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Insulin-like Growth Factor 1 gene polymorphism and breast cancer risk

ABSTRACT

Insulin-like Growth Factor-1 (IGF-1) gene polymorphism has been associated with an increased risk for breast cancer. IGF-1 is a key regulator of proliferation, cell differentiation and apoptosis. It has important mitogenic and anti-apoptotic activities in normal cells and in breast cancer cells, acting synergistically with estrogen to increase neoplastic cell proliferation. This review aims to present the recent finds of IGF-1 gene polymorphism and its relationship with the risk of breast cancer through following the polymorphic dinucleotide repeat cytosine-adenine (CA) and single nucleotide polymorphisms (SNPs) by searching in the PubMed database publications focused studies published from 2010 to 2015 related to IGF-1 gene polymorphism and breast cancer risk. A growing number of studies support an association between IGF-1 gene polymorphism and breast cancer risk with conflicting results, nevertheless elucidation of the patterns of IGF-1 gene expression may permit characterization of women at high-risk for breast cancer, as well as the development of strategies for early diagnosis and efficient treatment against the disease.

Key words:
Breast cancer; risk factors; IGF-1; IGF-1 gene polymorphism

INTRODUCTION

Breast cancer is the most common malignancy in women worldwide. It is the second most frequent neoplasm, excluding non-melanoma skin cancer. Incidence rates are higher in more developed regions, in comparison to developing regions of the world. Breast cancer rates vary from 27 cases per 100,000 women in eastern Africa to 96 cases per 100,000 women in western Europe (Ferlay et al. 2015FERLAY J, SOERJOMATARAM I, DIKSHIT R, ESER S, MATHERS C, REBELO M, PARKIN DM, FORMAN D and BRAY F. 2015. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136: 359-386.).

Breast cancer etiology is unknown. However, it is a multifactorial disease and genetic factor is the main risk factor for the disease. It is well-known that breast cancer (BRCA) 1 and 2 gene mutations may increase the risk of developing hereditary breast and ovarian cancer over time (Mersch et al. 2015MERSCH J, JACKSON MA, PARK M, NEBGEN D, PETERSON SK, SINGLETARY C, ARUN BK and LITTON JK. 2015. Cancers associated with BRCA1 and BRCA2 mutations other than breast and ovarian. Cancer 121: 269-275.). Nevertheless, the participation of breast cancer genes has not been fully elucidated. Some authors have shown a significant association between IGF-1 gene polymorphism and breast cancer, however there is a need for further elucidation of the association between IGF-1polymorphism and increased risk of breast cancer (Sarkissyan et al. 2011SARKISSYAN M, MISHRA DK, WU Y, SHANG X, SARKISSYAN S and VADGAMA JV. 2011. IGF gene polymorphisms and breast cancer in African-American and Hispanic women. Int J Oncol38: 1663-1673., Sarfstein et al. 2012SARFSTEIN R, PASMANIK-CHOR M, YEHESKEL A, EDRY L, SHOMRON N, WARMAN N WERTHEIMER E, MAOR S, SHOCHAT L and WERNER H. 2012. Insulin-like Growth Factor-I Receptor (IGF-IR) translocates to nucleus and auto regulates IGF-IR gene expression in breast cancer cells. J Biol Chem 287: 2766-2776., Christopoulos et al. 2015CHRISTOPOULOS PF, MSAOUEL P and KOUTSILIERIS H. 2015. The role of the insulin-like growth factor-1 system in breast cancer. Mol Cancer 14: 43.).

IGF-1 is produced mainly by the liver and is directly stimulated by growth factor (GH) (Philippou et al. 2014PHILIPPOU A, MARIDAKI M, PNEUMATICOS S and KOUTSILIERIS M. 2014. The complexity of the IGF-1 gene splicing, post-translational modification and bioactivity. Mol Med Camb Mass 20: 202-214.). Insulin-like growth factor 1 and Insulin-like growth factor 2 (IGF-2) are part of a large family of peptide hormones. IGF-1 is a single-chain polypeptide, located on chromosome 12q22-q24 and formed by 70 aminoacids with a length of 100 kilobase (kb) and it contains 6 exons (Yu et al. 2001YU H, LI BD, SMITH M, SHI R, BERKEL HJ and KATO I. 2001. Polymorphic CA repeats in the IGF-I gene and breast cancer. Breast Cancer Res T58.reat 70: 117-122., Pavelić et al. 2007PAVELIĆ J, MATIJEVIĆ T and KNEZEVIC J. 2007. Biological & physiological aspects of action of insulin-like growth factor peptide family. Indian J Med Res 125: 511-522., Lelbach et al. 2005LELBACH A, MUZES G and FEHER J. 2005. The insulin-like growth fator system: IGFs, IGF-binding proteins and IGFBP-proteases. Acta Physiol Hung 92: 97-107., Renehan et al. 2004RENEHAN AG, ZWAHLEN M, MINDER C, O'DWYER ST, SHALET SM and EGGER M. 2004. Insulin-like growth factor (IGF)-1, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet 363: 1346-1353.). IGF-1 gene expression is controlled by both transcriptional and post-translational modifications. Therefore, diverse IGF-1 peptides may result from the use of different promoters, alternative splicing, proteolytic processing and glycosylation events (Denley et al. 2005DENLEY A, COSGROVE LJ, BOOKER GW, WALLACE JC and FORBES BE. 2005. Molecular interactions of the IGF system. Cytokine Growth Factor Rev 16: 421-439.).

IGF-1 is found in the majority of human tissues, such as in normal and malignant mammary glands, being mainly expressed by stromal and only rarely by epithelial cells (Macias and Hinck 2012MACIAS H and HINCK L. 2012. Mammary gland development. Wiley Interdiscip Rev Dev Biol 1: 533-557.). In combination with GH, insulin and sex hormones, IGF-1 is a crucial regulator of cell growth, differentiation and apoptosis. It has significant mitogenic and anti-apoptotic activities in breast cancer cells and acts synergistically with estrogen to promote tumor growth (Cleveland et al. 2006CLEVELAND RJ, GAMMON MD, EDMISTON SN, TEITELBAUM SL, BRITTON JA, TERRY MB,ENG SM, NEUGUT AI, SANTELLA RM and CONWAY K. 2006. IGF-1 CA repeat polymorphisms, lifestyle factors and breast cancer risk in the long island breast cancer study project. Carcinogenesis 27: 758-765., Philippouet al. 2014PHILIPPOU A, MARIDAKI M, PNEUMATICOS S and KOUTSILIERIS M. 2014. The complexity of the IGF-1 gene splicing, post-translational modification and bioactivity. Mol Med Camb Mass 20: 202-214., Gunter et al. 2009GUNTER MJ ET AL. 2009. Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 101: 48-60.). These activities are mainly mediated by the transmembrane tyrosine-kinase of IGF-1 receptor (IGF-1R), that in contrast to IGF-1, it is expressed mainly in the mammary epithelium (Philippou et al. 2007), however IGF-1 is segregated by breast tissue for its differentiation from mammary connective tissue and adipocytes (Gonzalez-Zuloeta et al. 2007).

Circulating IGF-1 levels vary according to the age of the person, since initially, IGF-1 levels increase slowly from birth to puberty and later these levels decline with age in a stable manner, due to low GH levels (Philippou et al. 2007PHILIPPOU A, HALAPAS A, MARIDAKI M and KOUTSILIERIS M. 2007. Type I insulin-like growth factor receptor signaling in skeletal muscle regeneration and hypertrophy. J Musculoskelet Neuronal Interact 7: 208-218., Yu and Rohan 2000YU H and ROHAN T. 2000. Role of the insulin-like growth factor family in cancer development and progression. J Natl Cancer Inst 92: 1472-1489., Gennigens et al. 2006GENNIGENS C, MENETRIER-CAUX C and DROZ JP. 2006. Insulin-Like Growth Factor (IGF) family and prostate cancer. Crit Rev Oncol Hematol 58: 124-145.).

The half-life and bioavailability of circulating IGF-1 is regulated by a family of six IGF binding proteins (IGFBP1-6) (LeRoith and Roberts 2003) that control the distribution, function and activity of insulin-like growth factors in various cells, tissues and body fluids (Subramani et al. 2007SUBRAMANI T, SAKKARAI A, SENTHILKUMAR K, PERIASAMY S, ABRAHAM G and RAO S. 2007. Expression of insulin like growth factor binding protein-5 in drug induced human gingival overgrowth. Indian J Med Res 125: 43-48.). .Each IGFBP may bind to IGF-1 with a high affinity and is regulated by various specific IGFBP proteases. Circulating IGF-1 binds mainly to IGFBP3 and only 1% remains unbound, generating a complex with an acid labile subunit (Pollak 2008POLLAK M. 2008. Insulin and insulin-like growth factor signalling in neoplasia. Nat Rev Cancer 8: 915-928.).

Although IGF-1 levels may be affected by environmental factors and lifestyle, there is evidence that a significant level of IGF-1 expression may be influenced by genetic polymorphisms (Guntur and Rosen 2013GUNTUR AR and ROSEN CJ. 2013. IGF-1 regulation of key signaling pathways in bone. Bonekey Rep 2: 437.).

Genetic variations are mainlycomposed of single nucleotide polymorphisms (SNPs) and these variations lead to genetic differences in susceptibility to breast cancer (Kang et al. 2014KANG HS, AHN SH, MISHRA SK, HONG KM, LEE ES, SHIN KH, RO J, LEE KS and KIM MK. 2014. Association of polymorphisms and haplotypes in the insulin-like growth factor 1 receptor (IGF-1R) gene with the risk of breast cancer in korean women. PLoS One 9: 84532.). Insulin-like growth factors types 1 and 2 are peptide growth hormones that promote epithelial cell proliferation in the normal and neoplastic breast (Sachdev and Yee 2001SACHDEV D and YEE D. 2001. The IGF system and breast cancer. Endocr Relat Cancer 8: 197-209.).

It is known that IGF-1 is associated with an increased risk of developing a number of cancers (Tsuchiya et al. 2013TSUCHIYA N ET AL. 2013. Insulin-like growth factor-1 genotypes and haplotypes influence the survival of prostate cancer patients withbone metastasis at initial diagnosis. BMC Cancer 13: 150., Cao et al. 2014CAO Y ET AL. 2014. Insulin-like growth factor pathway genetic polymorphisms, circulating IGF-1 and IGFBP-3, and prostate cancer survival. J Natl Cancer Inst 106: 085., Ong et al. 2014ONG J, SALOMON J, MORSCHE RH, ROELOFS HM, WITTEMAN BJ, DURA P, LACKO M and PETERS WH. 2014. Polymorphisms in the insulin-like growth factor axis are associated with gastrointestinal cancer. PLoS One 9: 90916.) including breast cancer (Wang et al. 2014WANG Q, LIU L, LI H, MCCULLOUGH LE, QI YN, LI JY, ZHANG J, MILLER E, YANG CX and SMITH JS. 2014. Genetic and dietary determinants of insulin-like growth factor (IGF)-1 and IGF binding protein (BP)-3 levels among chinese women. PLoS One 9: 108934., Gu et al. 2010GU F ET AL. 2010. Eighteen insulin-like growth factor pathway genes, circulating levels of IGF-I and its binding protein, and risk of prostate and breast cancer. Cancer Epidemiol Biomarkers Prev 19: 2877-2887.). Thus, due to an increased risk of breast cancer caused by IGF-1 polymorphism and elevated IGF-1 levels and also the scarcity of studies on the subject, the aim of this review is to conduct a bibliographic research on IGF-1 gene polymorphism and its relationship with breast cancer risk.

MATERIALS AND METHODS

Literature searches were undertaken on PubMed database, by using a specific query. The base search strategy included the following search terms: Breast Neoplasms and Polymorphism Genetic, Breast Neoplasms and Insulin-Like Growth Factor 1, Polymorphism Genetic and Insulin-Like Growth Factor 1, Polymorphism Genetic and Breast Neoplasms and Insulin-like Growth Factor 1. The paper selection process included a two-step approach in which the screening of title and abstract was followed by the application of inclusion criteria to the full paper of the selected studies. Studies published from 2010 to 2015 related to the Insulin-Like Growth Factor 1 family and studies that explored the relationship between IGF-1 gene polymorphism and the risk for breast cancer, such as the study of polymorphic cytosine-adenine (CA) dinucleotide repeat sequences and SNP polymorphism were included. Case reports, animal studies, literature review, Meta analisys, letters to the editor and articles not in english were excluded.

RESULTS

As a result of the search, 3,393 papers were identified for initial screening. Of these, 876 satisfied the inclusion criteria. 867 studies were later excluded because eight of them were duplicate articles, 624 of them not envolved polymorphic cytosine-adenine (CA) dinucleotide repeat sequences and SNP polymorphism, 96 were literature review and 139 Meta analisys. Thus, only 9 studies were used in the review and Table I summarizes the studies published (Figure 1).

TABLE I
Description of the selected studies.

Figure 1
Algorithm the database used.

DISCUSSION

IGF-1 GENE POLYMORPHISM AND RISK OF BREAST CANCER

Population-based studies have shown that circulating IGF-1 levels, IGFBP-3 concentrations and genetic IGF-1 variations have been associated with cancer. Some Genome-Wide Association Studies (GWAS) identified various breast cancer susceptibility loci associated with risk of breast cancer Chang et al. 2012CHANG CI, LOW HP, QIU L, STROHSNITTER WC and HSIEH CC. 2012. Prenatal modulation of breast density and breast stem cells by insulin-like growth factor-1. Am J Stem Cells 1: 239-252., Stacey et al. 2007STACEY SN ET AL. 2007. Common variants on chromosomes 2q35 and 16q12 confer susceptibility to estrogen receptor-positive breast cancer. Nat Genet 39 : 865-869., 2008, Easton et al. 2007EASTON DF ET AL. 2007. Genome-wide association study identifies novel breast cancer susceptibility loci. Nature 447: 1087-1093.).These susceptibility variants of low penetrance are commonly present in the population in general and when these variants are expressed individually, only a low risk for breast cancer exists. However, when these variants are combined in a polygenic model, the risk of developing cancer increases considerably (Dai et al. 2012DAI J, HU Z, JIANG Y, SHEN H, DONG J, MA H and SHEN H. 2012. Breast cancer risk assessment with five independent genetic variants and two risk factors in Chinese women. Breast Cancer Res 14: 17., Harlid et al. 2012HARLID S ET AL. 2012. Combined effect of low-penetrant SNPs on breast cancer risk. Br J Cancer 106: 389-396.). In the last few years, there has been increasing interest in the study of genomic analysis of the IGF-1 gene in an attempt to identify specific alterations involved in tumor formation and progression, in particular in breast carcinoma. Two of the most widely studied genetic alterations of IGF-1 gene is a polymorphic cytosine-adenine (CA) dinucleotide repeat sequence and SNP polymorphism (Gu et al. 2010GU F ET AL. 2010. Eighteen insulin-like growth factor pathway genes, circulating levels of IGF-I and its binding protein, and risk of prostate and breast cancer. Cancer Epidemiol Biomarkers Prev 19: 2877-2887., Javadi et al. 2012JAVADI M, HEMATTI S and TAVASSOLI M. 2012. Polymorphic CA repeat length in insulin-like growth factor 1 and risk of breast cancer in Iranian women. Med Oncol 29: 516-520., Muendlein et al. 2013MUENDLEIN A ET AL. 2013. Association of a common genetic variant of the IGF-1 gene with event-free survival in patients with HER2-positive breast cancer. J Cancer Res Clin Oncol 139: 491-498., Qian et al. 2011QIAN B, ZHENG H, YU H and CHEN K. 2011. Genotypes and phenotypes of IGF-1 and IGFBP-3 in breast tumors among Chinese women. Breast Cancer Res Treat 130: 217-226.).

Polymorphic CA dinucleotide repeat sequences may vary from 10 to 24 repeats in length, and CA 19 is the most common allele. This repeating sequence is located 1 kb upstream of the transcription initiation site and is thus considered a promoter polymorphism that is probably related to regulation of IGF-1 protein levels (Sarkissyan et al. 2011SARKISSYAN M, MISHRA DK, WU Y, SHANG X, SARKISSYAN S and VADGAMA JV. 2011. IGF gene polymorphisms and breast cancer in African-American and Hispanic women. Int J Oncol38: 1663-1673.). Al-Ajmi et al. (2012) analyzing IGF-1 gene polymorphism (CA 19) by genomic DNA extracted from peripheral blood of 147 patients with breast cancer, found difference in cases and controls was significant among postmenopausal women (p = 0.026) and no significant association between CA 19 and risk of breast cancer among Arab Omani women in the premenopausal period (p= 0.394) with 95% confidence intervals. However, in another study of 268 African-American and Hispanic/Latin-American women with breast cancer, a significant correlation of the non-19 /non-19 allele genotype with breast cancer by univariate analysis (Odds Ratio (OR) = 1.75; 95% CI = 1.07-2.88; p=0.027). (Sarkissyan et al. 2011).

There is growing evidence that CA 19 allele is associated with an increased incidence of breast cancer and other cancers in Asians (Qian et al. 2011QIAN B, ZHENG H, YU H and CHEN K. 2011. Genotypes and phenotypes of IGF-1 and IGFBP-3 in breast tumors among Chinese women. Breast Cancer Res Treat 130: 217-226.). .A correlation was also found between length of the allele and development of the disease. A study demonstrated that the risk of developing breast cancer increased in Iranian women carrying an allele longer than CA 19 and decreased in those carrying alleles shorter than 20, nevertheless this effect was more profund in women with both alleles longer than 19 (OD= 4.1; p = 0. 0002) (Javadi et al. 2012JAVADI M, HEMATTI S and TAVASSOLI M. 2012. Polymorphic CA repeat length in insulin-like growth factor 1 and risk of breast cancer in Iranian women. Med Oncol 29: 516-520.).

In a meta-analysis, Huang et al. (2011HUANG Q, WANG C, QIU LJ, SHAO F and YU JH. 2011. The association between IGF-1 CA repeat polymorphisms and breast cancer risk: a meta-analysis. Breast Cancer Res Treat 129: 191-194.) observed no association between CA 17, 19 and 20 alleles and the risk of breast cancer, while two years later He et al. (2013HE B, XU Y, PAN Y, LI R, GAO T, SONG G, GU L, NIE Z, CHEN L and WANG S. 2013. Differential effects of insulin-like growth factor-1 CA repeat polymorphism on breast cancer risk along with race: a meta-analysis. Gene 525: 92-98.) carried out a meta-analysis demonstrating that CA 19/19 alleles may provoke a decrease in the risk of developing breast cancer in Caucasian women, but not in Asian women.

In turn, SNP polymorphism and its combinations (haplotypes) among other genetic variations have been studied to investigate a possible association with breast cancer. The majority of SNPs studied are found in highly located areas known as Evolutionarily Conserved Regions (ECR) that are close to the transcription binding domains that provoke alterations in transcription regulation (Biong et al. 2010BIONG M ET AL. 2010. Genotypes and haplotypes in the insulin-like growth factors, their receptors and binding proteins in relation to plasma metabolic levels and mammographic density. BMC Med Genomics 3: 9.).

Increased mammographic density is considered one of the most important risk factors for the development of breast cancer (Harvey and Bovbjerg 2004HARVEY JA and BOVBJERG VE. 2004. Quantitative assessment of mammographic breast density: relationship with breast cancer risk. Radiology 230: 29-41., Boyd et al. 2005BOYD NF, ROMMENS JM, VOGT K, LEE V, HOPPER JL and YAFFE MJ. 2005. Mammographic breast density as an intermediate phenotype for breast cancer. Lancet Oncol 6: 798-808., Byrne et al. 2001BYRNE C, SCHAIRER C, BRINTON LA, WOLFE J, PAREKH N and SALANE M. 2001. Effects of mammographic density and benign breast disease on breast cancer risk (United States). Cancer Cause Control 12: 103-110.). Around one-third of breast cancers occur in breasts with mammographic density greater than 50% (Ursin et al. 2005URSIN G, HOVANESSIAN-LARSEN L, PARISKY YR, PIKE MC and WU AH. 2005. Greatly increased occurrence of breast cancers in areas of mammographically dense tissue. Breast Cancer Res 7: 605-608., Russo et al. 2005RUSSO J, MAILO D, HU YF, BALOGH G, SHERIFF F and RUSSO IH. 2005. Breast differentiation and its implication in cancer prevention. Clin Cancer Res 11: 931-936., Ziv et al. 2003ZIV E, SHEPHERD J, SMITH-BINDMAN R and KERLIKOWSKE K. 2003. Mammographic breast density and family history of breast cancer. J Natl Cancer Inst 95: 556-558.). Mammographic density may be affected by body mass index, age, parity and also genetic variations in genes involved in the development of the breast, such as IGF-1 gene (Haiman et al. 2003HAIMAN CA, HANKINSON SE, DE VI, GUILLEMETTE C, ISHIBE N and HUNTER DJ. 2003. Polymorphisms in steroid hormone pathway genes and mammographic density. Breast Cancer Res Treat 77: 27-36., Tamimiet al. 2007TAMIMI RM, COX DG, KRAFT P, POLLAK MN, HAIMAN CA and CHENG I. 2007. Common genetic variation in IGF-1, IGFBP-1, and IGFBP-3 in relation to mammographic density: a cross-sectional study. Breast Cancer Res 9: 18.).Diorio et al. (2005DIORIO C, POLLAK M, BYRNE C, MÂSSE B, HÉBERT-CROTEAU N, YAFFE M, COTÉ G, BÉRUBÉ S, MORIN C and BRISSON J. 2005. Insulin-like growth factor 1, IGF-binding protein-3, and mammographic breast density. Cancer Epidemiol Biomark Prev 14: 1065-1073.) found an association between mammographic density and IGF-1 serum in premenopausal women, although more recent studies have contradictory results (Rice et al. 2012RICE MS, TWOROGER SS, ROSNER BA, POLLAK MN, HANKINSON SE and TAMIMI RM. 2012. Insulin-like growth factor-1, insulin-like growth factor-binding protein-3, growth hormone, and mammographic density in the Nurses' Health Studies. Breast Cancer Res Treat 136: 805-812., Rinaldi et al. 2014RINALDI S, BIESSY C, HERNANDEZ M, LESUEUR F, DOS SANTOS SILVA I, RICE MS, LAJOUS M, LOPEZ-RIDAURA R, TORRES-MEJÍA G and ROMIEU I. 2014. Circulating concentrations of insulin-like growth factor-I, insulin-like growth factor-binding protein-3, genetic polymorphisms and mammographic density in premenopausal Mexican women: Results from the ESMaestras cohort. Int J Cancer 134: 1436-1444.).

A study conducted with 964 postmenopausal women aimed at confirming correlations between mammographic density, SNP polymorphism, IGF-1 circulating levels and its binding protein, demonstrated only a common genetic association between IGF-1 haplotype, IGF-1 plasma levels and mammographic density in Norwegian postmenopausal women (Biong et al. 2010BIONG M ET AL. 2010. Genotypes and haplotypes in the insulin-like growth factors, their receptors and binding proteins in relation to plasma metabolic levels and mammographic density. BMC Med Genomics 3: 9.). Henningson et al. (2011HENNINGSON M, HIETALA M, TÖRNGREN T, OLSSON H and JERNSTRÖM H. 2011. IGF-1 htSNPs in relation to IGF-1 levels in young women from high-risk breast cancer families: implications for early-onset breast cancer. Fam Cancer 10: 173-185.) showed a relationship between SNP polymorphism, circulating IGF-1 levels and the risk of breast cancer. It was shown that neither a single SNP nor any diplotype (combination of two haplotypes) were associated with circulating IGF-1 levels in 325 Swedish women, and a rare diplotype variant was found to be significantly associated with a higher risk of developing breast cancer.

Another individual SNP (rs 7965399), located close to the transcription initiation site, more specifically at the 5' untranslated region of the IGF-1 gene has been associated with breast cancer risk in a recessive model, in which 403 Chinese women with breast cancer were recruited. This association became particularly more evident in patients who were menopausal before age 50 and in those who were estrogen-receptor negative (ER-) (OR=2.48; 95%CI: 1.08 - 5.67) and infiltrating ductal carcinoma (OR = 2.18; 95% CI: 1.08-4.38) (Qian et al. 2011QIAN B, ZHENG H, YU H and CHEN K. 2011. Genotypes and phenotypes of IGF-1 and IGFBP-3 in breast tumors among Chinese women. Breast Cancer Res Treat 130: 217-226.).

The Breast and Prostate Cohort Consortium (BPC3), a collaboration of large North-American and European cohorts genotyped 1416 SNP for 24 gene variants involved in the IGF-1 pathway in 6,292 Caucasian postmenopausal women, diagnosed with breast cancer. A comparison between these women and 8135 women from the control group showed no significant association between SNPs and risk of breast cancer (Ptrend 0.003-0.996 ) (Canzian et al. 2010CANZIAN F ET AL. 2010. Comprehensive analysis of common genetic variation in 61 genes related to steroid hormone and insulin-like growth factor-1 metabolism and breast cancer risk in the NCI breast and prostate cancer cohort consortium. Hum Mol Genet 19: 3873-3884.). Another study that used BPC3 data, genotyped a total of 302 SNP Insulin-like Growth Factor (IGF) pathway genes in a sample of more than 5,500 Caucasian women and also failed to observe any association with breast cancer risk, but with a positive association of the SNP with the levels of circulating IGF, adjusted significance criteria (nominal p value < 2.1×10−4) (Gu et al. 2010GU F ET AL. 2010. Eighteen insulin-like growth factor pathway genes, circulating levels of IGF-I and its binding protein, and risk of prostate and breast cancer. Cancer Epidemiol Biomarkers Prev 19: 2877-2887.).

Although a large number of studies have identified an association between IGF-1 gene polymorphism and breast cancer risk, few studies have investigated the relationship between these polymorphisms and disease progression. In analysis of the association between type CA-19 IGF-1 gene polymorphism in a breast cancer patient along with patient clinic pathological characteristics, as well as disease recurrence and survival, it was observed that homozygotes for non-19/non 19 CA alleles with non-metastatic breast cancer had favorable prognostic factors, a lower tumor recurrence rate (95% CI: 0.93-5.92, p = 0.06), longer disease-free interval (95%CI: 38.6-115.6) and longer survival (95% CI: 1.04-8.6, p = 0.03) (Yaren et al. 2012YAREN A, TURGUT S, AYADA C, AKCILAR R, DEGIRMENCIOGLU S and GOKOZ DOGU G. 2012. Insulin-like growth factor 1 (IGF-1) gene polymorphism in patients with non-metastatic breast cancer. Gene 503: 244-247.), while patients testing positive for human epidermal growth factor (HER2+) and carriers of the SNP (rs 2946834) allele have a worse prognosis (p = 0.020) and a reduction in disease-free survival (p = 0.027), probably due to increased levels of circulating IGF-1 (Muendlein et al. 2013MUENDLEIN A ET AL. 2013. Association of a common genetic variant of the IGF-1 gene with event-free survival in patients with HER2-positive breast cancer. J Cancer Res Clin Oncol 139: 491-498.). Thus, the reason behind the conflicting results between studies is still unknown but a possible explanation could be the variation in the ethnic composition of the study populations (Al-ajmi et al. 2012AL-AJMI K, GANGULY SS, AL-AJMI A, MANDHARI ZA and AL-MOUNDHRI MS. 2012. Insulin-like growth factor 1 gene polymorphism and breast cancer risk among Arab Omani women: a case-control study. Breast Cancer 6: 103-112.).

CONCLUSIONS

A growing number of studies support an association between IGF-1 gene polymorphism and breast cancer risk. However, conflicting results have been observed with different methodological approaches, distinct molecular subtypes studied, genetic differences between different populations and tumor heterogeneity. Therefore, elucidation of the patterns of IGF-1 gene expression may permit characterization of women at high-risk for breast cancer, as well as the development of strategies for early diagnosis and efficient treatment against the disease.

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Publication Dates

  • Publication in this collection
    01 Dec 2016
  • Date of issue
    Oct-Dec 2016

History

  • Received
    27 Apr 2016
  • Accepted
    23 Aug 2016
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