Pre-diagnostic changes in body mass index and mortality among breast cancer patients

  • Signe Benzon Larsen
  • Maia Torstensson
  • Line Kenborg
  • Jane Christensen
  • Niels Kroman
  • Susanne Oksbjerg Dalton
  • Anne Tjønneland
  • Christoffer Johansen
  • Pernille Envold Bidstrup
Epidemiology
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Abstract

Purpose

We investigated whether changes in body mass index (BMI) before a breast cancer diagnosis affected mortality and whether trajectories more accurately predict overall mortality compared to a single measure of BMI.

Methods

Our prospective cohort comprised 2012 women with breast cancer who reported their weight in each decade from 20 to 50–64 years of age. We used trajectory analysis to identify groups with similar development patterns in BMI and Cox proportional hazards models to examine the association between trajectory groups and mortality, and interactions with oestrogen receptor status and smoking. We used c-index statistics to compare the trajectory model with the single measure model of BMI.

Results

We identified three distinct trajectory groups, with a mean BMI at age 20 of 19, 22 and 24 increasing to 23 (normal-to-normal), 29 (normal-to-overweight) and 37 (normal-to-obese) at 50–64 years of age, respectively. Women in the normal-to-obese trajectory group experienced significantly higher overall mortality than those in the normal-to-normal trajectory group (HR 1.76, 95% CI 1.21‒2.56). The association declined to a non-significant level after adjustments for clinical prognostic factors. Although not significant, the same tendency was seen for breast cancer-specific mortality. The association was strongest in women with oestrogen receptor-negative tumours. Weight changes over time were not significantly different from a single BMI measure before diagnosis to predict survival.

Conclusion

Weight gain affects overall mortality after breast cancer but clinical prognostic factors largely eliminate the association. Using trajectories of weight changes did not improve the predictive value compared to a single measure of BMI.

Keywords

Breast neoplasms Mortality Body mass index Weight changes Oestrogen receptor status Smoking 

Abbreviations

BMI

Body mass index

HR

Hazard ratio

BIC

Bayesian information criterion

IQR

Interquartile range

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Notes

Acknowledgements

This work was supported by The Health Foundation (Helsefonden j.nr.2007B121) and the Nordic Cancer Union (Reference S-11/07). We would like to thank Katja Boll for her exceptional work on data management in the Diet, Cancer and Health study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Niraula S, Ocana A, Ennis M, Goodwin PJ (2012) Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat 134(2):769–781CrossRefPubMedGoogle Scholar
  2. 2.
    Zheng H, Tumin D, Qian Z (2013) Obesity and mortality risk: new findings from body mass index trajectories. Am J Epidemiol 178(11):1591–1599CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Mikkelsen KL, Heitmann BL, Keiding N, Sorensen TI (1999) Independent effects of stable and changing body weight on total mortality. Epidemiology 10(6):671–678CrossRefPubMedGoogle Scholar
  4. 4.
    His M, Le Guelennec M, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Dossus L (2018) Life course evolution of body size and breast cancer survival in the E3N cohort. Int J Cancer 142(8):1542–1553CrossRefPubMedGoogle Scholar
  5. 5.
    Enger SM, Bernstein L (2004) Exercise activity, body size and premenopausal breast cancer survival. Br J Cancer 90(11):2138–2141CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomark Prev 14(8):2009–2014CrossRefGoogle Scholar
  7. 7.
    Chan DS, Vieira AR, Aune D, Bandera EV, Greenwood DC, McTiernan A, Navarro Rosenblatt D, Thune I, Vieira R, Norat T (2014) Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol 25(10):1901–1914CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Parekh N, Chandran U, Bandera EV (2012) Obesity in cancer survival. Annu Rev Nutr 32:311–342CrossRefPubMedGoogle Scholar
  9. 9.
    Picon-Ruiz M, Morata-Tarifa C, Valle-Goffin JJ, Friedman ER, Slingerland JM (2017) Obesity and adverse breast cancer risk and outcome: mechanistic insights and strategies for intervention. CA Cancer J Clin 67(5):378–397CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Griggs JJ, Sorbero ME, Lyman GH (2005) Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med 165(11):1267–1273CrossRefPubMedGoogle Scholar
  11. 11.
    Litton JK, Gonzalez-Angulo AM, Warneke CL, Buzdar AU, Kau SW, Bondy M, Mahabir S, Hortobagyi GN, Brewster AM (2008) Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol 26(25):4072–4077CrossRefPubMedGoogle Scholar
  12. 12.
    Larsen SB, Kroman N, Ibfelt EH, Christensen J, Tjonneland A, Dalton SO (2015) Influence of metabolic indicators, smoking, alcohol and socioeconomic position on mortality after breast cancer. Acta Oncol 54(5):780–788CrossRefPubMedGoogle Scholar
  13. 13.
    Tjonneland A, Olsen A, Boll K, Stripp C, Christensen J, Engholm G, Overvad K (2007) Study design, exposure variables, and socioeconomic determinants of participation in Diet, Cancer and Health: a population-based prospective cohort study of 57,053 men and women in Denmark. Scand J Public Health 35(4):432–441CrossRefPubMedGoogle Scholar
  14. 14.
    Gjerstorff ML (2011) The Danish cancer registry. Scand J Public Health 39(7 Suppl):42–45CrossRefPubMedGoogle Scholar
  15. 15.
    Schmidt M, Pedersen L, Sorensen HT (2014) The Danish civil registration system as a tool in epidemiology. Eur J Epidemiol 29(8):541–549CrossRefPubMedGoogle Scholar
  16. 16.
    Helweg-Larsen K (2011) The Danish register of causes of death. Scand J Public Health 39(7 Suppl):26–29CrossRefPubMedGoogle Scholar
  17. 17.
    Moller S, Jensen MB, Ejlertsen B, Bjerre KD, Larsen M, Hansen HB, Christiansen P, Mouridsen HT, Danish Breast Cancer Cooperative G (2008) The clinical database and the treatment guidelines of the Danish Breast Cancer Cooperative Group (DBCG); its 30-years experience and future promise. Acta Oncol 47(4):506–524CrossRefPubMedGoogle Scholar
  18. 18.
    Jones BL, Nagin DS, Roeder K (2001) A SAS procedure based on mixture models for estimating developmental trajectories. Sociol Methods Res 29(3):374–393CrossRefGoogle Scholar
  19. 19.
    Nagin D (1999) Analyzing developmental trajectories: a semiparametric, group-based approach. Psychol Methods 4(2):139–157CrossRefGoogle Scholar
  20. 20.
    Andruff H, Carraro N, Thompson A, Gaudreau P, Louvet B (2009) Latent Class growth modelling: a tutorial. Tutor Quant Methods Psychol 51(1):11–24CrossRefGoogle Scholar
  21. 21.
    DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3):837–845CrossRefPubMedGoogle Scholar
  22. 22.
    Patterson RE, Cadmus LA, Emond JA, Pierce JP (2010) Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas 66(1):5–15CrossRefPubMedGoogle Scholar
  23. 23.
    Roberts DL, Dive C, Renehan AG (2010) Biological mechanisms linking obesity and cancer risk: new perspectives. Annu Rev Med 61:301–316CrossRefPubMedGoogle Scholar
  24. 24.
    Renehan AG, Roberts DL, Dive C (2008) Obesity and cancer: pathophysiological and biological mechanisms. Arch Physiol Biochem 114(1):71–83CrossRefPubMedGoogle Scholar
  25. 25.
    Larsen SB, Dalton SO, Schuz J, Christensen J, Overvad K, Tjonneland A, Johansen C, Olsen A (2012) Mortality among participants and non-participants in a prospective cohort study. Eur J Epidemiol 27(11):837–845CrossRefPubMedGoogle Scholar
  26. 26.
    Dal Maso L, Zucchetto A, Talamini R, Serraino D, Stocco CF, Vercelli M, Falcini F, Franceschi S (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123(9):2188–2194CrossRefGoogle Scholar
  27. 27.
    Huang Z, Hankinson SE, Colditz GA, Stampfer MJ, Hunter DJ, Manson JE, Hennekens CH, Rosner B, Speizer FE, Willett WC (1997) Dual effects of weight and weight gain on breast cancer risk. JAMA 278(17):1407–1411CrossRefPubMedGoogle Scholar
  28. 28.
    Cleveland RJ, Eng SM, Abrahamson PE, Britton JA, Teitelbaum SL, Neugut AI, Gammon MD (2007) Weight gain prior to diagnosis and survival from breast cancer. Cancer Epidemiol Biomark Prev 16(9):1803–1811CrossRefGoogle Scholar
  29. 29.
    Althuis MD, Fergenbaum JH, Garcia-Closas M, Brinton LA, Madigan MP, Sherman ME (2004) Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomark Prev 13(10):1558–1568Google Scholar
  30. 30.
    Maehle BO, Tretli S, Thorsen T (2004) The associations of obesity, lymph node status and prognosis in breast cancer patients: dependence on estrogen and progesterone receptor status. APMIS 112(6):349–357CrossRefPubMedGoogle Scholar
  31. 31.
    Chen X, Lu W, Zheng W, Gu K, Chen Z, Zheng Y, Shu XO (2010) Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat 122(3):823–833CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Bradshaw PT, Ibrahim JG, Stevens J, Cleveland R, Abrahamson PE, Satia JA, Teitelbaum SL, Neugut AI, Gammon MD (2012) Postdiagnosis change in bodyweight and survival after breast cancer diagnosis. Epidemiology 23(2):320–327CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Signe Benzon Larsen
    • 1
  • Maia Torstensson
    • 1
  • Line Kenborg
    • 1
  • Jane Christensen
    • 1
  • Niels Kroman
    • 2
    • 3
  • Susanne Oksbjerg Dalton
    • 1
  • Anne Tjønneland
    • 1
  • Christoffer Johansen
    • 1
    • 4
  • Pernille Envold Bidstrup
    • 1
  1. 1.Danish Cancer Society Research CenterCopenhagen ØDenmark
  2. 2.Department of Breast Surgery and the Danish Breast Cancer Group, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
  3. 3.Danish Cancer Society ManagementCopenhagen ØDenmark
  4. 4.Oncology Clinic, Finsen Centre, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark

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