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Weight gain in hormone receptor-positive (HR+) early-stage breast cancer: is it menopausal status or something else?

  • Epidemiology
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Abstract

Purpose

This study investigates weight trajectories in pre- versus postmenopausal breast cancer (BC) survivors diagnosed with hormone receptor-positive tumors, with a specific focus on discerning menopausal status and type of endocrine treatment (ET) as risk factors for weight gain during ET.

Methods

We conducted a retrospective review of electronic medical records. Descriptive statistics and Chi-squared and t tests were used to compare pre- and postmenopausal women. Chi-squared tests and ANOVA were used for within-group associations between patient characteristics and weight trajectories. Log-binomial regression models were used to estimate relative risk for weight gain.

Results

The final sample was 32% premenopausal (n = 140) and 68% postmenopausal (n = 298). Relative risk (RR) for weight gain during ET was highest in women who were premenopausal (RR = 1.29, 1.03–1.52) and had Stage 3 BC (RR = 2.12, 1.59–2.82), mastectomy (RR = 1.49, 1.19–1.88), axillary node dissection (RR = 1.39, 1.11–1.73), and chemotherapy (RR = 1.80, 1.37–2.36). For each kg of weight gained between BC diagnosis and start of ET, and for each additional year of age, RR of gaining weight during ET decreased (RR = 0.98, 0.97–0.99, and RR = 0.99, 0.98–0.99, respectively). Menopausal status and type of ET were not significant predictors of weight gain. In multivariable analysis, only weight loss between BC diagnosis and start of ET was significant.

Conclusion

The association of weight loss prior to ET and subsequent substantial weight gain during ET warrants further investigation.

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References

  1. Kohler BA, Sherman RL, Howlader N et al (2015) Annual report to the Nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 107(6):djv048

    Article  PubMed  PubMed Central  Google Scholar 

  2. Clarke CA, Keegan TH, Yang J et al (2012) Age-specific incidence of breast cancer subtypes: understanding the black-white crossover. J Natl Cancer Inst 104(14):1094–1101

    Article  PubMed  PubMed Central  Google Scholar 

  3. DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A (2016) Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin 66(1):31–42

    Article  PubMed  Google Scholar 

  4. Howlader N, Altekruse SF, Li CI et al (2014) US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst. doi:10.1093/jnci/dju055

    PubMed  PubMed Central  Google Scholar 

  5. Yang XR, Chang-Claude J, Goode EL et al (2011) Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the breast cancer association consortium studies. J Natl Cancer Inst 103(3):250–263

    Article  PubMed  Google Scholar 

  6. Chen L, Li CI (2015) Racial disparities in breast cancer diagnosis and treatment by hormone receptor and HER2 status. Cancer Epidemiol Biomark Prevent 24(11):1666–1672

    Article  CAS  Google Scholar 

  7. Clark GM, Osborne CK, McGuire WL (1984) Correlations between estrogen receptor, progesterone receptor, and patient characteristics in human breast cancer. J Clin Oncol 2:1102–1109

    Article  CAS  PubMed  Google Scholar 

  8. Benz CC (2008) Impact of aging on the biology of aging. Crit Rev Oncol Hematol 66(1):65–74

    Article  PubMed  Google Scholar 

  9. Parise CA, Caggiano V (2014) Breast cancer survival defined by the ER/PR/HER2 subtypes and a surrogate classification according to tumor grade and immunohistochemical biomarkers. J Cancer Epidemiol 2014:469251

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gershuni V, Li YR, Williams AD et al (2017) Breast cancer subtype distribution is different in normal weight, overweight, and obese women. Breast Cancer Res Treat 163(2):375–381

    Article  PubMed  Google Scholar 

  11. Dunnwald LK, Rossing MA, Li CI (2007) Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Res 9(1):R6

    Article  PubMed  PubMed Central  Google Scholar 

  12. Eppenberger-Castori S, Moore DH Jr, Thor AD et al (2002) Age-associated biomarker profiles of human breast cancer. Int J Biochem Cell Biol 34(11):1318–1330

    Article  CAS  PubMed  Google Scholar 

  13. Schiavon G, Smith IE (2014) Status of adjuvant endocrine therapy for breast cancer. Breast Cancer Res 16(2):206

    Article  PubMed  PubMed Central  Google Scholar 

  14. Taylor WC, Muss HB (2010) Recent advances: adjuvant therapy for older women with breast cancer. Cancer J 16(4):289–293

    Article  PubMed  Google Scholar 

  15. Dowsett M, Cuzick J, Ingle J et al (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28(3):509–518

    Article  CAS  PubMed  Google Scholar 

  16. Goss PE, Ingle JN, Pritchard KI et al (2016) Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med 375:209–219

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Burstein HJ, Temin S, Anderson H et al (2014) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. J Clin Oncol 32(21):255–2269

    Article  Google Scholar 

  18. Burstein HJ, Lacchetti C, Anderson H et al (2016) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American society of clinical oncology clinical practice guideline update on ovarian suppression. J Clin Oncol 34(14):1689–1701

    Article  CAS  PubMed  Google Scholar 

  19. Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J et al (1999) Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol 17(1):120–129

    Article  CAS  PubMed  Google Scholar 

  20. Rock CL, Flatt SW, Newman V, Caan BJ, Haan MN et al (1999) Factors associated with weight gain in women after diagnosis of breast cancer. Women’s healthy eating and living study group. J Am Diet Assoc 99:1212–1221

    Article  CAS  PubMed  Google Scholar 

  21. Demark-Wahnefried W, Rimer BK, Winer EP (1997) Weight gain in women diagnosed with breast cancer. J Am Diet Asso 97(5):519–526, 529; quiz 527–518

  22. Saquib N, Flatt SW, Natarajan L, Thomson CA, Bardwell WA et al (2007) Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women’s healthy eating and living (WHEL) study. Breast Cancer Res Treat 105(2):177–186

    Article  PubMed  Google Scholar 

  23. Kim SH, Cho YU, Kim SJ (2013) Weight gain and its correlates among breast cancer survivors. Asian Nurs Res 7(4):161–167

    Article  Google Scholar 

  24. Irwin ML, McTiernan A, Baumgartner RN, Bernstein L, Gilliland FD, Ballard-Barbash R (2005) Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol 23(4):774–782

    Article  PubMed  PubMed Central  Google Scholar 

  25. van den Berg MM, Winkels RM, de Kruif JT et al (2017) Weight change during chemotherapy in breast cancer patients: a meta-analysis. BMC Cancer 17(1):259

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mortimer J, Behrendt CE (2013) Severe menopausal symptoms are widespread among survivors of breast cancer treatment regardless of time since diagnosis. J Palliat Med 16(9):1130–1134

    Article  PubMed  Google Scholar 

  27. Sadim M, Xu Y, Selig K et al (2017) Clinical and genetic predictors of weight gain in patients diagnosed with breast cancer. Cancer 109:872

    Google Scholar 

  28. Gross AL, May BJ, Axilbund JE, Armstrong DK, Roden RB, Visvanathan K (2015) Weight change in breast cancer survivors compared to cancer-free women: a prospective study in women at familial risk of breast cancer. Cancer Epidemiol Biomark Prevent 24(8):1262–1269

    Article  CAS  Google Scholar 

  29. Heideman WH, Russell NS, Gundy C, Rookus MA, Voskuil DW (2009) The frequency, magnitude and timing of post-diagnosis body weight gain in Dutch breast cancer survivors. Eur J Cancer 45:119–126

    Article  CAS  PubMed  Google Scholar 

  30. Makari-Judson G, Judson CH, Mertens WC (2007) Longitudinal patterns of weight gain after breast cancer diagnosis: observations beyond the first year. Breast 13(3):258–265

    Article  Google Scholar 

  31. Vagenas D, DiSipio T, Battistutta D et al (2015) Weight and weight change following breast cancer: evidence from a prospective, population-based, breast cancer cohort study. BMC Cancer 15(1):28

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sestak I, Harvie M, Howell A, Forbes JF, Dowsett M, Cuzick J (2012) Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer. Breast Cancer Res Treat 134(2):727–734

    Article  CAS  PubMed  Google Scholar 

  33. Sedjo RL, Byers T, Ganz PA et al (2014) Weight gain prior to entry into a weight-loss intervention study among overweight and obese breast cancer survivors. J Cancer Surviv 8(3):410–418

    Article  PubMed  PubMed Central  Google Scholar 

  34. Francini G, Petrioli R, Montagnani A et al (2006) Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids. Br J Cancer 95(2):153–158

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Aiello Bowles EJ, Boudreau DM, Chubak J et al (2012) Patient-reported discontinuation of endocrine therapy and related adverse effects among women with early-stage breast cancer. J Oncol Prac. 8(6):49–57

    Article  Google Scholar 

  36. Malinovszky KM, Cameron D, Douglas S et al (2004) Breast cancer patients’ experiences on endocrine therapy: monitoring with a checklist for patients on endocrine therapy (C-PET). Breast 13(5):363–368

    Article  CAS  PubMed  Google Scholar 

  37. Hoskin PJ, Ashley S, Yarnold JR (1992) Weight gain after primary surgery for breast cancer–effect of tamoxifen. Breast Cancer Res Treat 22(2):129–132

    Article  CAS  PubMed  Google Scholar 

  38. Han HS, Lee KW, Kim JH et al (2009) Weight changes after adjuvant treatment in Korean women with early breast cancer. Breast Cancer Res Treat 114(1):147–153

    Article  CAS  PubMed  Google Scholar 

  39. Nyrop KA, Deal AM, Lee JT et al (2017) Weight changes in postmenopausal breast cancer survivors over 2 years of endocrine therapy: a retrospective chart review. Breast Cancer Res Treat 162:375–388

    Article  CAS  PubMed  Google Scholar 

  40. Nyrop KA, Williams GR, Muss HB, Shachar SS (2016) Weight gain during adjuvant endocrine treatment for early-stage breast cancer: what is the evidence? Breast Cancer Res Treat 158(2):203–217

    Article  CAS  PubMed  Google Scholar 

  41. Giordano SH, Lin YL, Kuo YF, Hortobagyi GN, Goodwin JS (2012) Decline in the use of anthracyclines for breast cancer. J Clin Oncol 30(18):2232–2239

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kritchevsky SB, Wilcosky TC, Morris DL, Truong KN, Tyroler HA (1991) Changes in plasma lipid and lipoprotein cholesterol and weight prior to the diagnosis of cancer. Can Res 51(12):3198–3203

    CAS  Google Scholar 

  43. McTiernan A, Sorensen B, Irwin ML et al (2007) Exercise effect on weight and body fat in men and women. Obesity 15(6):1496–1512

    Article  PubMed  Google Scholar 

  44. Myers CA, Slack T, Martin CK, Broyles ST, Heymsfield SB (2016) Change in obesity prevalence across the United States is influenced by recreational and healthcare contexts, food environments, and hispanic populations. PLoS ONE 11(2):e0148394

    Article  PubMed  PubMed Central  Google Scholar 

  45. Vassar M, Holzmann M (2013) The retrospective chart review: important methodological considerations. J Educ Eval Health Prof 10:12

    Article  PubMed  Google Scholar 

  46. Lee MK, Varzi LA, Chung DU et al (2015) The effect of young age in hormone receptor positive breast cancer. Biomed Res Int 2015:325715

    PubMed  PubMed Central  Google Scholar 

  47. Chollet-Hinton L, Anders CK, Tse CK et al (2016) Breast cancer biologic and etiologic heterogeneity by young age and menopausal status in the Carolina breast cancer study: a case-control study. Breast Cancer Res 18(1):79

    Article  PubMed  PubMed Central  Google Scholar 

  48. Coughlin SS, Smith SA (2015) The insulin-like growth factor axis, adipokines, physical activity, and obesity in relation to breast cancer incidence and recurrence. Cancer Clin Oncol 4(2):24–31

    PubMed  PubMed Central  Google Scholar 

  49. Keum N, Greenwood DC, Lee DH et al (2015) Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst 107(2):djv088

    Article  PubMed  Google Scholar 

  50. Cheraghi Z, Poorolajal J, Hashem T, Esmailnasab N, Doosti Irani A (2012) Effect of body mass index on breast cancer during premenopausal and postmenopausal periods: a meta-analysis. PLoS ONE 7(12):e51446

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Biglia N, Peano E, Sgandurra P et al (2013) Body mass index (BMI) and breast cancer: impact on tumor histopathologic features, cancer subtypes and recurrence rate in pre and postmenopausal women. Gynecol Endocrinol 29(3):263–267

    Article  PubMed  Google Scholar 

  52. Loi S, Milne RL, Friedlander ML et al (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomark Prevent 14(7):1686–1691

    Article  Google Scholar 

  53. Ewertz M, Jensen MB, Gunnarsdottir KA et al (2011) Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29(1):25–31

    Article  PubMed  Google Scholar 

  54. Litton JK, Gonzalez-Angulo AM, Warneke CL et al (2008) Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol 26(25):4072–4077

    Article  PubMed  Google Scholar 

  55. Caan BJ, Emond JA, Su HI et al (2012) Effect of postdiagnosis weight change on hot flash status among early-stage breast cancer survivors. J Clin Oncol 30(13):1492–1497

    Article  PubMed  PubMed Central  Google Scholar 

  56. Su H, Sammel MD, Springer E, Freeman EW, DeMichele A, Mao JJ (2010) Weight gain is associated with increased risk of hot flashes in breast cancer survivors on aromatase inhibitors. Breast Cancer Res Treat 124(1):205–211

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Glaus A, Boehme C, Thurlimann B et al (2006) Fatigue and menopausal symptoms in women with breast cancer undergoing hormonal cancer treatment. Ann Oncol 17(5):801–806

    Article  CAS  PubMed  Google Scholar 

  58. Alfano CM, McGregor BA, Kuniyuki A et al (2006) Psychometric properties of a tool for measuring hormone-related symptoms in breast cancer survivors. Psychooncology. 15(11):985–1000

    Article  PubMed  PubMed Central  Google Scholar 

  59. Young A, Weltzien E, Kwan M, Castillo A, Caan B, Kroenke CH (2014) Pre- to post-diagnosis weight change and associations with physical functional limitations in breast cancer survivors. J Cancer Surviv 8(4):539–547

    Article  PubMed  PubMed Central  Google Scholar 

  60. Imayama I, Alfano CM, Neuhouser ML et al (2013) Weight, inflammation, cancer-related symptoms and health related quality of life among breast cancer survivors. Breast Cancer Res Treat 140(1):159–176

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Befort CA, Austin H, Klemp JR (2011) Weight control needs and experiences among rural breast cancer survivors. Psychooncology. 20(10):1069–1075

    Article  PubMed  Google Scholar 

  62. Sestak I, Cuzick J, Sapunar F et al (2008) Risk factors for joint symptoms in patients enrolled in the ATAC trial: a retrospective, exploratory analysis. Lancet Oncol. 9(9):866–872

    Article  PubMed  Google Scholar 

  63. Brown JC, Mao JJ, Stricker C, Hwang WT, Tan KS, Schmitz KH (2013) Aromatase inhibitor associated musculoskeletal symptoms are associated with reduced physical activity among breast cancer survivors. The Breast J. 20(1):22–28

    Article  PubMed  Google Scholar 

  64. Cespedes Feliciano EM, Kwan ML, Kushi LH et al (2017) Body mass index, PAM50 subtype, recurrence and survival among patients with nonmetastatic breast cancer. Cancer 123:2535–2542

    Article  CAS  PubMed  Google Scholar 

  65. Dignam JJ, Wieand K, Johnson KA et al (2006) Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Res Treat 97(3):245–254

    Article  PubMed  Google Scholar 

  66. Kamineni A, Anderson ML, White E et al (2013) Body mass index, tumor characteristics, and prognosis following diagnosis of early-stage breast cancer in a mammographically screened population. Cancer Causes Control 24(2):305–312

    Article  PubMed  Google Scholar 

  67. Minicozzi P, Berrino F, Sebastiani F et al (2013) High fasting blood glucose and obesity significantly and independently increase risk of breast cancer death in hormone receptor-positive disease. Eur J Cancer 49(18):3881–3888

    Article  CAS  PubMed  Google Scholar 

  68. Petrelli JM, Calle EE, Rodriguez C, Thun MJ (2002) Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 13(4):325–332

    Article  PubMed  Google Scholar 

  69. Sparano JA, Wang M, Zhao F et al (2012) Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer 118(23):5937–5946

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Fedele P, Orlando L, Schiavone P et al (2014) BMI variation increases recurrence risk in women with early-stage breast cancer. Future Oncol. 10(15):2459–2468

    Article  CAS  PubMed  Google Scholar 

  71. Nechuta S, Chen WY, Cai H et al (2016) A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis. Int J Cancer 138(9):2088–2097

    Article  CAS  PubMed  Google Scholar 

  72. Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378

    Article  PubMed  Google Scholar 

  73. Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L (2009) Holmes MD, al. e. Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev 18(5):1403–1409

    Article  PubMed  PubMed Central  Google Scholar 

  74. Wolin KY, Schwartz AL, Matthews CE, Courneya KS, Schmitz KH (2012) Implementing the exercise guidelines for cancer survivors. J Support Oncol. 10(5):171–177

    Article  PubMed  PubMed Central  Google Scholar 

  75. Santa Mina D, Alibhai SM, Matthew AG et al (2012) Exercise in clinical cancer care: a call to action and program development description. Curr Oncol. 19(3):e136–e144

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Ruiz-Casado A, Lucia A (2014) The time has come for oncologists to recommend physical activity to cancer survivors. Arch Exerc Health Dis. 4(1):214–215

    Google Scholar 

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Acknowledgements

This study was supported by the Breast Cancer Research Foundation, NCI Breast Cancer Specialized Program of Research Excellence (CA58223), and the UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund. Dr. Shachar’s fellowship at UNC was supported by the Friends of Rambam Medical Center and The J&G Zukier Medical Fund Donation, Haifa, Israel.

Disclaimers

The authors do not have any disclaimers.

Funding

This study was funded in part by the Breast Cancer Research Foundation of New York and UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund.

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Authors and Affiliations

  1. Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA

    Kirsten A. Nyrop, Hyman B. Muss, Lisa A. Carey & Shlomit S. Shachar

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Kirsten A. Nyrop, Allison M. Deal, Hyman B. Muss, Amy Wheless & Lisa A. Carey

  3. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Jordan T. Lee

  4. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Seul Ki Choi

  5. Oncology Institute, Rambam Health Care Campus, Haifa, Israel

    Shlomit S. Shachar

Authors
  1. Kirsten A. Nyrop
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  2. Allison M. Deal
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  3. Jordan T. Lee
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  4. Hyman B. Muss
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  5. Seul Ki Choi
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  6. Amy Wheless
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  7. Lisa A. Carey
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  8. Shlomit S. Shachar
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Correspondence to Kirsten A. Nyrop.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This study did not entail direct contact with humans and therefore did not entail obtaining informed consent.

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The abstract for this study was accepted for publication, 2017 ASCO Annual Meeting.

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Nyrop, K.A., Deal, A.M., Lee, J.T. et al. Weight gain in hormone receptor-positive (HR+) early-stage breast cancer: is it menopausal status or something else?. Breast Cancer Res Treat 167, 235–248 (2018). https://doi.org/10.1007/s10549-017-4501-4

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