Cancer Causes & Control

, Volume 24, Issue 2, pp 305–312 | Cite as

Body mass index, tumor characteristics, and prognosis following diagnosis of early-stage breast cancer in a mammographically screened population

  • Aruna Kamineni
  • Melissa L. Anderson
  • Emily White
  • Stephen H. Taplin
  • Peggy Porter
  • Rachel Ballard-Barbash
  • Kathleen Malone
  • Diana S. M. Buist
Original paper

Abstract

Purpose

Many studies suggest increased body mass index (BMI) is associated with worse breast cancer outcomes, but few account for variability in screening, access to treatment, and tumor differences. We examined the association between BMI and risk of breast cancer recurrence, breast cancer-specific mortality, and all-cause mortality, and evaluated whether tumor characteristics differ by BMI among a mammographically screened population with access to treatment.

Methods

Using a retrospective cohort study design, we followed 485 women aged ≥40 years diagnosed with stage I/II breast cancer within 24 months of a screening mammogram occurring between 1988 and 1993 for 10-year outcomes. BMI before diagnosis was categorized as normal (<25 kg/m2), overweight (25–29.9 kg/m2), and obese (≥30 kg/m2). Tumor marker expression was assessed via immunohistochemistry using tissue collected before adjuvant treatment. Medical records were abstracted to identify treatment, recurrence, and mortality. We used Cox proportional hazards to separately model the hazard ratios (HR) of our three outcomes by BMI while adjusting for age, stage, and tamoxifen use.

Results

Relative to normal-weight women, obese women experienced increased risk of recurrence (HR 2.43; 95 % CI 1.34–4.41) and breast cancer death (HR 2.41; 95 % CI 1.00–5.81) within 10 years of diagnosis. There was no association between BMI and all-cause mortality. Obese women had significantly faster growing tumors, as measured by Ki-67.

Conclusions

Our findings add to the growing evidence that obesity may contribute to poorer breast cancer outcomes, and also suggest that increased tumor proliferation among obese women is a pathway that explains part of their excess risk of adverse outcomes.

Keywords

Breast cancer recurrence Breast cancer-specific mortality Tumor characteristics Obesity Body mass index 

Notes

Acknowledgments

This work was supported by a grant from the American Cancer Society (CRTG-03-024-01-CCE) and a cooperative agreement (U01CA63731) and grant (K05CA154337) from the National Cancer Institute.

Conflict of interest

All authors listed on the manuscript have met all three requirements for authorship as stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals and the authors declare that they have no conflicts of interest regarding this work.

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Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Aruna Kamineni
    • 1
  • Melissa L. Anderson
    • 1
  • Emily White
    • 2
    • 3
  • Stephen H. Taplin
    • 4
  • Peggy Porter
    • 2
  • Rachel Ballard-Barbash
    • 4
  • Kathleen Malone
    • 2
    • 3
  • Diana S. M. Buist
    • 1
  1. 1.Group Health Research InstituteSeattleUSA
  2. 2.Fred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.School of Public HealthUniversity of WashingtonSeattleUSA
  4. 4.National Cancer InstituteBethesdaUSA

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