Adult weight change and the risk of pre- and postmenopausal breast cancer in the Chinese Wuxi Exposure and Breast Cancer Study

  • Shang Cao
  • Jinyi Zhou
  • Zheng Zhu
  • Feiran Wei
  • Wei Li
  • Shurong Lu
  • Jian Su
  • Hao Yu
  • Wencong Du
  • Lan Cui
  • Pingmin Wei
  • Ming Wu



The accumulating evidence indicates that weight gain in adulthood is more predictive of breast cancer risk than absolute body weight. However, the relative impact of timing of weight gain in adulthood on breast cancer as well as other characteristics of the association between weight and breast cancer has not been well documented.


This population-based case–control study of breast cancer included 818 patients with newly diagnosed primary breast cancer and 935 residence and age-matched healthy controls. The body weight values at 18 years old, 1 year before diagnosis, and at menopause were obtained during in-person interviews. Unconditional logistic regression was used to estimate the effects of the weight change over adulthood on breast cancer risk. Linear mixed-effects regression was also applied as a secondary analysis.


We found that the increased risk of breast cancer was associated with the weight gain in adulthood among postmenopausal women (OR 1.23; 95% CI 1.10–1.37 per 5 kg increase) but not in the premenopausal women. The risk associated with weight gain since menopause (OR 1.65; 95% CI 1.28–2.14 a 5-kg increase) was higher than that from age 18 to menopause (OR 1.14; 95% CI 1.02, 1.28 a 5-kg increase). The association tended to be stronger in those with higher waist circumference and who had never used hormone replacement therapy (HRT). Women who had never used HRT, the increased risk of breast cancer associated with weight gain was more consistent in leaner women at age 18 (BMI < 18.5) or at menopause (BMI < 24).


Our findings indicated that weight gain has significant impact on postmenopausal breast cancer risk. The time periods of weight gain, central body fat, and HRT may affect the observed association, which should be further studied.


Breast cancer Weight gain Central obesity Hormone replacement therapy Case–control study 



We are grateful to all study participants for their contributions. We thank the entire data collection team. Incident breast cancer cases and controls for this study were collected by Wuxi Center for Disease Control, Jiangsu Center for Disease Control.


This study was supported by World Cancer Research Fund (2011/RFA/473).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was approved by the ethical review committee of the Jiangsu Center for Disease Control and Prevention (Jiangsu, China).

Supplementary material

10549_2018_5016_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 31 KB)


  1. 1.
    Lahmann PH, Hoffmann K, Allen N, van Gils CH, Khaw KT, Tehard B, Berrino F, Tjonneland A, Bigaard J, Olsen A et al (2004) Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC). Int J Cancer 111(5):762–771CrossRefGoogle Scholar
  2. 2.
    Lahmann PH, Schulz M, Hoffmann K, Boeing H, Tjonneland A, Olsen A, Overvad K, Key TJ, Allen NE, Khaw KT et al (2005) Long-term weight change and breast cancer risk: the European prospective investigation into cancer and nutrition (EPIC). Br J Cancer 93(5):582–589CrossRefGoogle Scholar
  3. 3.
    Neuhouser ML, Aragaki AK, Prentice RL, Manson JE, Chlebowski R, Carty CL, Ochs-Balcom HM, Thomson CA, Caan BJ, Tinker LF et al (2015) Overweight, obesity, and postmenopausal invasive breast cancer risk: a secondary analysis of the women’s health initiative randomized clinical trials. JAMA Oncol 1(5):611–621CrossRefGoogle Scholar
  4. 4.
    Keum N, Greenwood DC, Lee DH, Kim R, Aune D, Ju W, Hu FB, Giovannucci EL (2015) Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst 107(3)Google Scholar
  5. 5.
    White AJ, Nichols HB, Bradshaw PT, Sandler DP (2015) Overall and central adiposity and breast cancer risk in the Sister Study. Cancer 121(20):3700–3708CrossRefGoogle Scholar
  6. 6.
    Imperial College London (2008) WCRF/AICR Systematic Literature Review Continuous Update Report The Associations between Food, Nutrition and Physical Activity and the Risk of Breast Cancer LondonGoogle Scholar
  7. 7.
    Feigelson HS, Jonas CR, Teras LR, Thun MJ, Calle EE (2004) Weight gain, body mass index, hormone replacement therapy, and postmenopausal breast cancer in a large prospective study. Cancer Epidemiol Biomarkers Prev 13(2):220–224CrossRefGoogle Scholar
  8. 8.
    Suzuki R, Iwasaki M, Inoue M, Sasazuki S, Sawada N, Yamaji T, Shimazu T, Tsugane S (2011) Body weight at age 20 years, subsequent weight change and breast cancer risk defined by estrogen and progesterone receptor status–the Japan public health center-based prospective study. Int J Cancer 129(5):1214–1224CrossRefGoogle Scholar
  9. 9.
    Krishnan K, Bassett JK, MacInnis RJ, English DR, Hopper JL, McLean C, Giles GG, Baglietto L (2013) Associations between weight in early adulthood, change in weight, and breast cancer risk in postmenopausal women. Cancer Epidemiol Biomarkers Prev 22(8):1409–1416CrossRefGoogle Scholar
  10. 10.
    Kawai M, Minami Y, Kuriyama S, Kakizaki M, Kakugawa Y, Nishino Y, Ishida T, Fukao A, Tsuji I, Ohuchi N (2010) Adiposity, adult weight change and breast cancer risk in postmenopausal Japanese women: the Miyagi Cohort Study. Br J Cancer 103(9):1443–1447CrossRefGoogle Scholar
  11. 11.
    Ahn J, Schatzkin A, Lacey JJ, Albanes D, Ballard-Barbash R, Adams KF, Kipnis V, Mouw T, Hollenbeck AR, Leitzmann MF (2007) Adiposity, adult weight change, and postmenopausal breast cancer risk. Arch Intern Med 167(19):2091–2102CrossRefGoogle Scholar
  12. 12.
    Berstad P, Coates RJ, Bernstein L, Folger SG, Malone KE, Marchbanks PA, Weiss LK, Liff JM, McDonald JA, Strom BL et al (2010) A case-control study of body mass index and breast cancer risk in white and African-American women. Cancer Epidemiol Biomarkers Prev 19(6):1532–1544CrossRefGoogle Scholar
  13. 13.
    Friedenreich CM (2001) Review of anthropometric factors and breast cancer risk. Eur J Cancer Prev 10(1):15–32CrossRefGoogle Scholar
  14. 14.
    Key TJ, Appleby PN, Reeves GK, Roddam A, Dorgan JF, Longcope C, Stanczyk FZ, Stephenson HJ, Falk RT, Miller R et al (2003) Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst 95(16):1218–1226CrossRefGoogle Scholar
  15. 15.
    Key TJ, Appleby PN, Reeves GK, Roddam AW, Helzlsouer KJ, Alberg AJ, Rollison DE, Dorgan JF, Brinton LA, Overvad K et al (2011) Circulating sex hormones and breast cancer risk factors in postmenopausal women: reanalysis of 13 studies. Br J Cancer 105(5):709–722CrossRefGoogle Scholar
  16. 16.
    Eliassen AH, Colditz GA, Rosner B, Willett WC, Hankinson SE (2006) Adult weight change and risk of postmenopausal breast cancer. JAMA 296(2):193–201CrossRefGoogle Scholar
  17. 17.
    Han D, Nie J, Bonner MR, McCann SE, Muti P, Trevisan M, Ramirez-Marrero FA, Vito D, Freudenheim JL (2006) Lifetime adult weight gain, central adiposity, and the risk of pre- and postmenopausal breast cancer in the Western New York exposures and breast cancer study. Int J Cancer 119(12):2931–2937CrossRefGoogle Scholar
  18. 18.
    Lu S, Qian Y, Huang X, Yu H, Yang J, Han R, Su J, Du W, Zhou J, Dong M et al (2017) The association of dietary pattern and breast cancer in Jiangsu, China: A population-based case-control study. PLoS ONE 12(9):e0184453CrossRefGoogle Scholar
  19. 19.
    van Kruijsdijk RC, van der Wall E, Visseren FL (2009) Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev 18(10):2569–2578CrossRefGoogle Scholar
  20. 20.
    Kaaks R, Lukanova A, Kurzer MS (2002) Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev 11(12):1531–1543PubMedGoogle Scholar
  21. 21.
    Nelson LR, Bulun SE (2001) Estrogen production and action. J Am Acad Dermatol 45(3 Suppl):S116–S124CrossRefGoogle Scholar
  22. 22.
    Toth MJ, Tchernof A, Sites CK, Poehlman ET (2000) Menopause-related changes in body fat distribution. Ann N Y Acad Sci 904:502–506CrossRefGoogle Scholar
  23. 23.
    Potischman N, Swanson CA, Siiteri P, Hoover RN (1996) Reversal of relation between body mass and endogenous estrogen concentrations with menopausal status. J Natl Cancer Inst 88(11):756–758CrossRefGoogle Scholar
  24. 24.
    Stoll BA (2000) Adiposity as a risk determinant for postmenopausal breast cancer. Int J Obes Relat Metab Disord 24(5):527–533CrossRefGoogle Scholar
  25. 25.
    Ballard-Barbash R (1994) Anthropometry and breast cancer. Body size–a moving target. Cancer 74(3 Suppl):1090–1100CrossRefGoogle Scholar
  26. 26.
    Huang Z, Willett WC, Colditz GA, Hunter DJ, Manson JE, Rosner B, Speizer FE, Hankinson SE (1999) Waist circumference, waist: hip ratio, and risk of breast cancer in the Nurses’ Health Study. Am J Epidemiol 150(12):1316–1324CrossRefGoogle Scholar
  27. 27.
    Kaaks R, Van Noord P, Den Tonkelaar I, Peeters P, Riboli E, Grobbee DE (1998) Breast-cancer incidence in relation to height, weight and body-fat distribution in the Dutch “DOM” cohort. Int J Cancer 76(5):647–651CrossRefGoogle Scholar
  28. 28.
    Ballard-Barbash R, Schatzkin A, Carter CL, Kannel WB, Kreger BE, D’Agostino RB, Splansky GL, Anderson KM, Helsel WE (1990) Body fat distribution and breast cancer in the Framingham Study. J Natl Cancer Inst 82(4):286–290CrossRefGoogle Scholar
  29. 29.
    Folsom AR, Kaye SA, Prineas RJ, Potter JD, Gapstur SM, Wallace RB (1990) Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol 131(5):794–803CrossRefGoogle Scholar
  30. 30.
    Morimoto LM, White E, Chen Z, Chlebowski RT, Hays J, Kuller L, Lopez AM, Manson J, Margolis KL, Muti PC et al (2002) Obesity, body size, and risk of postmenopausal breast cancer: the Women’s Health Initiative (United States). Cancer Causes Control 13(8):741–751CrossRefGoogle Scholar
  31. 31.
    Lahmann PH, Hoffmann K, Allen N, van Gils CH, Khaw K, Tehard B, Berrino F, Tjønneland A, Bigaard J, Olsen A et al (2004) Body size and breast cancer risk: Findings from the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer 111(5):762–771CrossRefGoogle Scholar
  32. 32.
    Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288(3):321–333CrossRefGoogle Scholar
  33. 33.
    Friedenreich C, Cust A, Lahmann PH, Steindorf K, Boutron-Ruault MC, Clavel-Chapelon F, Mesrine S, Linseisen J, Rohrmann S, Boeing H et al (2007) Anthropometric factors and risk of endometrial cancer: the European prospective investigation into cancer and nutrition. Cancer Causes Control 18(4):399–413CrossRefGoogle Scholar
  34. 34.
    Baer HJ, Colditz GA, Rosner B, Michels KB, Rich-Edwards JW, Hunter DJ, Willett WC (2005) Body fatness during childhood and adolescence and incidence of breast cancer in premenopausal women: a prospective cohort study. Breast Cancer Res 7(3):R314–R325CrossRefGoogle Scholar
  35. 35.
    Baer HJ, Tworoger SS, Hankinson SE, Willett WC (2010) Body fatness at young ages and risk of breast cancer throughout life. Am J Epidemiol 171(11):1183–1194CrossRefGoogle Scholar
  36. 36.
    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):1407–1411CrossRefGoogle Scholar
  37. 37.
    Shu XO, Jin F, Dai Q, Shi JR, Potter JD, Brinton LA, Hebert JR, Ruan Z, Gao YT, Zheng W (2001) Association of body size and fat distribution with risk of breast cancer among Chinese women. Int J Cancer 94(3):449–455CrossRefGoogle Scholar
  38. 38.
    Grodin JM, Siiteri PK, MacDonald PC (1973) Source of estrogen production in postmenopausal women. J Clin Endocrinol Metab 36(2):207–214CrossRefGoogle Scholar
  39. 39.
    Siiteri PK (1987) Adipose tissue as a source of hormones. Am J Clin Nutr 45(1 Suppl):277–282CrossRefGoogle Scholar
  40. 40.
    Hankinson SE, Willett WC, Manson JE, Hunter DJ, Colditz GA, Stampfer MJ, Longcope C, Speizer FE (1995) Alcohol, height, and adiposity in relation to estrogen and prolactin levels in postmenopausal women. J Natl Cancer Inst 87(17):1297–1302CrossRefGoogle Scholar
  41. 41.
    Thomas HV, Key TJ, Allen DS, Moore JW, Dowsett M, Fentiman IS, Wang DY (1997) Re: Reversal of relation between body mass and endogenous estrogen concentrations with menopausal status. J Natl Cancer Inst 89(5):396–398CrossRefGoogle Scholar
  42. 42.
    Newcomb PA, Klein R, Klein BE, Haffner S, Mares-Perlman J, Cruickshanks KJ, Marcus PM (1995) Association of dietary and life-style factors with sex hormones in postmenopausal women. Epidemiology 6(3):318–321CrossRefGoogle Scholar
  43. 43.
    Barnes-Josiah D, Potter JD, Sellers TA, Himes JH (1995) Early body size and subsequent weight gain as predictors of breast cancer incidence (Iowa, United States). Cancer Causes Control 6(2):112–118CrossRefGoogle Scholar
  44. 44.
    Enriori CL, Orsini W, Del CCM, Etkin AE, Cardillo LR, Reforzo-Membrives J (1986) Decrease of circulating level of SHBG in postmenopausal obese women as a risk factor in breast cancer: reversible effect of weight loss. Gynecol Oncol 23(1):77–86CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Shang Cao
    • 1
  • Jinyi Zhou
    • 2
  • Zheng Zhu
    • 2
  • Feiran Wei
    • 3
  • Wei Li
    • 1
  • Shurong Lu
    • 2
  • Jian Su
    • 2
  • Hao Yu
    • 2
  • Wencong Du
    • 2
  • Lan Cui
    • 2
  • Pingmin Wei
    • 1
  • Ming Wu
    • 1
    • 2
  1. 1.Department of Epidemiology and Health StatisticsSoutheast UniversityNanjingChina
  2. 2.Department of Chronic Disease ControlJiangsu Provincial Center for Disease Control and PreventionNanjingChina
  3. 3.Department of OncologySoutheast UniversityNanjingChina

Personalised recommendations