Journal of Cancer Survivorship

, Volume 6, Issue 4, pp 398–406 | Cite as

Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study

  • Adriana Villaseñor
  • Rachel Ballard-Barbash
  • Kathy Baumgartner
  • Richard Baumgartner
  • Leslie Bernstein
  • Anne McTiernan
  • Marian L. Neuhouser



This study aimed to determine the prevalence of sarcopenia and examine whether sarcopenia was associated with overall and breast-cancer-specific mortality in a cohort of women diagnosed with breast cancer (stages I–IIIA).


A total of 471 breast cancer patients from western Washington State and New Mexico who participated in the prospective Health, Eating, Activity, and Lifestyle Study were included in this study. Appendicular lean mass was measured using dual X-ray absorptiometry scans at study inception, on average, 12 months after diagnosis. Sarcopenia was defined as two standard deviations below the young healthy adult female mean of appendicular lean mass divided by height squared (<5.45 kg/m2). Total and breast-cancer-specific mortality data were obtained from Surveillance Epidemiology and End Results registries. Multivariable Cox proportional hazard models assessed the associations between sarcopenia and mortality.


Median follow-up was 9.2 years; 75 women were classified as sarcopenic, and among 92 deaths, 46 were attributed to breast cancer. In multivariable models that included age, race-ethnicity/study site, treatment type, comorbidities, waist circumference, and total body fat percentage, sarcopenia was independently associated with overall mortality (hazard ratio (HR) = 2.86; 95 % CI, 1.67–4.89). Sarcopenic women had increased risk of breast-cancer-specific mortality, although the association was not statistically significant (HR = 1.95, 95 % CI, 0.87–4.35).


Sarcopenia is associated with an increased risk of overall mortality in breast cancer survivors and may be associated with breast-cancer-specific mortality. The development of effective interventions to maintain and/or increase skeletal muscle mass to improve prognosis in breast cancer survivors warrants further study.

Implications for Cancer Survivors

Such interventions may help breast cancer patients live longer.


Sarcopenia Appendicular lean mass Mortality Breast cancer survivor 



The authors would like to thank Anita Ambs and Todd Gibson for their continued assistance and support, as well as the HEAL participants for their ongoing dedication to this study. This study was supported through National Cancer Institute contracts NO1-CN-75036-20, NO1-CN-05228, NO1-PC-67010, U54-CA116847, and training grant R25-CA094880. A portion of this work was conducted through the Clinical Research Center at the University of Washington and support by the National Institutes of Health grant MO1-RR-0037 and University of New Mexico grant, NCRR MO1-RR-0997.

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Adriana Villaseñor
    • 1
    • 2
  • Rachel Ballard-Barbash
    • 3
  • Kathy Baumgartner
    • 4
  • Richard Baumgartner
    • 4
  • Leslie Bernstein
    • 5
  • Anne McTiernan
    • 2
    • 6
  • Marian L. Neuhouser
    • 1
    • 2
  1. 1.Cancer Prevention Program, Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.School of Public Health, Department of EpidemiologyUniversity of WashingtonSeattleUSA
  3. 3.Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer InstituteBethesdaUSA
  4. 4.Department of Epidemiology and Population HealthUniversity of LouisvilleLouisvilleUSA
  5. 5.Division of Cancer Etiology, Department of Population SciencesBeckman Research Institute, City of HopeDuarteUSA
  6. 6.Epidemiology Program, Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA

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