Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis

Abstract

Obesity is associated with poor survival after breast cancer diagnosis in individual studies and meta-analyses. Evidence regarding associations of obesity with breast cancer-specific survival (BCSS) and overall survival (OS) in relation to hormone receptor status, or BCSS in relation to menopausal status has not been evaluated in a previous meta-analysis. In this study, we conducted a meta-analysis of the association of obesity with OS and BCSS in relation to hormone receptor status and menopausal status. MEDLINE, EMBASE, and COCHRANE databases from the first record to December 2011 and presentations made at major international meetings in the last 5 years were searched. We included observational or interventional studies reporting hazard ratios (HRs) of obesity with OS and/or BCSS in relation to hormone receptor and/or menopausal status. Twenty-one studies qualified, meeting the above criteria. The pooled HR for OS in heavier versus lighter women was 1.31 (95 % CI 1.17–1.46) for estrogen receptor/progesterone receptor (ER/PgR) positive cancers; 1.18 (95 % CI 1.06–1.31) for ER/PgR negative cancers; and the difference between the two groups was not significant (p = 0.31). The pooled HR for OS in heavier versus lighter women was 1.23 (95 % CI 1.07–1.42) for premenopausal women and 1.15 (95 % CI 1.06–1.26) for post-menopausal women, and the difference between the two groups was not significant (p = 0.57). Comparable pooled HRs for BCSS were 1.36 (95 % CI 1.20–1.54) for ER/PgR positive cancers and 1.46 (95 % CI 0.98–2.19) for ER/PgR negative cancers; and 1.18 (95 % CI 0.82–1.70) for pre-menopausal women and 1.38 (95 % CI 1.11–1.71) for post-menopausal women, also without significant group differences. Results were similar after adjustment for BMI measurement technique, years of follow-up, or study design. These findings led us to conclude that there is no evidence showing that the association of obesity with breast cancer outcome differs by hormone receptor or menopausal status. This has implications for studies of weight loss interventions in the adjuvant BC setting.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Kelly T et al (2008) Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 32(9):1431–1437

    Article  CAS  Google Scholar 

  2. 2.

    Renehan AG et al (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371(9612):569–578

    PubMed  Article  Google Scholar 

  3. 3.

    van den Brandt PA et al (2000) Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol 152(6):514–527

    PubMed  Article  Google Scholar 

  4. 4.

    Harvie M, Hooper L, Howell AH (2003) Central obesity and breast cancer risk: a systematic review. Obes Rev 4(3):157–173

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Goodwin P et al (1995) Development of a weight management program in women with newly diagnosed locoregional breast cancer. In: 11th international congress of psychosomatic obstetrics and gynaecology, Basel, Switzerland

  6. 6.

    Protani M, Coory M, Martin JH (2010) Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 123(3):627–635

    PubMed  Article  Google Scholar 

  7. 7.

    Ryu S et al (2001) Is body mass index the prognostic factor in breast cancer?: a meta-analysis. J Korean Med Sci 16(5):610–614

    PubMed  CAS  Google Scholar 

  8. 8.

    Hursting SD et al (2008) Reducing the weight of cancer: mechanistic targets for breaking the obesity-carcinogenesis link. Best Pract Res Clin Endocrinol Metab 22(4):659–669

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Renehan AG, Roberts DL, Dive C (2008) Obesity and cancer: pathophysiological and biological mechanisms. Arch Physiol Biochem 114(1):71–83

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Subbaramaiah K et al (2011) Obesity is associated with inflammation and elevated aromatase expression in the mouse mammary gland. Cancer Prev Res (Phila) 4(3):329–346

    Article  CAS  Google Scholar 

  11. 11.

    Morris PG et al (2011) Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer. Cancer Prev Res (Phila) 4(7):1021–1029

    Article  CAS  Google Scholar 

  12. 12.

    Pfeiler G et al (2011) Impact of body mass index on the efficacy of endocrine therapy in premenopausal patients with breast cancer: an analysis of the prospective ABCSG-12 trial. J Clin Oncol 29(19):2653–2659

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Bowers L et al. (2010) Obesity promotes breast cancer progression and tamoxifen resistance via cross-talk between growth factor and estrogen signaling pathways. In: San Antonio breast cancer symposium 2010 [PD09-06]

  14. 14.

    Wells G et al (2011) The Newcastle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Assessed on January 20, 2011

  15. 15.

    Deeks J, Higgins J, Altman D (2006) Analysing and presenting results: cochrane handbook for systematic reviews of interventions 4 2 5. In: The cochrane library. John Wiley and Sons, Chichester

  16. 16.

    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Higgins JP et al (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    PubMed  Article  Google Scholar 

  18. 18.

    van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21(4):589–624

    PubMed  Article  Google Scholar 

  19. 19.

    Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Softw 36(3):1–48

    Google Scholar 

  20. 20.

    de Azambuja E et al (2010) The effect of body mass index on overall and disease-free survival in node-positive breast cancer patients treated with docetaxel and doxorubicin-containing adjuvant chemotherapy: the experience of the BIG 02-98 trial. Breast Cancer Res Treat 119(1):145–153

    PubMed  Article  Google Scholar 

  21. 21.

    Berclaz G et al (2004) Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol 15(6):875–884

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Conroy SM et al (2011) Obesity and breast cancer survival in ethnically diverse postmenopausal women: the Multiethnic Cohort Study. Breast Cancer Res Treat 129(2):565–574

    PubMed  Article  Google Scholar 

  23. 23.

    Chang S et al (2000) Inflammatory breast cancer survival: the role of obesity and menopausal status at diagnosis. Breast Cancer Res Treat 64(2):157–163

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Chen X et al (2010) Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat 122(3):823–833

    PubMed  Article  Google Scholar 

  25. 25.

    Dal Maso L et al (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123(9):2188–2194

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Dignam JJ et al (2003) Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst 95(19):1467–1476

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Dignam JJ et al (2006) Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Res Treat 97(3):245–254

    PubMed  Article  Google Scholar 

  28. 28.

    Daling JR et al (2001) Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma. Cancer 92(4):720–729

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Enger SM, Bernstein L (2004) Exercise activity, body size and premenopausal breast cancer survival. Br J Cancer 90(11):2138–2141

    PubMed  CAS  Google Scholar 

  30. 30.

    Goodwin PJ et al (2002) Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 20(1):42–51

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Keegan THM et al (2010) Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the Breast Cancer Family Registry. Breast Cancer Res Treat 123(2):531–542

    PubMed  Article  Google Scholar 

  32. 32.

    Kwan ML et al. (2011) Pre-diagnosis body mass index and survival after breast cancer in the After Breast Cancer Pooling Project. Breast Cancer Research & Treatment

  33. 33.

    Loi S et al (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14(7):1686–1691

    PubMed  Article  Google Scholar 

  34. 34.

    Majed B et al (2008) Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 111(2):329–342

    PubMed  Article  Google Scholar 

  35. 35.

    Vitolins MZ, Kimmick GG, Case LD (2008) BMI influences prognosis following surgery and adjuvant chemotherapy for lymph node positive breast cancer. Breast J 14(4):357–365

    PubMed  Article  Google Scholar 

  36. 36.

    Whiteman MK et al (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 14(8):2009–2014

    PubMed  Article  Google Scholar 

  37. 37.

    Sparano JA et al (2008) Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med 358(16):1663–1671

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Davidson NE et al (2005) Chemoendocrine therapy for premenopausal women with axillary lymph node-positive, steroid hormone receptor-positive breast cancer: results from INT 0101 (E5188). J Clin Oncol 23(25):5973–5982

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Fetting JH et al (1998) Sixteen-week multidrug regimen versus cyclophosphamide, doxorubicin, and fluorouracil as adjuvant therapy for node-positive, receptor-negative breast cancer: an Intergroup study. J Clin Oncol 16(7):2382–2391

    PubMed  CAS  Google Scholar 

  40. 40.

    Sparano J et al. (2010) Obesity at diagnosis is associated with inferior outcomes in hormone receptor positive breast cancer. In: San Antonio breast cancer symphosium 2010 [S2-1]

  41. 41.

    Sestak I et al (2010) Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol 28(21):3411–3415

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    den Tonkelaar I, Seidell JC, Collette HJ (1995) Body fat distribution in relation to breast cancer in women participating in the DOM-project. Breast Cancer Res Treat 34(1):55–61

    Article  Google Scholar 

  43. 43.

    Demirkan B, Alacacioglu A, Yilmaz U (2007) Relation of body mass index (BMI) to disease free (DFS) and distant disease free survivals (DDFS) among Turkish women with operable breast carcinoma. Jpn J Clin Oncol 37(4):256–265

    PubMed  Article  Google Scholar 

  44. 44.

    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(2):123–130

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Mohle-Boetani JC et al (1988) Body size, reproductive factors, and breast cancer survival. Prev Med 17(5):634–642

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Lu Y et al (2011) Obesity and survival among black women and white women 35 to 64 years of age at diagnosis with invasive breast cancer. J Clin Oncol 29(25):3358–3365

    PubMed  Article  Google Scholar 

  47. 47.

    Jain MG et al (2005) Body mass index and mortality in women: follow-up of the Canadian National Breast Screening Study cohort. Int J Obes 29(7):792–797

    Article  CAS  Google Scholar 

  48. 48.

    Kroenke CH et al (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378

    PubMed  Article  Google Scholar 

  49. 49.

    den Tonkelaar I 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(2):129–137

    Article  Google Scholar 

  50. 50.

    Abrahamson PE et al (2006) General and abdominal obesity and survival among young women with breast cancer. Cancer Epidemiol Biomarkers Prev 15(10):1871–1877

    PubMed  Article  Google Scholar 

  51. 51.

    Barnett GC et al (2008) Risk factors for the incidence of breast cancer: do they affect survival from the disease? J Clin Oncol 26(20):3310–3316

    PubMed  Article  Google Scholar 

  52. 52.

    Bastarrachea J et al (1994) Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer. Ann Intern Med 120(1):18–25

    PubMed  CAS  Google Scholar 

  53. 53.

    Borugian MJ et al (2003) Waist-to-hip ratio and breast cancer mortality. Am J Epidemiol 158(10):963–968

    PubMed  Article  Google Scholar 

  54. 54.

    Caan BJ 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(10):1319–1328

    PubMed  Article  Google Scholar 

  55. 55.

    Carmichael AR et al (2004) Does obesity compromise survival in women with breast cancer? Breast 13(2):93–96

    PubMed  Article  CAS  Google Scholar 

  56. 56.

    Cleveland RJ et al (2007) Weight gain prior to diagnosis and survival from breast cancer. Cancer Epidemiol Biomarkers Prev 16(9):1803–1811

    PubMed  Article  Google Scholar 

  57. 57.

    Dawood S et al (2008) Prognostic value of body mass index in locally advanced breast cancer. Clin Cancer Res 14(6):1718–1725

    PubMed  Article  Google Scholar 

  58. 58.

    Eley JW et al (1994) Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA 272(12):947–954

    PubMed  Article  CAS  Google Scholar 

  59. 59.

    Greenberg ER et al (1985) Body size and survival in premenopausal breast cancer. Br J Cancer 51(5):691–697

    PubMed  Article  CAS  Google Scholar 

  60. 60.

    Hebert JR, Hurley TG, Ma Y (1998) The effect of dietary exposures on recurrence and mortality in early stage breast cancer. Breast Cancer Res Treat 51(1):17–28

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Holmberg L et al (1994) Oral contraceptives and prognosis in breast cancer: effects of duration, latency, recency, age at first use and relation to parity and body mass index in young women with breast cancer. Eur J Cancer 30A(3):351–354

    PubMed  Article  CAS  Google Scholar 

  62. 62.

    Katoh A, Watzlaf VJ, D’Amico F (1994) An examination of obesity and breast cancer survival in post-menopausal women. Br J Cancer 70(5):928–933

    PubMed  Article  CAS  Google Scholar 

  63. 63.

    Labidi SI et al (2008) Inflammatory breast cancer in Tunisia in the era of multimodality therapy. Ann Oncol 19(3):473–480

    PubMed  Article  CAS  Google Scholar 

  64. 64.

    Litton JK et al (2008) Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol 26(25):4072–4077

    PubMed  Article  Google Scholar 

  65. 65.

    Mason BH et al (1990) Season of tumour detection influences factors predicting survival of patients with breast cancer. Breast Cancer Res Treat 15(1):27–37

    PubMed  Article  CAS  Google Scholar 

  66. 66.

    Moon HG, Han W, Noh DY (2009) Underweight and breast cancer recurrence and death: a report from the Korean Breast Cancer Society. J Clin Oncol 27(35):5899–5905

    PubMed  Article  Google Scholar 

  67. 67.

    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(3):484–490

    PubMed  Article  CAS  Google Scholar 

  68. 68.

    Nichols HB 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(5):1403–1409

    PubMed  Article  Google Scholar 

  69. 69.

    Petrelli JM et al (2002) Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 13(4):325–332

    PubMed  Article  Google Scholar 

  70. 70.

    Pierce JP et al (2007) Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 25(17):2345–2351

    PubMed  Article  Google Scholar 

  71. 71.

    Reeves GK et al (2000) Hormonal and other factors in relation to survival among breast cancer patients. Int J Cancer 89(3):293–299

    PubMed  Article  CAS  Google Scholar 

  72. 72.

    Rosenberg L, Czene K, Hall P (2009) Obesity and poor breast cancer prognosis: an illusion because of hormone replacement therapy? Br J Cancer 100(9):1486–1491

    PubMed  Article  CAS  Google Scholar 

  73. 73.

    Saxe GA et al (1999) Diet and risk for breast cancer recurrence and survival. Breast Cancer Res Treat 53(3):241–253

    PubMed  Article  CAS  Google Scholar 

  74. 74.

    Tao MH et al (2006) Association of overweight with breast cancer survival. Am J Epidemiol 163(2):101–107

    PubMed  Article  Google Scholar 

  75. 75.

    Vatten LJ, Foss OP, Kvinnsland S (1991) Overall survival of breast cancer patients in relation to preclinically determined total serum cholesterol, body mass index, height and cigarette smoking: a population-based study. Eur J Cancer 27(5):641–646

    PubMed  Article  CAS  Google Scholar 

  76. 76.

    Chlebowski RT et al (2006) Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst 98(24):1767–1776

    PubMed  Article  Google Scholar 

  77. 77.

    Rock CL et al (2008) Reproductive steroid hormones and recurrence-free survival in women with a history of breast cancer. Cancer Epidemiol Biomark Prev 17(3):614–620

    Article  CAS  Google Scholar 

  78. 78.

    Mulligan AM et al (2007) Insulin receptor is an independent predictor of a favorable outcome in early stage breast cancer. Breast Cancer Res Treat 106(1):39–47

    PubMed  Article  CAS  Google Scholar 

  79. 79.

    Law JH et al (2008) Phosphorylated insulin-like growth factor-i/insulin receptor is present in all breast cancer subtypes and is related to poor survival. Cancer Res 68(24):10238–10246

    PubMed  Article  CAS  Google Scholar 

  80. 80.

    Goodwin PJ et al (2005) Is leptin a mediator of adverse prognostic effects of obesity in breast cancer? J Clin Oncol 23(25):6037–6042

    PubMed  Article  CAS  Google Scholar 

  81. 81.

    Duggan C et al (2011) Associations of insulin resistance and adiponectin with mortality in women with breast cancer. J Clin Oncol 29(1):32–39

    PubMed  Article  CAS  Google Scholar 

  82. 82.

    Emaus A et al (2010) Metabolic profile, physical activity, and mortality in breast cancer patients. Breast Cancer Res Treat 121(3):651–660

    PubMed  Article  Google Scholar 

  83. 83.

    Erickson K et al (2011) Clinically defined type 2 diabetes mellitus and prognosis in early-stage breast cancer. J Clin Oncol 29(1):54–60

    PubMed  Article  Google Scholar 

  84. 84.

    Irwin ML et al (2011) Fasting C-peptide levels and death resulting from all causes and breast cancer: the health, eating, activity, and lifestyle study. J Clin Oncol 29(1):47–53

    PubMed  Article  CAS  Google Scholar 

  85. 85.

    Ma J et al (2008) Prediagnostic body-mass index, plasma C-peptide concentration, and prostate cancer-specific mortality in men with prostate cancer: a long-term survival analysis. Lancet Oncol 9(11):1039–1047

    PubMed  Article  CAS  Google Scholar 

  86. 86.

    Pollak M (2008) Insulin and insulin-like growth factor signalling in neoplasia. Nat Rev Cancer 8(12):915–928

    PubMed  Article  CAS  Google Scholar 

  87. 87.

    Doyle SL et al (2011) Visceral obesity, metabolic syndrome, insulin resistance and cancer. Proc Nutr Soc 1–9

  88. 88.

    Goodwin PJ et al (2011) Insulin- and obesity-related variables in early-stage breast cancer: correlations and time course of prognostic associations. J Clin Oncol

  89. 89.

    Egger M, Schneider M, Davey Smith G (1998) Spurious precision? Meta-analysis of observational studies. BMJ 316(7125):140–144

    PubMed  Article  CAS  Google Scholar 

  90. 90.

    Thivat E et al (2010) Weight change during chemotherapy changes the prognosis in non metastatic breast cancer for the worse. BMC Cancer 10:648

    PubMed  Article  Google Scholar 

  91. 91.

    Chauvet B et al (1990) Prognostic significance of breast relapse after conservative treatment in node-negative early breast cancer. Int J Radiat Oncol Biol Phys 19(5):1125–1130

    PubMed  Article  CAS  Google Scholar 

  92. 92.

    Marret H 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(1):17–23

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgment

We would like to thank Drs. Prakesh Shah and Joseph Beyene at University of Toronto for their valuable suggestions during preparation of this manuscript.

Conflict of interest

This is to confirm that none of the authors of the above manuscript have conflict of interest of any kind which may arise from being named as an author on the manuscript.

It is to certify that (i) all financial support or benefits received by me, by any member of my immediate family, or any individual or entity with whom or with which I have a significant relationship from any commercial source related directly or indirectly to the scientific work reported in the article have been disclosed and have been included in the submitted manuscript, (II) neither I, nor any member of my immediate family, nor any individual or entity with whom or with which I have a significant relationship has a financial interest in the subject matter discussed in the manuscript, except as disclosed (I understand an example of such a financial interest would be a stock interest in any business entity which is included in the subject matter of the manuscript or which sells a product relating to the subject matter of the manuscript.), (III) all funding sources supporting the work and all institutional or corporate affiliations are acknowledged in a footnote, and (Iv) I have had full access to all the data in the study (if applicable) and thereby accept full responsibility for the integrity of the data and the accuracy of the data analysis.

Signed by: Saroj Niraula, Alberto Ocana, Marguerite Ennis and Pamela J. Goodwin

Author information

Affiliations

Authors

Corresponding author

Correspondence to Pamela J. Goodwin.

Appendix

Appendix

See Tables 2 and 3.

Table 2 Quality rating of the included studies according to modified Newcastle–Ottawa quality assessment scale
Table 3 List and short description of excluded studies (only those that could potentially be included are listed)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Niraula, S., Ocana, A., Ennis, M. et al. Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat 134, 769–781 (2012). https://doi.org/10.1007/s10549-012-2073-x

Download citation

Keywords

  • Obesity
  • Body mass index
  • BMI
  • Breast cancer
  • Prognosis
  • Survival
  • Hormone receptor
  • ER
  • Menopausal