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Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Summary

Background

Several factors may contribute to poorer prognosis for obese breast cancer patients, including unfavorable disease features, the influence of fat on estrogen availability, co-morbidity, and socio-demographic factors. Both obesity and estrogen receptor negative (ER-) tumors are more prevalent in black women than in whites in North America. We evaluated obesity and race in relation to outcomes in women with ER-breast cancer.

Methods

Among 4077 women from National Surgical Adjuvant Breast and Bowel Project clinical trials for node-negative, ER-breast cancer, we evaluated disease-free survival (DFS) and its constituents (tumor recurrence, contralateral breast cancer (CBC), second primary cancers, deaths prior to these events) and mortality in relation to body mass index (BMI) and race, using statistical modeling to account for other prognostic factors.

Results

Compared to those of normal weight (BMI≤24.9), DFS hazard was greater for obese (BMI ≥ 30) women [hazard ratio (HR)=1.16, 95% confidence interval (CI)=1.01–1.33]. Obesity did not increase recurrence hazard, but did influence CBC (HR=2.08, 95% CI=1.22–3.55 in postmenopausal women) and second cancers (HR=1.49, 95% CI=1.06–2.10). Mortality increased with obesity; when partitioned by likely cause, those with BMI ≥ 35.0 had greater risk of non-breast cancer mortality (HR=1.86, 95% CI=1.21–2.84). Relative to whites and adjusted for BMI, black women had greater hazard for DFS (HR=1.17, 95% CI=1.00–1.38), CBC (HR=1.37, 95% CI=0.94–1.99), and non-breast cancer deaths (HR=2.10, 95% CI=1.45–3.03); risk for deaths likely due to breast cancer was closer to that in whites (HR=1.18; 95% CI=0.93–1.50).

Conclusions

For women with node-negative, ER-breast cancer from clinical trials, obesity did not increase recurrence risk, but was associated with greater risk for second cancers, CBC, and mortality, particularly non-breast cancer deaths. Less favorable prognosis for black women persists in clinical trials, and is in part attributable to non-breast cancer outcomes.

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Acknowledgements

We thank Barbara Good, PhD for lending her technical writing expertise to the development of this article. Funding: Supported by Public Health Service grants NCI-R03-CA-99508, NCI-U10-CA-69651, NCI-U10-CA-12027, and NCI P30-CA-14599 from the US National Cancer Institute.

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Authors and Affiliations

  1. Department of Health Studies, The University of Chicago, Chicago, IL, USA

    James J. Dignam & Kelly Wieand

  2. Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA

    Karen A. Johnson

  3. AMC Cancer Research Center and University of Colorado Health Sciences Center, Denver, CO, USA

    Peter Raich

  4. National Surgical Adjuvant Breast and Bowel Project (NSABP) Biostatistical Center, Pittsburgh, PA, USA

    James J. Dignam & Stewart J. Anderson

  5. University of Pittsburgh, Pittsburgh, PA, USA

    Stewart J. Anderson

  6. Kaiser Permanente Division of Research, Oakland, CA, USA

    Carol Somkin

  7. NSABP Operations Center and Allegheny General Hospital, Pittsburgh, PA, USA

    D. Lawrence Wickerham

  8. Department of Health Studies, The University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL, 60637, USA

    James J. Dignam

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  1. James J. Dignam
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Correspondence to James J. Dignam.

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Dignam, J.J., Wieand, K., Johnson, K.A. et al. Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Res Treat 97, 245–254 (2006). https://doi.org/10.1007/s10549-005-9118-3

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