International Journal of Clinical Oncology

, Volume 20, Issue 2, pp 317–323 | Cite as

Aggressive estrogen-receptor-positive breast cancer arising in patients with elevated body mass index

  • Cesar Augusto Santa-MariaEmail author
  • Jingsheng Yan
  • Xian-Jin Xie
  • David Michael Euhus
Original Article



Obese women with estrogen receptor (ER)-positive breast cancer may experience worse disease-free and overall survival. We hypothesize that this observation is due to intrinsically aggressive disease and that obesity will be associated with higher histologic grade and Ki67.


A sequential cohort of women with breast cancer diagnosed over 2 years was assembled from institutional tumor registries. Patient and tumor characteristics were abstracted from medical records; those with non-invasive tumors, or lacking body mass index (BMI), Ki67 or histologic grade data, were excluded. Univariate and multivariate analysis was performed to investigate the relationship between markers of aggressive disease (grade and Ki67) and multiple variables associated with obesity. A subgroup analysis was performed to investigate further whether ER and menopausal status influenced associations between BMI and aggressive phenotypes.


Of the 1007 patients initially identified, 668 (68 %) met the eligibility criteria. In univariate analysis, histologic grade and Ki67 were strongly associated with increased BMI, younger age, and African-American race, but less so with diabetes, hypertension, and hyperlipidemia. Multivariate analysis confirmed that higher histologic grade was associated with increased BMI (p = 0.02), and that increased Ki67 was associated with younger age (p = 0.0003) and African-American race (p = 0.002). Additional analysis found that the association between increased BMI and higher-grade tumors was particularly significant in premenopausal women with ER-positive disease.


This study concludes that increased BMI is associated with aggressive-phenotype breast cancer and may be particularly relevant to ER-positive breast cancer developing in premenopausal African-American women.


Breast cancer Obesity Aggressive phenotype Histologic grade Ki67 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Japan Society of Clinical Oncology 2014

Authors and Affiliations

  • Cesar Augusto Santa-Maria
    • 1
    Email author
  • Jingsheng Yan
    • 2
  • Xian-Jin Xie
    • 2
  • David Michael Euhus
    • 3
  1. 1.Department of Medical Oncology, Sidney Kimmel Comprehensive Cancer Center, Bunting-Blaustein Cancer Research BldgJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Clinical Sciences, Simmons Comprehensive Cancer CenterUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Department of Surgery, Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins UniversityBaltimoreUSA

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