S-Space Graduate School of Public Health (보건대학원) Dept. of Public Health (보건학과) Theses (Ph.D. / Sc.D._보건학과)
Visceral obesity measured by Comupterized Tomography and breast cancer
비만으로 인한 유방암 발생의 영향 연구: 복부비만도 측정과 그 외 생활 요인
- 보건대학원 보건학과
- Issue Date
- 서울대학교 보건대학원
- 학위논문 (박사)-- 서울대학교 보건대학원 : 보건대학원 보건학과 분자역학전공, 2016. 2. 성주헌.
- Cancer statics in Korea has been the highest causes of death with steadily increasing. In annual rate of change, the most prevalent cancer was breast cancer in female. Incidence rates of breast cancer have been rising in South Korea, with change in intake of high fat western diet, reproductive patterns, lack of physical activity, obesity, and rising stress level the main contributory. Therefore to find obesity as risk factors on breast, assess proper to usual dietary intake, estimated abdominal obesity, and related personality factors.
The study was case – control study and approved by the Institutional Review Board of the National Cancer Center (NCC2014-0124). The patient groups were set as newly diagnosed cancer patients (breast cancer who visited at the Korean National Cancer Center hospital from August 1st, 2014 to May 29th, 2015. Undiagnosed cancer person as control group, who visited Korean National Cancer Center hospital for the health examination service by national health insurance from September 1st, 2011 to September 30th, 2014.
The breast cancer patients were 255 female aged ranges from 32 to 82 years with a mean age of 52.6 years old and that of the control participants were 222 female aged ranges from 27 to 62 years with a mean of 52.3 years old. All cancer patients were only for a newly diagnosed cancer without any related to cancer treatment as take any chemotherapy, radiation therapy and surgery before the start of the study.
Dietary intake was assessed with the semi-quantitative food frequency questionnaire (FFQ) method (developed for cancer research in Korea) at the onset of this validation study in 2012. All participants were asked to an additional question about behavior questionnaire (regular dietary pattern, family history, breast feeding, parity, physical activity, other disease, stress level, hobby, smoking, alcohol, level of education, menarche and menopause) with FFQ.
All CT examinations of related breast cancer study were performed on the 64-Multi detector row computed tomography system (Lightspeed VCT, Discovery HD 750
GE Healthcare system, Milwaukee, WI, USA). Measuring abdominal fat was used to approximate a level at the umbilicus or the fourth lumbar vertebra, which is a valid virtually all the information on abdominal fat in human.
Breast cancer patients had a lower dietary fiber intake (adjusted for total calories, p = 0.003), moderate higher animal lipid, and higher abdominal fat ratio than control groups. Abdominal fat ratio is more effect on premenopausal women for risk of breast cancer than in postmenopausal women.
There were no significant associations between personality factors (physical activity, menarche, BMI, and stress perception) and breast cancer risk, while risk of breast cancer was a positive first degree of family history with moderate and moderate inverse association with education level. Effect of physical activity was show stronger inversely association in hormone positive groups. There were no significant associations of smoking and alcohol consumption to incidence of breast cancer.
However, compared normal subjects, breast cancer patients have more association between breast cancer risks and increased in abdominal fat. Breast cancer risk was positive associated with obesity in total women, also the more positive associated with obesity categorized in post-menopausal women. While obesity may influence breast cancer risk in post-menopausal women, the opposing effects that association between breast cancer and pre-menopausal women when obesity is protective for breast cancer risk. Abdominal distribution fat is metabolic indica¬tors in breast cancer women, and may play a role in the pre-menopausal breast cancer risk (Harris et al., 2011), though more effect of visceral fat on breast cancer incidence in post-menopausal women.
There were no correlation between total calories intake and all of anthropometric measurements (BMI, abdominal fat ratio). Abdominal total fat was highest positive correlation with all of anthropometric measurements p < 0.001), exclude abdominal fat ratio (r = 0.43).
To know cancer mortality, subjects were categorized into two groups by histological grade score (< 2, ≥ 2)), high histological grade patients were marginal negative relation with intake of dietary fiber (p = 0.06 for adjust for total calories). Abdominal fat ratio was statistical significant difference in low and high breast cancer malignant.
In conclusion, this study shows clear association of breast cancer with high dietary animal fat and low dietary fiber intake. In addition, abdominal fat ratio is useful as an indicator of risk factor on breast as well malignancy.