Skip to main content

Advertisement

Log in

Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis

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

Abstract

Triple-negative breast cancer (TNBC) is a subtype of breast tumor with unique characteristics in terms of clinical−pathological presentation, prognosis, and response to therapy. Epidemiological investigations focusing on the identification of risk factors involved in the onset and progression of TNBCs have identified unique demographic, anthropometric, and reproductive characteristics involved in the etiopathogenesis of this subtype of breast tumors. This systematic review and meta-analysis evaluates the association between TNBCs and obesity and menopause status. Eligible articles were identified through three databases and secondary reference analysis. The search was conducted from the first record to February 2012. Eleven original articles meeting a priori established inclusion criteria were incorporated in the quantitative analysis. Case−case and case–control comparisons were performed. In addition, a case–case comparison was conducted before and after stratification according to menopausal status. Based on the level of between-study heterogeneity, pooled odds ratio (OR) and 95 % confidence interval were calculated using fixed or random models. The case−case comparison showed a significant association between TNBC and obesity (OR: 1.20; 95 % CI: 1.03−1.40). These results were confirmed by the case–control comparison (OR: 1.24; 95 % CI: 1.06−1.46). Once stratification based on menopausal status was applied to the case–case analysis, significant results were observed only in the pre-menopausal group (OR: 1.43; 95 % CI: 1.23−1.65). According to this analysis, obese women are at a greater risk of presenting with a TNBC than non-obese women, and menopause status may be a mitigating factor. If validated, these findings should be taken into consideration for the development of targeted preventive programs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Rakha EA, Ellis IO (2009) Triple-negative/basal-like breast cancer: review. Patholology 41(1):40–47

    Article  Google Scholar 

  2. Elias AD (2010) Triple-negative breast cancer: a short review. Am J Clin Oncol 33(6):637–645

    Article  PubMed  Google Scholar 

  3. Perou C, Jeffrey S, Van de Rijn M et al (1999) Distinctive gene expression patterns in human mammary epithelial cells and breast cancers. Proc Natl Acad Sci 96:9212–9217

    Article  PubMed  CAS  Google Scholar 

  4. Perou C, Sorlie T, Eisen M et al (2000) Molecular portraits of human breast tumours. Nature 406:747–752

    Article  PubMed  CAS  Google Scholar 

  5. Sorlie T, Perou C, Tibshirani R et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci 98:10869–10874

    Article  PubMed  CAS  Google Scholar 

  6. Foulkes WD, Smith IE, Reis-Filho JS (2010) Triple-negative breast cancer. N Engl J Med 363(20):1938–1948

    Article  PubMed  CAS  Google Scholar 

  7. Dent R, Trudeau M, Pritchard KI et al (2007) Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 13(15 Pt 1):4429–4434

    Article  PubMed  Google Scholar 

  8. De Ruijter TC, Veeck J, De Hoon JP et al (2011) Characteristics of triple-negative breast cancer. J Cancer Res Clin Oncol 137(2):183–192

    Article  PubMed  CAS  Google Scholar 

  9. Irvin WJ Jr, Carey LA (2008) What is triple-negative breast cancer? Eur J Cancer 44(18):2799–2805

    Article  PubMed  CAS  Google Scholar 

  10. Bauer KR, Brown M, Cress RD et al (2007) Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer registry. Cancer 109(9):1721–1728

    Article  PubMed  Google Scholar 

  11. Vona-Davis L, Rose DP (2009) The influence of socioeconomic disparities on breast cancer tumor biology and prognosis: a review. J Womens Health (Larchmt) 18(6):883–893

    Article  Google Scholar 

  12. Dawood S (2010) Triple-negative breast cancer: epidemiology and management options. Drugs 70(17):2247–2258

    Article  PubMed  CAS  Google Scholar 

  13. Rose DP, Vona-Davis L (2010) Interaction between menopausal status and obesity in affecting breast cancer risk. Maturitas 66(1):33–38

    Article  PubMed  Google Scholar 

  14. Van den Brandt PA, Spiegelman D, Yaun SS et al (2000) Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol 152(6):514–527

    Article  PubMed  Google Scholar 

  15. Lahmann PH, Hoffmann K, Allen N et al (2004) Body size and breast cancer risk: findings from the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer 111(5):762–771

    Article  PubMed  CAS  Google Scholar 

  16. Rose DP, Vona-Davis L (2009) Influence of obesity on breast cancer receptor status and prognosis. Expert Rev Anticancer Ther 9(8):1091–1101

    Article  PubMed  CAS  Google Scholar 

  17. Phipps AI, Malone KE, Porter PL et al (2008) Body size and risk of luminal, HER2-overexpressing, and triple-negative breast cancer in postmenopausal women. Cancer Epidemiol Biomarkers Prev 17(8):2078–2086

    Article  PubMed  CAS  Google Scholar 

  18. Aronne LJ (2002) Classification of obesity and assessment of obesity-related health risks. Obes Res 10(Suppl 2):105S–115S

    Article  PubMed  Google Scholar 

  19. Guyatt GH, Oxman AD, Vist G et al (2011) GRADE guidelines: 4. rating the quality of evidence-study limitations (risk of bias). J Clin Epidemiol 64(4):407–415

    Article  PubMed  Google Scholar 

  20. Sutton AJ, Abrams KR, Jones DR et al (2000) Methods for meta-analysis in medical research. Wiley series in probability and statistics-applied probability and statistics section. Wiley, Hoboken

    Google Scholar 

  21. Millikan RC, Newman B, Tse CK et al (2008) Epidemiology of basal-like breast cancer. Breast Cancer Res Treat 109(1):123–139

    Article  PubMed  Google Scholar 

  22. Kwan ML, Kushi LH, Weltzien E et al (2009) Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast Cancer Res 11(3):R31

    Article  PubMed  Google Scholar 

  23. Trivers KF, Lund MJ, Porter PL et al (2009) The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control 20(7):1071–1082

    Article  PubMed  Google Scholar 

  24. Gaudet MM, Press MF, Haile RW et al (2011) Risk factors by molecular subtypes of breast cancer across a population-based study of women 56 years or younger. Breast Cancer Res Treat 130(2):587–597

    Article  PubMed  Google Scholar 

  25. Phipps AI, Chlebowski RT, Prentice R et al (2011) Body size, physical activity, and risk of triple-negative and estrogen receptor-positive breast cancer. Cancer Epidemiol Biomarkers Prev 20(3):454–463

    Article  PubMed  CAS  Google Scholar 

  26. Suzuki R, Orsini N, Saji S et al (2009) Body weight and incidence of breast cancer defined by estrogen and progesterone receptor status: a meta-analysis. Int J Cancer 124(3):698–712

    Article  PubMed  CAS  Google Scholar 

  27. Vona-Davis L, Rose DP (2007) Adipokines as endocrine, paracrine, and autocrine factors in breast cancer risk and progression. Endocr Relat Cancer 14(2):189–206

    Article  PubMed  CAS  Google Scholar 

  28. Schäffler A, Schölmerich J, Buechler C (2007) Mechanisms of disease: adipokines and breast cancer-endocrine and paracrine mechanisms that connect adiposity and breast cancer. Nat Clin Pract Endocrinol Metab 3(4):345–354

    Article  PubMed  Google Scholar 

  29. Bulun SE, Chen D, Moy I et al (2012) Aromatase, breast cancer and obesity: a complex interaction. Trends Endocrinol Metab 23(2):83–89

    Article  PubMed  CAS  Google Scholar 

  30. Stephenson GD, Rose DP (2003) Breast cancer and obesity: an update. Nutr Cancer 45(1):1–16

    Article  PubMed  CAS  Google Scholar 

  31. Lorincz AM, Sukumar S (2006) Molecular links between obesity and breast cancer. Endocr Relat Cancer 13(2):279–292

    Article  PubMed  CAS  Google Scholar 

  32. Federico A, Morgillo F, Tuccillo C et al (2007) Chronic inflammation and oxidative stress in human carcinogenesis. Int J Cancer 121(11):2381–2386

    Article  PubMed  CAS  Google Scholar 

  33. Daling JR, Malone KE, Doody DR et al (2001) Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma. Cancer 92(4):720–729

    Article  PubMed  CAS  Google Scholar 

  34. Goodwin PJ, Boyd NF (1990) Body size and breast cancer prognosis: a critical review of the evidence. Breast Cancer Res Treat 16(3):205–214

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  36. Gillespie EF, Sorbero ME, Hanauer DA et al (2010) Obesity and angiolymphatic invasion in primary breast cancer. Ann Surg Oncol 17(3):752–759

    Article  PubMed  Google Scholar 

  37. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  PubMed  CAS  Google Scholar 

  38. Vona-Davis L, Rose DP, Hazard H et al (2008) Triple-negative breast cancer and obesity in a rural Appalachian population. Cancer Epidemiol Biomarkers Prev 17(12):3319–3324

    Article  PubMed  CAS  Google Scholar 

  39. Dolle JM, Daling JR, White E et al (2009) Risk factors for triple-negative breast cancer in women under the age of 45 years. Cancer Epidemiol Biomarkers Prev 18(4):1157–1166

    Article  PubMed  Google Scholar 

  40. Stead LA, Lash TL, Sobieraj JE et al (2009) Triple-negative breast cancers are increased in black women regardless of age or body mass index. Breast Cancer Res 11(2):R18

    Article  PubMed  Google Scholar 

  41. 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. Natl Cancer Inst 103(3):250–263

    Article  Google Scholar 

  42. Lara-Medina F, Pérez-Sánchez V, Saavedra-Pérez D et al (2011) Triple-negative breast cancer in Hispanic patients: high prevalence, poor prognosis, and association with menopausal status, body mass index, and parity. Cancer 117(16):3658–3669

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mariaelena Pierobon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pierobon, M., Frankenfeld, C.L. Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis. Breast Cancer Res Treat 137, 307–314 (2013). https://doi.org/10.1007/s10549-012-2339-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-012-2339-3

Keywords

Navigation