Breast Cancer Research and Treatment

, Volume 122, Issue 3, pp 823–833 | Cite as

Obesity and weight change in relation to breast cancer survival

  • Xiaoli Chen
  • Wei Lu
  • Wei Zheng
  • Kai Gu
  • Zhi Chen
  • Ying Zheng
  • Xiao Ou Shu
Epidemiology

Abstract

The authors evaluated the prognostic effects of obesity and weight change after breast cancer diagnosis. A total of 5042 breast cancer patients aged 20–75 were identified through the population-based Shanghai Cancer Registry approximately 6 months after cancer diagnosis and recruited into the study between 2002 and 2006. Participants were followed by in-person interviews supplemented by record linkage with the Shanghai Vital Statistics Registry database. Anthropometric measurements were taken, and information on sociodemographic, clinical, and lifestyle factors was collected through in-person interviews. During the median follow-up of 46 months, 442 deaths and 534 relapses/breast cancer-specific deaths were documented. Women with body mass index (BMI) ≥30 at diagnosis had higher mortality than women with 18.5 ≤ BMI < 25; the multivariate-adjusted hazard ratios (HRs) were 1.55 (95% confidence interval (95% CI): 1.10–2.17) for total mortality and 1.44 (95% CI: 1.02–2.03) for relapse/disease-specific mortality. Similar results were found for pre- and post-diagnostic obesity. Women who gained ≥5 kg or lost >1 kg had higher mortality than those who maintained their weight. No association was observed between waist-to-hip ratio and mortality. Our study suggests that obesity and weight change after diagnosis are inversely associated with breast cancer prognosis. Weight control is important among women with breast cancer.

Keywords

Body mass index Central obesity Weight change Breast cancer Survival 

References

  1. 1.
    World Health Organization (2009) Programmes and projects. Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 28 Feb 2009
  2. 2.
    Renehan AG, Tyson M, Egger M et al (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578CrossRefPubMedGoogle Scholar
  3. 3.
    Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA A Cancer J Clin 58:71–96CrossRefGoogle Scholar
  4. 4.
    American Cancer Society (2007–2008) Breast cancer facts & figures. American Cancer Society, Inc, AtlantaGoogle Scholar
  5. 5.
    Goodwin PJ, Ennis M, Pritchard KI et al (1999) Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol 17:120–129PubMedGoogle Scholar
  6. 6.
    Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20:1128–1143CrossRefPubMedGoogle Scholar
  7. 7.
    Whiteman MK, Hillis SD, Curtis KM et al (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 14:2009–2014CrossRefPubMedGoogle Scholar
  8. 8.
    Zhang S, Folsom AR, Sellers TA et al (1995) Better breast cancer survival for postmenopausal women who are less overweight and eat less fat: Iowa women’s health study. Cancer 76:275–283CrossRefPubMedGoogle Scholar
  9. 9.
    Dal Maso L, Zucchetto A, Talamini R et al (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123:2188–2194CrossRefPubMedGoogle Scholar
  10. 10.
    Irwin ML, McTiernan A, Baumgartner RN et al (2005) Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol 23:774–782CrossRefPubMedGoogle Scholar
  11. 11.
    Rock CL, Demark-Wahnefried W (2002) Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 20:3302–3316CrossRefPubMedGoogle Scholar
  12. 12.
    Tao MH, Shu XO, Ruan ZX et al (2006) Association of overweight with breast cancer survival. Am J Epidemiol 163:101–107CrossRefPubMedGoogle Scholar
  13. 13.
    Reeves GK, Pirie K, Beral V et al (2007) Cancer incidence and mortality in relation to body mass index in the million women study: cohort study. BMJ 335:1134CrossRefPubMedGoogle Scholar
  14. 14.
    Goodwin PJ, Ennis M, Pritchard KI et al (2002) Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 20:42–51CrossRefPubMedGoogle Scholar
  15. 15.
    Kumar NB, Cantor A, Allen K et al (2000) Android obesity at diagnosis and breast carcinoma survival: evaluation of the effects of anthropometric variables at diagnosis, including body composition and body fat distribution and weight gain during life span, and survival from breast carcinoma. Cancer 88:2751–2757CrossRefPubMedGoogle Scholar
  16. 16.
    Bastarrachea J, Hortobagyi GN, Smith TL et al (1994) Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer. Ann Intern Med 120:18–25PubMedGoogle Scholar
  17. 17.
    Newman SC, Lees AW, Jenkins HJ (1997) The effect of body mass index and oestrogen receptor level on survival of breast cancer patients. Int J Epidemiol 26:484–490CrossRefPubMedGoogle Scholar
  18. 18.
    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 92:720–729CrossRefPubMedGoogle Scholar
  19. 19.
    Suissa S, Pollak M, Spitzer WO et al (1989) Body size and breast cancer prognosis: a statistical explanation of the discrepancies. Cancer Res 49:3113–3116PubMedGoogle Scholar
  20. 20.
    Kroenke CH, Chen WY, Rosner B et al (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23:1370–1378CrossRefPubMedGoogle Scholar
  21. 21.
    Majed B, Moreau T, Senouci K et al (2008) Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 111:329–342CrossRefPubMedGoogle Scholar
  22. 22.
    Loi S, Milne RL, Friedlander ML et al (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14:1686–1691CrossRefPubMedGoogle Scholar
  23. 23.
    Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7:333–340CrossRefPubMedGoogle Scholar
  24. 24.
    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 26:4072–4077CrossRefPubMedGoogle Scholar
  25. 25.
    Nichols HB, Trentham-Dietz A, Egan KM et al (2009) Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev 18:1403–1409 CrossRefPubMedGoogle Scholar
  26. 26.
    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 17:3319–3324CrossRefPubMedGoogle Scholar
  27. 27.
    Obermair A, Kurz C, Hanzal E et al (1995) The influence of obesity on the disease-free survival in primary breast cancer. Anticancer Res 15:2265–2269PubMedGoogle Scholar
  28. 28.
    Dignam JJ, Wieand K, Johnson KA et al (2003) Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst 95:1467–1476PubMedGoogle Scholar
  29. 29.
    den Tonkelaar I, de Waard F, Seidell JC et al (1995) Obesity and subcutaneous fat patterning in relation to survival of postmenopausal breast cancer patients participating in the DOM-project. Breast Cancer Res Treat 34:129–137CrossRefGoogle Scholar
  30. 30.
    Katoh A, Watzlaf VJ, D’Amico F (1994) An examination of obesity and breast cancer survival in post-menopausal women. Br J Cancer 70:928–933PubMedGoogle Scholar
  31. 31.
    Sohrabi A, Sandoz J, Spratt JS et al (1980) Recurrence of breast cancer. Obesity, tumor size, and axillary lymph node metastases. JAMA 244:264–265CrossRefPubMedGoogle Scholar
  32. 32.
    Marret H, Perrotin F, Bougnoux P et al (2001) Low body mass index is an independent predictive factor of local recurrence after conservative treatment for breast cancer. Breast Cancer Res Treat 66:17–23CrossRefPubMedGoogle Scholar
  33. 33.
    Rosenberg L, Czene K, Hall P (2009) Obesity and poor breast cancer prognosis: an illusion because of hormone replacement therapy? Br J Cancer 100:1486–1491CrossRefPubMedGoogle Scholar
  34. 34.
    Borugian MJ, Sheps SB, Kim-Sing C et al (2003) Waist-to-hip ratio and breast cancer mortality. Am J Epidemiol 158:963–968CrossRefPubMedGoogle Scholar
  35. 35.
    Abrahamson PE, Gammon MD, Lund MJ et al (2006) General and abdominal obesity and survival among young women with breast cancer. Cancer Epidemiol Biomarkers Prev 15:1871–1877CrossRefPubMedGoogle Scholar
  36. 36.
    Camoriano JK, Loprinzi CL, Ingle JN et al (1990) Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. J Clin Oncol 8:1327–1334PubMedGoogle Scholar
  37. 37.
    Levine EG, Raczynski JM, Carpenter JT (1991) Weight gain with breast cancer adjuvant treatment. Cancer 67:1954–1959CrossRefPubMedGoogle Scholar
  38. 38.
    Caan BJ, Kwan ML, Hartzell G et al (2008) Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control 19:1319–1328CrossRefPubMedGoogle Scholar
  39. 39.
    Dawood S, Broglio K, Gonzalez-Angulo AM et al (2008) Prognostic value of body mass index in locally advanced breast cancer. Clin Cancer Res 14:1718–1725CrossRefPubMedGoogle Scholar
  40. 40.
    Ahern TP, Lash TL, Thwin SS et al (2009) Impact of acquired comorbidities on all-cause mortality rates among older breast cancer survivors. Med Care 47:73–79CrossRefPubMedGoogle Scholar
  41. 41.
    Boyapati SM, Shu XO, Ruan ZX et al (2005) Soyfood intake and breast cancer survival: a followup of the Shanghai Breast Cancer Study. Breast Cancer Res Treat 92:11–17CrossRefPubMedGoogle Scholar
  42. 42.
    Yang YX, Wang GY, Pan XC (eds) (2002) China food composition 2002. Peking University Medical Press, BeijingGoogle Scholar
  43. 43.
    Grunau GL, Sheps S, Goldner EM et al (2006) Specific comorbidity risk adjustment was a better predictor of 5-year acute myocardial infarction mortality than general methods. J Clin Epidemiol 59:274–280CrossRefPubMedGoogle Scholar
  44. 44.
    Department of Health and Human Services (1998) The international classification of diseases, 9th rev edn, Clinical modification: ICD-9-CM. U.S Government Printing Office, Washington, DCGoogle Scholar
  45. 45.
    Korn EL, Graubard BI, Midthune D (1997) Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 145:72–80PubMedGoogle Scholar
  46. 46.
    World Health Organization (1997) Obesity: preventing and managing the global epidemic. Report of a WHO consultation of obesity. Geneva, 3–5 June, 1997Google Scholar
  47. 47.
    Cleveland RJ, Eng SM, Abrahamson PE et al (2007) Weight gain prior to diagnosis and survival from breast cancer. Cancer Epidemiol Biomarkers Prev 16:1803–1811CrossRefPubMedGoogle Scholar
  48. 48.
    Maehle BO, Tretli S, Thorsen T (2004) The associations of obesity, lymph node status and prognosis in breast cancer patients: dependence on estrogen and progesterone receptor status. APMIS 112:349–357CrossRefPubMedGoogle Scholar
  49. 49.
    Maehle BO, Tretli S (1996) Pre-morbid body-mass-index in breast cancer: reversed effect on survival in hormone receptor negative patients. Breast Cancer Res Treat 41:123–130CrossRefPubMedGoogle Scholar
  50. 50.
    Renehan AG, Frystyk J, Flyvbjerg A (2006) Obesity and cancer risk: the role of the insulin-IGF axis. Trends Endocrinol Metab 17:328–336CrossRefPubMedGoogle Scholar
  51. 51.
    McTiernan A, Rajan KB, Tworoger SS et al (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 21:1961–1966CrossRefPubMedGoogle Scholar
  52. 52.
    Kaye SA, Folsom AR, Soler JT et al (1991) Associations of body mass and fat distribution with sex hormone concentrations in postmenopausal women. Int J Epidemiol 20:151–156CrossRefPubMedGoogle Scholar
  53. 53.
    Yu H, Rohan T (2000) Role of the insulin-like growth factor family in cancer development and progression. J Natl Cancer Inst 92:1472–1489CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Xiaoli Chen
    • 1
  • Wei Lu
    • 2
  • Wei Zheng
    • 1
  • Kai Gu
    • 2
  • Zhi Chen
    • 1
  • Ying Zheng
    • 2
  • Xiao Ou Shu
    • 1
  1. 1.Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer CenterVanderbilt University Medical CenterNashvilleUSA
  2. 2.Shanghai Institute of Preventive MedicineShanghaiChina

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