Skip to main content

Advertisement

Log in

The Impact of Obesity on Breast Cancer: A Retrospective Review

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Obesity has been linked to many adverse health consequences, including breast cancer; however, the impact on clinical presentation, tumor characteristics, and survival outcomes has yet to be clearly defined.

Methods

Retrospective review of a prospectively collected database of patients treated at a single institution for invasive breast cancer from 2000–2008 comparing two groups: nonobese (body mass index of <30) and obese (body mass index of ≥30) patients. Continuous variables, categorical variables, and survival data were analyzed.

Results

Of 1352 total patients, 76% were classified as nonobese and 24% were obese. When comparing age, obese patients presented less frequently than nonobese patients <50 years old (10% vs. 90%), and when comparing patients >50 years old (18% vs. 82%, P = 0.0019). Obese patients were more likely to present with disease detected by imaging when compared to nonobese patients (67% vs. 56%, P = 0.0006). Obese patients had larger tumors (1.7 cm vs. 1.4 cm, P < 0.001) and higher rates of lymph node (LN) metastases (31% vs. 25%, P = 0.026). On multivariate analysis, obesity was associated with nonpalpable tumors, larger tumors, a higher incidence of LN metastasis, lower incidence of Her2 positivity, lower incidence of multifocality, and less likely to undergo reconstruction after mastectomy.

Conclusions

Obese patients clinically present at older ages with mammographically detected breast cancer at more advanced stages than nonobese patients. Strategies to encourage screening among the obese patient population are important.

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.

Fig. 1

Similar content being viewed by others

References

  1. Jernal A, Siegel R, Ward E, et al. Cancer Statistics 2008. CA Cancer J Clin. 2008;58:71–96.

    Article  Google Scholar 

  2. Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/data/trends.html.

  3. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States 2000. JAMA. 2004;291:1238–45.

    Article  PubMed  Google Scholar 

  4. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: actual causes of death in the United States 2000. JAMA. 2005;293:293–4.

    Article  PubMed  CAS  Google Scholar 

  5. Calle EE, Rodriguez C, Walker-Thurmod K, Thun MJ. Overweight, obesity, and mortality from cancer in a retrospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–38.

    Article  PubMed  Google Scholar 

  6. Guh DP, Zhang W, Bansback N, Amarsi Z, Birminghas 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.

    Article  PubMed  Google Scholar 

  7. Cleary MP, Maihle NJ. The role of body mass index in the relative risk of developing premenopausal versus postmenopausal breast cancer. Proc Soc Exp Biol Med. 1997;216:28–43.

    PubMed  CAS  Google Scholar 

  8. Harvie M, Hooper L, Howell AH. Central obesity and breast cancer risk: a systematic review. Obes Rev. 2003;4:157–73.

    Article  PubMed  CAS  Google Scholar 

  9. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ. 2007;335(7630):1134.

    Article  PubMed  Google Scholar 

  10. Carmichael AR, Bates T. Obesity and breast cancer: a review of the literature. Breast. 2004;13:85–92.

    Article  PubMed  CAS  Google Scholar 

  11. Cui Y, Whiteman MK, Flaws JA, Langenberg P, Tkaczuk KH, Bush TL. Body mass and stage of breast cancer at diagnosis. Int J Cancer. 2002;98:279–83.

    Article  PubMed  CAS  Google Scholar 

  12. Majed B, Moreau T, Senouci K, Salmon RJ, Fourquet A, Asselain B. Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat. 2008;111:329–42.

    Article  PubMed  Google Scholar 

  13. Carmichael AR. Obesity as a risk factor for development and poor prognosis of breast cancer. BJOG. 2006;113:1160–6.

    Article  PubMed  CAS  Google Scholar 

  14. Enger SM, Greif JM, Polikoff J, Press M. Body weight correlates with mortality in early stage breast cancer. Arch Surg. 2004;139:954–8.

    Article  PubMed  Google Scholar 

  15. Griggs JJ, Sorbero ME, Lyman GH. Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med. 2005;165:1267–73.

    Article  PubMed  Google Scholar 

  16. Lipscombe LL, Goodwin PJ, Zinman B, McLaughlin JR, Hux JE. The impact of diabetes on survival following breast cancer. Breast Cancer Res Treat. 2008;109:389–95.

    Article  PubMed  Google Scholar 

  17. Rose DP, Komninou D, Stephenson GD. Obesity, adipocytokines, and insulin resistance in breast cancer. Obes Rev. 2004;5:153–65.

    Article  PubMed  CAS  Google Scholar 

  18. Cleary MP, Grossmann ME. Obesity and breast cancer: the estrogen connection. Endocrinology. 2009;150:2537–42.

    Article  PubMed  CAS  Google Scholar 

  19. Daling JR, Malone KE, Doody DR, Johnson LG, Gralow JR, Porter PL. Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma. Cancer. 2001;92:720–9.

    Article  PubMed  CAS  Google Scholar 

  20. Phipps AI, Malone KE, Porter PL, Daling JR, Li CI. Body size and risk of luminal, HER2-overexpressing, and triple-negative breast cancer in postmenopausal women. Cancer Epidemiol Biomarkers Prev. 2008;17:2078–86.

    Article  PubMed  CAS  Google Scholar 

  21. Vona-Davis L, Rose DP, Hazard H, et al. Triple-negative breast cancer and obesity in a rural Appalachian population. Cancer Epidemiol Biomarkers Prev. 2008;17:3319–24.

    Article  PubMed  CAS  Google Scholar 

  22. Feigelson HS, Patel AV, Teras LR, Gansler TS, Thun MJ, Calle EE. Adult weight gain and histopathologic characteristics of breast cancer among postmenopausal women. Cancer. 2006;107:12–21.

    Article  PubMed  Google Scholar 

  23. Gillespie EF, Sorbero ME, Hanauer DA, et al. Obesity and angiolymphatic invasion in primary breast cancer. Ann Surg Oncol. 2010;17:752–9.

    Article  PubMed  Google Scholar 

  24. Deglise C, Bouchardy C, Burri M, et al. Impact of obesity on the diagnosis and treatment of breast cancer. Breast Cancer Res Treat. 2010;120:185–93.

    Article  PubMed  Google Scholar 

  25. Suzuki R, Rylander-Rudqvist T, Ye W, Saji S, Wolk A. Body weight and postmenopausal breast cancer risk defined by estrogen and progesterone receptor status among Swedish women: a prospective cohort study. Int J Cancer. 2006;119:1683–9.

    Article  PubMed  CAS  Google Scholar 

  26. Colditz GA, Rosner BA, Chen WY, Homes MD, Hankinson SE. Risk factors for breast cancer according to estrogen and progesterone receptor status. J Natl Cancer Inst. 2004;96:218–28.

    Article  PubMed  CAS  Google Scholar 

  27. National Heart Lung and Blood Institute. http://nhlbisupport.com/bmi/.

  28. Kaplan E, Meier P. Nonparametric estimation from incomplete observations. Am Stat Assoc J. 1958;(June):457–81.

  29. Bouchardy C, Le MG, Hill C. Risk factors for breast cancer according to age at diagnosis in a French case-control study. J Clin Epidemiol. 1990;43:267–75.

    Article  PubMed  CAS  Google Scholar 

  30. Rose DP, Vona-Davis L. Interaction between menopausal status and obesity in affecting breast cancer risk. Maturitas. 2010;66:33–8.

    Article  PubMed  Google Scholar 

  31. Shields M, Carrol MD, Ogden CL. Adult obesity prevalence in Canada and the United States. NCHS Data Brief. 2011;(56):1–8.

  32. Pisano ED, Hendrick E, Gatsonis CA, et al. Diagnostic accuracy of digital vs film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology. 2008;246:376–83.

    Article  PubMed  Google Scholar 

  33. Cohen SS, Palmieri RT, Nyante SJ, et al. Obesity and screening for breast, cervical, and colorectal cancer in women. Cancer. 2008;112:1892–904.

    Article  PubMed  Google Scholar 

  34. Maruthur NM, Bolen S, Brancati FL, Clark JM. Obesity and mammography: a systematic review and meta-analysis. J Gen Intern Med. 2009;24:665–77.

    Article  PubMed  Google Scholar 

  35. Berclas G, Li S, Price KN, et al.; International Breast Cancer Study Group. Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol. 2004;15:875–84.

    Article  Google Scholar 

  36. Arndt V, Sturmer T, Stegmaier C, Ziegler H, Dhom G, Brenner H. Patient delay and stage of diagnosis among breast cancer patients in Germany—a population based study. Br J Cancer. 2002;86:1034–40.

    Article  PubMed  CAS  Google Scholar 

  37. Olson CL, Schumaker HD, Yawn BP. Overweight women delay medical care. Arch Fam Med. 1994;3:888–92.

    Article  PubMed  CAS  Google Scholar 

  38. Fontaine KR, Faith MS, Allison DB, Cheskin LJ. Body weight and health care among women in the general population. Arch Fam Med. 1998;7:381–4.

    Article  PubMed  CAS  Google Scholar 

  39. Fiorio E, Mercanti A, Terrasi M, et al. Leptin/HER2 crosstalk in breast cancer: in vitro study and preliminary in vivo analysis. BMC Cancer. 2008;8:305.

    Article  PubMed  Google Scholar 

  40. Pollak MN, Schernhammer ES, Hankinson SE. Insulin-like growth factors and neoplasia. Nat Rev Cancer. 2004;4:505–18.

    Article  PubMed  CAS  Google Scholar 

  41. Schernhammer ES, Holly JM, Hunter DJ, Pollak MN, Hankinson SE. Insulin-like growth factor-I, its binding proteins (IGFBP-1 and IGFBP-3), and growth hormone and breast cancer risk in the Nurses Health Study II. Endocr Relat Cancer. 2006;13:583–92.

    Article  PubMed  CAS  Google Scholar 

  42. Ryan PD, Goss PE. The emerging role of the insulin-like growth factor pathway as a therapeutic target in cancer. Oncologist. 2008;13:16–24.

    Article  PubMed  CAS  Google Scholar 

  43. Goodwin PJ, Ligibel JA, Stambolic V. Metformin in breast cancer: time for action. J Clin Oncol. 2009;27:3271–3.

    Article  PubMed  CAS  Google Scholar 

  44. Ejlertsen B, Jensen MB, Rank F, et al. Population-based study of peritumoral lymphovascular invasion and outcome among patients with operable breast cancer. J Natl Cancer Inst. 2009;101:729–35.

    Article  PubMed  Google Scholar 

  45. Dhakal HP, Naume B, Synnestvedt M, et al. Vascularization in primary breast carcinomas: its prognostic significance and relationship with tumor cell dissemination. Clin Cancer Res. 2008;14:2341–50.

    Article  PubMed  CAS  Google Scholar 

  46. Garvey PB, Buchel EW, Pockaj BA, Gray RJ, Samson TD. The deep inferior epigastric perforator flap for breast reconstruction in overweight and obese patients. Plast Reconstr Surg. 2005;115:447–57.

    Article  PubMed  Google Scholar 

  47. Forouhi P, Dixon JM, Leonard RC, Chetty U. Prospective randomized study of surgical morbidity following primary systemic therapy for breast cancer. Br J Surg. 1995;82:79–82.

    Article  PubMed  CAS  Google Scholar 

  48. Vilar-Compte D, Jacquemin B, Robles-Vidal C, Volkow P. Surgical site infections in breast surgery: case-control study. World J Surg. 2004;28:242–6.

    Article  PubMed  Google Scholar 

  49. McCarthy CM, Mehrara BJ, Riedel E, et al. Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg. 2008;121:1886–92.

    Article  PubMed  CAS  Google Scholar 

  50. Bozikov K, Arnez T, Hertl K, Arnez ZM. Fat necrosis in free DIEP flaps: incidence, risk, and predictor factors. Ann Plast Surg. 2009;63:138–42.

    Article  PubMed  CAS  Google Scholar 

  51. Spear SL, Ducic I, Cuoco F, Taylor N. Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction. Plast Reconstr Surg. 2007;119:788–95.

    Article  PubMed  CAS  Google Scholar 

  52. Litton JK, Gonzalez-Angulo AM, Warneke CL, et al. Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol. 2008;26:4072–7.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

There are no disclosures for any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Barbara Pockaj MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haakinson, D.J., Leeds, S.G., Dueck, A.C. et al. The Impact of Obesity on Breast Cancer: A Retrospective Review. Ann Surg Oncol 19, 3012–3018 (2012). https://doi.org/10.1245/s10434-012-2320-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2320-8

Keywords

Navigation