Breast Cancer Research and Treatment

, Volume 146, Issue 3, pp 647–655 | Cite as

Central adiposity after breast cancer diagnosis is related to mortality in the Health, Eating, Activity, and Lifestyle study

  • Stephanie M. George
  • Leslie Bernstein
  • Ashley W. Smith
  • Marian L. Neuhouser
  • Kathy B. Baumgartner
  • Richard N. Baumgartner
  • Rachel Ballard-Barbash


We examined whether waist circumference (WC) and waist-to-hip ratio (WHR) after breast cancer diagnosis are associated with all-cause or breast cancer-specific mortality and explored potential biological pathways mediating these relationships. Our analysis included 621 women diagnosed with local or regional breast cancer who participated in the Health, Eating, Activity, and Lifestyle study. At 30 (±4) months postdiagnosis, trained staff measured participants’ waist and hip circumferences and obtained fasting serum samples for biomarker assays for assays of insulin, glucose, C-peptide, insulin growth factor-1 and binding protein-3, C-reactive protein (CRP), and adiponectin. We estimated multivariate hazard ratios (HR) and 95 % confidence intervals (CI) for death over ~9.5 years of follow-up. After adjustment for measured body mass index, treatment, comorbidities, race/ethnicity, diet quality, and postdiagnosis physical activity, WC was positively associated with all-cause mortality (HRq4:q1: 2.99, 95 % CI 1.14, 7.86) but its positive association with breast cancer-specific mortality was not statistically significant (HRq4:q1: 2.69, 95 % CI 0.69, 12.01). WHR was positively associated with all-cause mortality (HRq4:q1: 2.10, 95 % CI 1.08, 4.05) and breast cancer-specific mortality (HRq4:q1: 4.02, 95 % CI 1.31, 12.31). After adjustment for homeostatic model assessment (HOMA) score and C-reactive protein, risk estimates were attenuated and not statistically significant. In this diverse breast cancer survivor cohort, postdiagnosis WC and WHR were associated with all-cause mortality. Insulin resistance and inflammation may mediate the effects of central adiposity on mortality among breast cancer patients.


Central obesity Breast cancer Mortality Insulin resistance Inflammation 



We would like to thank Dr. Charles L. Wiggins, Dr. Anne McTiernan, Anita Ambs, HEAL study managers, Todd Gibson of Information Management Systems, and the HEAL study participants. This study was supported by the National Cancer Institute Grants N01-CN-75036-20, NO1-CN-05228, NO1-PC-67010, and, in part, by the Applied Research Program of the National Cancer Institute.

Conflict of interest

The authors have no conflicts of interest to report.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Stephanie M. George
    • 1
    • 5
  • Leslie Bernstein
    • 2
  • Ashley W. Smith
    • 1
  • Marian L. Neuhouser
    • 3
  • Kathy B. Baumgartner
    • 4
  • Richard N. Baumgartner
    • 4
  • Rachel Ballard-Barbash
    • 1
  1. 1.Applied Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleUSA
  2. 2.Department of Population SciencesCity of Hope Medical Center and Beckman Research InstituteDuarteUSA
  3. 3.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.Department of Epidemiology and Population Health, James Graham Brown Cancer CenterUniversity of LouisvilleLouisvilleUSA
  5. 5.BethesdaUSA

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