These factors, cytokines, free fatty acids, leptin, higher blood levels of insulin, and glucose are associated with cancer development due to direct effects on oncogenic signaling pathways and indirect effects on tumor microenvironment by inflammatory cells.36 Furthermore, it is known that a combination of dietary weight loss and exercise training induces a favorable development of these parameters in breast cancer patients.37, 38, 39 Whether a change of these markers after breast cancer diagnosis effects outcome has not been shown yet. This evidence concerns the gene INS and cancer.