, demographic, and reproductive risk factors. These data were analyzed to test the hypothesis that excess insulin and related factors are directly related to mortality after a diagnosis of breast cancer. The cohort was recruited from breast cancer patients treated at the British Columbia Cancer Agency between July 1991 and December 1992. Questionnaire and medical record data were collected at enrolment and outcomes were ascertained by linkage to the BC Cancer Registry after 10 years of follow-up. The primary outcome of interest was breast cancer-specific mortality (n = 112). Lifestyle data were analyzed using Cox proportional hazards regression models to relate risk factors to outcomes, controlling for potential confounders, such as age and stage at diagnosis. Data for biological variables were analyzed as a nested case-control study due to limited serum volumes, with at least one survivor from the same cohort as a control for each breast cancer death, matched on stage and length of follow-up. High levels of insulin were associated with poorer survival for postmenopausal women [odds ratio, 1.9; 95% confidence interval (CI), 0.7-6.6, comparing highest to lowest tertile, P trend = 0.10], while high dietary fat intake was associated with poorer survival for premenopausal women (relative risk, 4.8; 95% CI, 1.3-18.1, comparing highest to lowest quartile). Higher dietary protein intake was associated with better survival for all women (relative risk, 0.4; 95% CI, 0.2-0.8, comparing highest to lowest quartile).

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