Cancer Causes & Control

, Volume 23, Issue 8, pp 1307–1316 | Cite as

Given breast cancer, does breast size matter? Data from a prospective breast cancer cohort

  • Andrea Markkula
  • Anna Bromée
  • Maria Henningson
  • Maria Hietala
  • Anita Ringberg
  • Christian Ingvar
  • Carsten Rose
  • Helena JernströmEmail author
Original paper



Body mass index (BMI), waist-to-hip ratio (WHR), and tumor characteristics affect disease-free survival. Larger breast size may increase breast cancer risk, but its influence on disease-free survival is unclear. The purpose of this study was to elucidate whether breast size independently influenced disease-free survival in breast cancer patients.


Body measurements were obtained preoperatively from 772 breast cancer patients in a population-based ongoing cohort from southern Sweden. The research nurse measured breast volumes with plastic cups used by plastic surgeons doing breast reductions. Clinical data were obtained from patient charts and pathology reports.


Patients with a BMI ≥ 25 kg/m2 had larger tumors (p < 0.001) and more axillary nodal involvement (p = 0.030). Patients with a WHR > 0.85 had larger tumors (p = 0.013), more advanced histological grade (p = 0.0016), and more axillary nodal involvement (p = 0.012). Patients with right + left breast volume ≥ 850 mL were more likely to have larger tumor sizes (p = 0.018), more advanced histological grade (p = 0.031), and more axillary nodal involvement (p = 0.025). There were 62 breast cancer events during the 7-year follow-up. Breast volume ≥ 850 mL was associated with shorter disease-free survival (p = 0.004) and distant metastasis-free survival (p = 0.001) in patients with estrogen receptor (ER)-positive tumors independent of other anthropometric measurements and age. In patients with ER-positive tumors, breast size was an independent predictor of shorter disease-free (HR 3.64; 95 % CI 1.42–9.35) and distant metastasis-free survival (HR 6.33; 95 %CI 1.36–29.43), adjusted for tumor characteristics, BMI, age, and treatment.


A simple and cheap anthropometric measurement with standardized tools may help identify a subgroup of patients in need of tailored breast cancer therapy.


Breast cancer Prognosis Body mass index Waist-to-hip ratio Breast size 



This study was supported by grants from the Swedish Cancer Society, the Swedish Research Council, the Medical Faculty at Lund University, the Mrs. Berta Kamprad’s Foundation, the Gunnar Nilsson Foundation, the Crafoord Foundation, the Konung Gustaf V Jubileumsfond (104152), the South Swedish Health Care Region (Region Skåne ALF), Swedish Breast Cancer Group (BRO), and the Lund Hospital Fund. We thank our research nurses Linda Ågren, Anette Möller, Karin Henriksson, Anna Weddig, and Maj-Britt Hedenblad. We thank Dr Eric Dryver for proofreading the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    The National Board of Health and Welfare (2010) Cancer incidence in Sweden (Cited May 30, 2012)
  2. 2.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2008) GLOBOCAN 2008 v1.2, Cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. International Agency for Research on Cancer, LyonGoogle Scholar
  3. 3.
    Han D, Nie J, Bonner MR et al (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 119:2931–2937PubMedCrossRefGoogle Scholar
  4. 4.
    Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7:333–340PubMedCrossRefGoogle Scholar
  5. 5.
    Carmichael AR, Bates T (2004) Obesity and breast cancer: a review of the literature. Breast 13:85–92PubMedCrossRefGoogle Scholar
  6. 6.
    Loi S, Milne RL, Friedlander ML et al (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14:1686–1691PubMedCrossRefGoogle Scholar
  7. 7.
    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 123:627–635PubMedCrossRefGoogle Scholar
  8. 8.
    Petrelli JM, Calle EE, Rodriguez C, Thun MJ (2002) Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 13:325–332PubMedCrossRefGoogle Scholar
  9. 9.
    Enger SM, Ross RK, Paganini-Hill A, Carpenter CL, Bernstein L (2000) Body size, physical activity, and breast cancer hormone receptor status: results from two case-control studies. Cancer Epidemiol Biomarkers Prev 9:681–687PubMedGoogle Scholar
  10. 10.
    Suzuki R, Orsini N, Saji S, Key TJ, Wolk A (2009) Body weight and incidence of breast cancer defined by estrogen and progesterone receptor status—a meta-analysis. Int J Cancer 124:698–712PubMedCrossRefGoogle Scholar
  11. 11.
    Pinheiro RL, Sarian LO, Pinto-Neto AM, Morais S, Costa-Paiva L (2009) Relationship between body mass index, waist circumference and waist to hip ratio and the steroid hormone receptor status in breast carcinoma of pre- and postmenopausal women. Breast 18:8–12PubMedCrossRefGoogle Scholar
  12. 12.
    Healy LA, Ryan AM, Carroll P et al (2010) Metabolic syndrome, central obesity and insulin resistance are associated with adverse pathological features in postmenopausal breast cancer. Clin Oncol (R Coll Radiol) 22:281–288CrossRefGoogle Scholar
  13. 13.
    Baumgartner KB, Hunt WC, Baumgartner RN et al (2004) Association of body composition and weight history with breast cancer prognostic markers: divergent pattern for Hispanic and non-Hispanic White women. Am J Epidemiol 160:1087–1097PubMedCrossRefGoogle Scholar
  14. 14.
    Harvie M, Hooper L, Howell AH (2003) Central obesity and breast cancer risk: a systematic review. Obes Rev 4:157–173PubMedCrossRefGoogle Scholar
  15. 15.
    Borugian MJ, Sheps SB, Kim-Sing C et al (2003) Waist-to-hip ratio and breast cancer mortality. Am J Epidemiol 158:963–968PubMedCrossRefGoogle Scholar
  16. 16.
    Jernström H, Barrett-Connor E (1999) Obesity, weight change, fasting insulin, proinsulin, C-peptide, and insulin-like growth factor-1 levels in women with and without breast cancer: the Rancho Bernardo Study. J Womens Health Gend Based Med 8:1265–1272PubMedCrossRefGoogle Scholar
  17. 17.
    Björntorp P (1997) Hormonal control of regional fat distribution. Hum Reprod 12(Suppl 1):21–25PubMedCrossRefGoogle Scholar
  18. 18.
    Hollmann M, Runnebaum B, Gerhard I (1997) Impact of waist-hip-ratio and body-mass-index on hormonal and metabolic parameters in young, obese women. Int J Obes Relat Metab Disord 21:476–483PubMedCrossRefGoogle Scholar
  19. 19.
    Goodwin PJ, Ennis M, Pritchard KI et al (2002) Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 20:42–51PubMedCrossRefGoogle Scholar
  20. 20.
    Bruning PF, Bonfrer JM, van Noord PA, Hart AA, de Jong-Bakker M, Nooijen WJ (1992) Insulin resistance and breast-cancer risk. Int J Cancer 52:511–516PubMedCrossRefGoogle Scholar
  21. 21.
    Del Giudice ME, Fantus IG, Ezzat S, McKeown-Eyssen G, Page D, Goodwin PJ (1998) Insulin and related factors in premenopausal breast cancer risk. Breast Cancer Res Treat 47:111–120PubMedCrossRefGoogle Scholar
  22. 22.
    Sellahewa C, Nightingale P, Carmichael AR (2008) Women with large breasts are at an increased risk of advanced breast cancer. Int Semin Surg Oncol 5:16PubMedCrossRefGoogle Scholar
  23. 23.
    Hsieh CC, Trichopoulos D (1991) Breast size, handedness and breast cancer risk. Eur J Cancer 27:131–135PubMedCrossRefGoogle Scholar
  24. 24.
    Hall HI, Coates RJ, Uhler RJ et al (1999) Stage of breast cancer in relation to body mass index and bra cup size. Int J Cancer 82:23–27PubMedCrossRefGoogle Scholar
  25. 25.
    Ingram DM, Huang HY, Catchpole BN, Roberts A (1989) Do big breasts disadvantage women with breast cancer? Aust N Z J Surg 59:115–117PubMedCrossRefGoogle Scholar
  26. 26.
    Hoe AL, Mullee MA, Royle GT, Guyer PB, Taylor I (1993) Breast size and prognosis in early breast cancer. Ann R Coll Surg Engl 75:18–22PubMedGoogle Scholar
  27. 27.
    Sung J, Song YM, Stone J, Lee K, Kim SY (2010) Association of body size measurements and mammographic density in Korean women: the Healthy Twin study. Cancer Epidemiol Biomarkers Prev 19:1523–1531PubMedCrossRefGoogle Scholar
  28. 28.
    Wade TD, Zhu G, Martin NG (2010) Body mass index and breast size in women: same or different genes? Twin Res Hum Genet 13:450–454PubMedCrossRefGoogle Scholar
  29. 29.
    Jernström H, Olsson H (1997) Breast size in relation to endogenous hormone levels, body constitution, and oral contraceptive use in healthy nulligravid women aged 19–25 years. Am J Epidemiol 145:571–580PubMedCrossRefGoogle Scholar
  30. 30.
    Ray JG, Mohllajee AP, van Dam RM, Michels KB (2008) Breast size and risk of type 2 diabetes mellitus. CMAJ 178:289–295PubMedGoogle Scholar
  31. 31.
    Schrauder MG, Fasching PA, Haberle L et al (2011) Diabetes and prognosis in a breast cancer cohort. J Cancer Res Clin Oncol 137:975–983Google Scholar
  32. 32.
    Kusano AS, Trichopoulos D, Terry KL, Chen WY, Willett WC, Michels KB (2006) A prospective study of breast size and premenopausal breast cancer incidence. Int J Cancer 118:2031–2034PubMedCrossRefGoogle Scholar
  33. 33.
    Ringberg A, Bågeman E, Rose C, Ingvar C, Jernström H (2006) Of cup and bra size: reply to a prospective study of breast size and premenopausal breast cancer incidence. Int J Cancer 119: 2242–2243; Author reply 4Google Scholar
  34. 34.
    Strombeck JO, Malm M (1986) Priority grouping in a waiting list of patients for reduction mammaplasty. Ann Plast Surg 17:498–502PubMedCrossRefGoogle Scholar
  35. 35.
    (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization technical report series. 894:i–xii, 1–253Google Scholar
  36. 36.
    Bågeman E, Ingvar C, Rose C, Jernström H (2008) Coffee consumption and CYP1A2*1F genotype modify age at breast cancer diagnosis and estrogen receptor status. Cancer Epidemiol Biomarkers Prev 17:895–901PubMedCrossRefGoogle Scholar
  37. 37.
    Jernström H, Sandberg T, Bågeman E, Borg Å, Olsson H (2005) Insulin-like growth factor-1 (IGF1) genotype predicts breast volume after pregnancy and hormonal contraception and is associated with circulating IGF-1 levels: implications for risk of early-onset breast cancer in young women from hereditary breast cancer families. Br J Cancer 92:857–866PubMedCrossRefGoogle Scholar
  38. 38.
    Pollak M (2008) Insulin and insulin-like growth factor signalling in neoplasia. Nat Rev Cancer 8:915–928PubMedCrossRefGoogle Scholar
  39. 39.
    Hankinson SE, Willett WC, Colditz GA et al (1998) Circulating concentrations of insulin-like growth factor-I and risk of breast cancer. Lancet 351:1393–1396PubMedCrossRefGoogle Scholar
  40. 40.
    Gee JM, Robertson JF, Gutteridge E et al (2005) Epidermal growth factor receptor/HER2/insulin-like growth factor receptor signalling and oestrogen receptor activity in clinical breast cancer. Endocr Relat Cancer 12(Suppl 1):S99–S111PubMedCrossRefGoogle Scholar
  41. 41.
    Key TJ, Appleby PN, Reeves GK, Roddam AW (2010) Insulin-like growth factor 1 (IGF1), IGF binding protein 3 (IGFBP3), and breast cancer risk: pooled individual data analysis of 17 prospective studies. Lancet Oncol 11:530–542PubMedCrossRefGoogle Scholar
  42. 42.
    Hartmann BW, Laml T, Kirchengast S, Albrecht AE, Huber JC (1998) Hormonal breast augmentation: prognostic relevance of insulin-like growth factor-I. Gynecol Endocrinol 12:123–127PubMedCrossRefGoogle Scholar
  43. 43.
    Diorio C, Pollak M, Byrne C et al (2005) Insulin-like growth factor-I, IGF-binding protein-3, and mammographic breast density. Cancer Epidemiol Biomarkers Prev 14:1065–1073PubMedCrossRefGoogle Scholar
  44. 44.
    Chiu SY, Duffy S, Yen AM, Tabar L, Smith RA, Chen HH (2010) Effect of baseline breast density on breast cancer incidence, stage, mortality, and screening parameters: 25-year follow-up of a Swedish mammographic screening. Cancer Epidemiol Biomarkers Prev 19:1219–1228PubMedCrossRefGoogle Scholar
  45. 45.
    Heidegger I, Pircher A, Klocker H, Massoner P (2011) Targeting the insulin-like growth factor network in cancer therapy. Cancer Biol Ther 11:701–707PubMedCrossRefGoogle Scholar
  46. 46.
    Mayes JS, Watson GH (2004) Direct effects of sex steroid hormones on adipose tissues and obesity. Obes Rev 5:197–216PubMedCrossRefGoogle Scholar
  47. 47.
    Lundin KB, Henningson M, Hietala M, Ingvar C, Rose C, Jernström H (2011) Androgen receptor genotypes predict response to endocrine treatment in breast cancer patients. Br J Cancer 105:1676–1683PubMedCrossRefGoogle Scholar
  48. 48.
    van Anders SM, Hampson E (2005) Waist-to-hip ratio is positively associated with bioavailable testosterone but negatively associated with sexual desire in healthy premenopausal women. Psychosom Med 67:246–250PubMedCrossRefGoogle Scholar
  49. 49.
    Peiris AN, Struve MF, Kissebah AH (1987) Relationship of body fat distribution to the metabolic clearance of insulin in premenopausal women. Int J Obes 11:581–589PubMedGoogle Scholar
  50. 50.
    Subbaramaiah K, Howe LR, Bhardwaj P et al (2011) Obesity is associated with inflammation and elevated aromatase expression in the mouse mammary gland. Cancer Prev Res 4:329–346CrossRefGoogle Scholar
  51. 51.
    Goodwin PJ, Stambolic V, Lemieux J et al (2011) Evaluation of metformin in early breast cancer: a modification of the traditional paradigm for clinical testing of anti-cancer agents. Breast Cancer Res Treat 126:215–220PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Andrea Markkula
    • 1
  • Anna Bromée
    • 1
  • Maria Henningson
    • 1
    • 2
  • Maria Hietala
    • 1
    • 3
  • Anita Ringberg
    • 4
  • Christian Ingvar
    • 5
  • Carsten Rose
    • 6
  • Helena Jernström
    • 1
    Email author
  1. 1.Department of Oncology, Clinical SciencesLund UniversityLundSweden
  2. 2.Sahlgrenska University HospitalGöteborgSweden
  3. 3.Vrinnevi HospitalNorrköpingSweden
  4. 4.Department of Plastic and Reconstructive Surgery, Clinical Sciences, Skane University Hospital MalmöLund UniversityMalmöSweden
  5. 5.Department of Surgery, Clinical Sciences, Skane University Hospital LundLund UniversityLundSweden
  6. 6.Division of Cancer and HaematologySkane University HospitalLundSweden

Personalised recommendations