To the Editor,

We read with great interest the recent paper by Goodwin

other components of the metabolic syndrome (e.g., obesity,

high waist–hip ratio, impaired lipid profile) in patients

affected by breast cancer. As correctly reported by the

cancer prognosis through several mechanisms, such as: (i)

a direct interaction between insulin and insulin/IGF

receptors able to stimulate cell proliferation; (ii) some

indirect effects of insulin on the circulating levels of both

IGF and of insulin/IGF binding proteins; (iii) an effect of

insulin on the free circulating estrogen levels.