Breast Cancer Lymphedema: Role of Insulin Resistance/FOXC2
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Introduction: Breast cancer surgery and radiation therapy is life-saving, but can leave survivors at risk to develop chronic swelling, pain, and loss mobility in the arm adjacent to the prior cancer. This condition is called `lymphedema'. When it occurs, it has been shown to have a profound impact on the function and quality of life of affected individuals. It is difficult to identify the patients at highest risk for lymphedema and current treatment options are very limited and not highly successful. In order to ensure quality-of-life and high function in breast cancer survivors, we must better understand the mechanisms in the body that lead to the development of lymphedema.
 
 
 
 
 
 
 
 Hypotheses: Since 15-25% of breast cancer survivors develop lymphedema, and this risk does not appear to be strongly linked to the extent of original disease or surgery, it is likely that hereditary factors (genetic variation) play a strong role. While these factors have not yet been identified, there is a suggestion that a particular gene, whose structure varies in the general population, may be responsible. This gene is of particular interest, because it also affects the way in which the body handles sugar, starch and fat. When the gene is underactive, the indivual is predisposed to resistance to the action of insulin. Insulin resistance has been linked to breast cancer in general, and may be responsible, in part for the risk of lymphedema and for the changes in the lymphedema arm over time. If we can identify that lymphedema-stricken survivors are more insulin resistant than women without swelling, this will provide avenues to treat lymphedema with medication, currently unavailable. Also, if the insulin resistance/lymphedema gene is found to vary in the lymphedema patients, it will provide avenues to create screening and prevention strategies in future patients who face breast cancer treatment.
 
 
 
 
 
 
 
 Methodology: Breast cancer survivors who are at least 4 years beyond initial treatment will be studied. Thirty women with arm swelling will be compared with age-matched women who lack swelling. Blood studies will be performed in a clinical research outpatient setting. These will allow determination of insulin sensitivity and glucose tolerance. Blood will also be obtained for DNA analysis of the gene in question. The results will be analyzed with reference to whether the individual does or does not have arm swelling.
 
 
 
 
 
 
 
 Innovative elements: Few studies have been performed that provide insight the mechanisms of this breast cancer complication. The risk of lymphedema is a feared outcome of successful treatment of breast cancer, yet we have minimal tools and technology to predict risk, prevent swelling, or treat full-blown lymphedema. If these studies are successful, they will provide much-needed advances in each of these relevant areas.
 
 
 
 
 
 
 
 Advocacy involvement: Lay advocacy groups both regionally and nationally have identified breast cancer lymphedema as an area of significant concern. Our research group has worked closely with advocacy groups and will continue to do so. We will continue to seek input from this constituency and will rely upon advocacy organizations to assist us in identifying breast cancer survivors who wish to participate in these research endeavors and potentially change the face of breast cancer care in the future.