||5R01CA241409-04 Interpret this number
||Kaiser Foundation Research Institute
||Breast White Adipose Tissue Inflammation and Breast Cancer Outcomes
Obesity and excess adiposity at the time of breast cancer diagnosis are associated with increased
likelihood of recurrence and cancer-related death. Understanding the mechanisms by which excess adiposity
affects breast cancer progression would provide critical insights into strategies to improve patient outcomes.
We have identified a novel tissue-based inflammatory biomarker in breast adipose tissue, crown-like structures
of the breast (CLS-B), that we have shown to be associated with obesity and dysregulated metabolic factors.
The presence of CLS-B, which are comprised of an adipocyte surrounded by a “crown” of macrophages,
indicates a state of inflammation in the breast white adipose tissue (B-WATi). We previously reported that B-
WATi is associated with metabolic syndrome characteristics. Importantly, B-WATi is associated with increased
breast cancer risk and shortened time to recurrence in women with metastatic disease.
The Pathways Study, a prospective cohort study of women with invasive breast cancer supported by an
NCI cancer epidemiology cohort infrastructure grant, provides an outstanding opportunity to conduct a large-
scale, definitive investigation of the pathophysiologic state associated with B-WATi, and to investigate the
association of B-WATi with breast cancer outcomes. From January 2006 to May 2013, we enrolled a racially-
and ethnically-diverse cohort of 4,505 women soon after a breast cancer diagnosis in Kaiser Permanente
Northern California (KPNC). Pathways Study participants provided blood specimens and reported on lifestyle
factors, including diet and physical activity. Linkage to KPNC electronic health records captures details of
cancer diagnosis and clinical care, and a biorepository of diagnostic slides and formalin-fixed, paraffin-
embedded tissue blocks has been created from definitive breast cancer surgeries for all cohort members.
We propose to determine B-WATi presence and severity in Pathways Study participants who underwent
mastectomy (n=1,982), leveraging the substantial non-tumor breast tissue available in the biorepository. We
also propose to assay systemic measures of inflammation and metabolic aberration, and examine measures of
adipose tissue distribution in a subset of women with computed tomography (CT) images. Specific Aims are
to: 1) Characterize the pathophysiological state of B-WATi in women with invasive breast cancer, including
associations with lifestyle factors, adipose tissue distribution, and circulating cytokine and metabolic profiles; 2)
Determine the associations between B-WATi and breast cancer outcomes; and, 3) Examine whether the
associations between B-WATi and breast cancer outcomes vary by lifestyle factors and other breast cancer
prognostic factors such as race/ethnicity, hormone receptor status, stage of disease, and breast cancer
treatment. This project brings together ground-breaking and innovative work on B-WATi with the outstanding
resources and infrastructure of the Pathways Study. It promises to provide insight into the impact of B-WATi
on breast cancer and to identify actionable and modifiable risk factors to improve breast cancer outcomes.
Plant-Based and Ketogenic Diets As Diverging Paths to Address Cancer: A Review.
, Iyengar N.M.
JAMA oncology, 2022-08-01; 8(8), p. 1201-1208.