Weight gain prior to entry into a weight-loss intervention study among overweight and obese breast cancer survivors
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Changes in cancer therapy, in addition to changes in obesity prevalence, suggest the need for a current assessment of weight gain patterns following breast cancer diagnosis. The aim of this study was to evaluate factors associated with weight gain among breast cancer survivors prior to enrolling into a behavioral weight loss intervention.
Anthropometric measures and data on weight-related factors were collected at baseline on 665 breast cancer survivors. Postdiagnosis weight gain was determined between entry into the trial and previous diagnosis up to 5 years. Multivariate logistic regression analyses were used to evaluate the association between weight gain and influencing factors.
The mean weight gain was 4.5 % body weight (standard deviation = 10.6); 44 % of women experienced ≥5 % body weight gain. The risk of weight gain was inversely associated with age (adjusted odds ratio (ORadj) = 0.97, 95 % confidence interval (95 % CI) 0.95–0.99), Hispanic ethnicity (ORadj = 0.30, 95 % CI 0.13–0.68), and overweight (ORadj = 0.11, 95 % CI 0.05–0.23) or obese (ORadj = 0.03, 95 % CI 0.02–0.07) status at diagnosis and positively associated with time elapsed since diagnosis (ORadj = 1.19/year, 95 % CI 1.04–1.36). Women prescribed aromatase inhibitors were 46 % less likely to gain weight compared to women prescribed selective estrogen-receptor modulators (ORadj = 0.54, 95 % CI 0.31–0.93). The risk of weight gain was positively associated with smoking at diagnosis (ORadj = 2.69, 95 % CI 1.12–6.49) although this was attributable to women who subsequently quit smoking.
Postdiagnosis weight gain is common and complex and influenced by age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy.
Implications for cancer survivors
Weight gain continues to be a concern following a diagnosis of breast cancer. Factors influencing this weight gain include age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy. Effective weight management strategies are needed for this population of women.
- Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123:627–35. CrossRef
- Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol. 2005;23:1370–8. CrossRef
- Caan BJ, Emond JA, Natarajan L, Castillo A, Gunderson EP, Habel L, et al. Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer. Breast Cancer Res Treat. 2006;99:47–57. CrossRef
- Caan BJ, Kwan ML, Hartzell G, Castillo A, Slattery ML, Sternfeld B, et al. Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control. 2008;19:1319–28. CrossRef
- Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, et al. Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev. 2009;18:1403–9. CrossRef
- Caan BJ, Kwan ML, Shu XO, Pierce JP, Patterson RE, Nechuta SJ, et al. Weight change and survival after breast cancer in the After Breast Cancer Pooling Project. Cancer Epidemiol Biomarkers Prev. 2012;21:1260–71. CrossRef
- Su HI, Sammel MD, Springer E, Freeman EW, DeMichele A, Mao JJ. Weight gain is associated with increased risk of hot flashes in breast cancer survivors on aromatase inhibitors. Breast Cancer Res Treat. 2010;124:205–11. CrossRef
- Caan BJ, Emond JA, Su HI, Patterson RE, Flatt SW, Gold EB, et al. Effect of postdiagnosis weight change on hot flash status among early-stage breast cancer survivors. J Clin Oncol. 2012;30:1492–7. CrossRef
- Forsythe LP, Alfano CM, George SM, McTiernan A, Baumgartner KB, Bernstein L, et al. Pain in long-term breast cancer survivors: the role of body mass index, physical activity, and sedentary behavior. Breast Cancer Res Treat. 2013;137:617–30. CrossRef
- Imayama I, Alfano CM, Neuhouser ML, George SM, Wilder Smith A, Baumgartner RN, et al. Weight, inflammation, cancer-related symptoms and health-related quality of life among breast cancer survivors. Breast Cancer Res Treat. 2013;140:159–76. CrossRef
- Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78. CrossRef
- Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2010. JAMA. 2010;303:235–41. CrossRef
- Vance V, Mourtzakis M, McCargar L, Hanning R. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12:282–94. CrossRef
- Demark-Wahnefried W, Rimer BK, Winer EP. Weight gain in women diagnosis with breast cancer. J Am Diet Assoc. 1997;97:519–29. CrossRef
- Rock CL, Flatt SW, Newman V, Caan BJ, Haan MN, Stefanick ML, et al. Factors associated with weight gain in women after diagnosis of breast cancer. J Am Diet Assoc. 1999;99:1212–21. CrossRef
- Goodwin P, Ennis M, Pritchard K, McCready D, Koo J, Sidlofsky S, et al. Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol. 1999;17:120–9.
- Rock CL, Byers TE, Colditz GA, Demark-Wahnefried W, Ganz P, Wolin KY, et al. Reducing breast cancer recurrence with weight loss, a vanguard trial: the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) Trial. Contemp Clin Trials. 2013;34:282–95. CrossRef
- Klein S, Burke LE, Bray GA, Blair S, Allison DB, Pi-Sunyer X, et al. Clinical implications of obesity with specific focus on cardiovascular disease. A statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2004;110:2952–67. CrossRef
- Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2006;56:323–53. CrossRef
- American Diabetes Association Task Force for Writing Nutrition Principles and Recommendations for the management of diabetes: American Diabetes Association position statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. J Am Diet Assoc. 2002;102;109–18.
- Saquib N, Flatt SW, Natarajan L, Thomson CA, Bardwell WA, Caan B, et al. 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. 2007;105:177–86. CrossRef
- Sedjo RL, Hines LM, Byers T, Giuliano AR, Marcus A, Vadaparampil S, et al. Long-term weight gain among Hispanic and non-Hispanic White women with and without breast cancer. Nutr Cancer. 2013;65:34–42. CrossRef
- Travier N, Agudo A, May AM, Gonzalez C, Luan J, Wareham NJ, et al. Longitudinal changes in weight in relation to smoking cessation in participants of the EPIC-PANACEA study. Prev Med. 2012;54:183–92. CrossRef
- Williamson DF, Madans J, Anda RF, Kleinman JC, Giovino GA, Byers T. Smoking cessation and severity of weight gain in a national cohort. NEJM. 1991;324:739–45. CrossRef
- Basterra-Cortari FJ, Forga L, Bes-Rastrollo M, Toledo E, Martinez JA, Martinex-Gonzalez MA. Effects of smoking on body weight: longitudinal analysis of the SUN cohort. Rev Esp Cardiol. 2010;63:20–7. CrossRef
- Luo J, Rossouw J, Margolis KL. Smoking cessation, weight change, and coronary heart disease among postmenopausal women with and without diabetes. JAMA. 2013;310(1):94–6. doi:10.1001/jama.2013.6871. CrossRef
- Gu K, Chen X, Zhen Y, Chen Z, Zheng W, Lu W, et al. Weight change patterns among breast cancer survivors: results from the Shanghai breast cancer survival study. Cancer Causes Control. 2010;21(4):621–9. CrossRef
- Han HS, Lee KW, Kim JH, Kim SW, Kim IA, Oh DY, et al. Weight changes after adjuvant treatment in Korean women with early breast cancer. Breast Cancer Res Treat. 2009;114:147–53. CrossRef
- Chen X, Lu W, Gu K, Chen Z, Zheng Y, Zheng W, et al. Weight change and its correlates among breast cancer survivors. Nutr Cancer. 2011;63:538–48. CrossRef
- Yaw WH, Shariff ZM, Kaniah M, Mun CY, Yusof RM, Othman Z, et al. Weight changes and lifestyle behaviors in women after breast cancer diagnosis: a cross-sectional study. BMC Public Health. 2011;11:309–18. CrossRef
- Trédan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, et al. Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr. 2010;29:187–91. CrossRef
- Reddy S, Sadim M, Li J, Yi N, Agarwal S, Mantzoroas CS, et al. Clinical and genetic predictors of weight gain in patients diagnosed with breast cancer. Br J Cancer. 2013;109:872–81. CrossRef
- Wing RR. Obesity and weight gain during adulthood: a health problem for United States women. WHI. 1992;2:114–22.
- Colditz GA, Willett WC, Stampfer MJ, London SJ, Segal MR, Speizer FE. Patterns of weight change and their relations to diet in a cohort of healthy women. Am J Clin Nutr. 1990;51:1100–5.
- Brown WJ, Williams L, Ford JH, Ball K, Dobson AJ. Identifying the energy gap: magnitude and determinants of 5-year weigh gain in midage women. Obes Res. 2005;13:1431–44. CrossRef
- Irwin ML, McTiernan A, Baumgartener R, Bumgartener KB, Bernstein L, Gilliland FD, et al. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognastic, and lifestyle factors. J Clin Oncol. 2005;23:774–82. CrossRef
- Theriault RL, Carlson RW, Anderson BO, Burstein HJ, Edge SB, Farrar WB, et al. Breast cancer. National Comprehensive Cancer Network Guidelines, version 3.2013. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (Accessed: 10/23/2013)
- Filozof C, Pinilla CF, Fernández-Cruz A. Smoking cessation and weight gain. Obes Rev. 2004;5:95–103. CrossRef
- Makari-Judson G, Judson CH, Mertens WC. Longitudinal patterns of weight gain after breast cancer diagnosis: observations beyond the first year. Breast J. 2007;13(3):258–65. CrossRef
- Heideman WH, Russell NS, Gundy C, Rookus MA, Voskuil DW. The frequency, magnitude and timing of post-diagnosis body weight gain in Dutch breast cancer survivors. Eur J Cancer. 2009;45:119–26. CrossRef
- Freedman RJ, Aziz N, Albanes D, Hartman T, Danforth D, Hill S, et al. Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab. 2004;89:2248–53. CrossRef
- The ATAC (Arimidex, Tamoxifen Alone or in Combination) Trialists’ Group. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet. 2002;359:2131–9. CrossRef
- Francini G, Petrioli R, Montagnani A, Cadirni A, Campagna S, Francini E, et al. Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids. Br J Cancer. 2006;95:153–8. CrossRef
- Petrek JA, Naughton MJ, Case LD, Paskett ED, Naftalis EZ, Singletary SE, et al. Incidence, time course, and determinates of menstrual bleeding after breast cancer treatment: a prospective study. J Clin Oncol. 2006;24:1045–51. CrossRef
- Partridge A, Gelber S, Gelber RD, Castiglione-Gertsch M, Goldhirsch A, Winer E. Age of menopause among women who remain premenopausal following treatment for early breast cancer: long-term results from International Breast Cancer Study Group Trials V and VI. Eur J Cancer. 2007;43:1646–53. CrossRef
- Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62:220–41. CrossRef
- Lin CJ, Deroo LA, Jacobs SR, Sandler DP. Accuracy and reliability of self-reported weight and height in the Sister Study. Public Health Nutr. 2011;9:1–11.
- Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88–108. doi:10.1186/1471-2458-9-88. CrossRef
- Pi-Sunyer X. The medical risks of obesity. Postgrad Med. 2009;121:21–33. CrossRef
- World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007.
- Weight gain prior to entry into a weight-loss intervention study among overweight and obese breast cancer survivors
Journal of Cancer Survivorship
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Breast cancer survivors
- Weight gain
- Industry Sectors
- Author Affiliations
- 1. Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Place, MS F519, Aurora, CO, 80045, USA
- 2. Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO, 80045, USA
- 3. Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA
- 4. Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, Saint Louis, MO, 63110, USA
- 5. University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Avenue, Birmingham, AL, 35294, USA
- 6. Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave, Maywood, IL, 60153, USA
- 7. Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, 348 Webb, Birmingham, AL, 35294, USA
- 8. Department of Family and Preventive Medicine, School of Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA