IGF1 and neoplasm: Furthermore, previous studies also suggest that higher scores of DED index, via increasing insulin concentration, can increase the synthesis of insulin-like growth factor IGF-1 and inhibit IGF-1-binding proteins, known to be a predictor of cancer and a factor associated with increasing estrogen in adipose tissue, and promoting tumor growth by inhibiting apoptosis, stimulating cell proliferation, and enhancing angiogenesis [29, 34].