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Review
. 2014 Jun 9;9(6):e99317.
doi: 10.1371/journal.pone.0099317. eCollection 2014.

Association between insulin resistance and breast carcinoma: a systematic review and meta-analysis

Adrian V Hernandez  1 , Mirella Guarnizo  2 , Yony Miranda  2 , Vinay Pasupuleti  3 , Abhishek Deshpande  4 , Socorro Paico  2 , Hosten Lenti  2 , Silvia Ganoza  2 , Laritza Montalvo  2 , Priyaleela Thota  3 , Herbert Lazaro  2
Affiliations
Review

Association between insulin resistance and breast carcinoma: a systematic review and meta-analysis

Adrian V Hernandez et al. PLoS One. .

Abstract

Objective: This study was undertaken to evaluate the association between components defining insulin resistance and breast cancer in women.

Study design: We conducted a systematic review of four databases (PubMed-Medline, EMBASE, Web of Science, and Scopus) for observational studies evaluating components defining insulin resistance in women with and without breast cancer. A meta-analysis of the association between insulin resistance components and breast cancer was performed using random effects models.

Results: Twenty-two studies (n = 33,405) were selected. Fasting insulin levels were not different between women with and without breast cancer (standardized mean difference, SMD -0.03, 95%CI -0.32 to 0.27; p = 0.9). Similarly, non-fasting/fasting C-peptide levels were not different between the two groups (mean difference, MD 0.07, -0.21 to 0.34; p = 0.6). Using individual odds ratios (ORs) adjusted at least for age, there was no higher risk of breast cancer when upper quartiles were compared with the lowest quartile (Q1) of fasting insulin levels (OR Q2 vs. Q1 0.96, 0.71 to 1.28; OR Q3 vs. Q1 1.22, 0.91 to 1.64; OR Q4 vs. Q1 0.98, 0.70 to 1.38). Likewise, there were no differences for quartiles of non-fasting/fasting C-peptide levels (OR Q2 vs. Q1 1.12, 0.91 to 1.37; OR Q3 vs. Q1 1.20, 0.91 to 1.59; OR Q4 vs. Q1 1.40, 1.03 to 1.92). Homeostatic model assessment (HOMA-IR) levels in breast cancer patients were significantly higher than in people without breast cancer (MD 0.22, 0.13 to 0.31, p<0.00001).

Conclusions: Higher levels of fasting insulin or non-fasting/fasting C-peptide are not associated with breast cancer in women. HOMA-IR levels are slightly higher in women with breast cancer.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: Adrian V. Hernandez is a PLOS ONE Editorial Board member. This does not alter the authors‚ adherence to all the PLOS ONE policies on sharing data and materials. All other authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart of selected studies.
Flow diagram showing the number of citations identified, excluded (with reasons for exclusion), and finally included in the meta-analysis.
Figure 2
Figure 2. Forest plot of observational studies comparing women with and without breast cancer for (A) Fasting insulin levels and (B) Non-fasting/fasting C-peptide levels.
(IV, Random  =  Inverse variance, Random effects model.)
Figure 3
Figure 3. Forest plot of observational studies with adjusted ORs for breast cancer between quartiles of fasting insulin levels (A) Q2 versus Q1; (B) Q3 versus Q1; (C) Q4 versus Q1 ORs.
(IV, Random =  Inverse variance, Random effects model.)
Figure 4
Figure 4. Forest plot of observational studies with adjusted ORs for breast cancer between quartiles of non-fasting/fasting C-peptide levels (A) Q2 versus Q1; (B) Q3 versus Q1; (C) Q4 versus Q1.
(IV, Random =  Inverse variance, Random effects model.)
Figure 5
Figure 5. Forest plot of observational studies comparing women with and without breast cancer for HOMA-IR levels.
(IV, Random  =  Inverse variance, Random effects model.)
See this image and copyright information in PMC

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Grants and funding

This study was funded by the Instituto Médico de la Mujer, Lima, Peru. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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