Abstract
Purpose
Many studies suggest increased body mass index (BMI) is associated with worse breast cancer outcomes, but few account for variability in screening, access to treatment, and tumor differences. We examined the association between BMI and risk of breast cancer recurrence, breast cancer-specific mortality, and all-cause mortality, and evaluated whether tumor characteristics differ by BMI among a mammographically screened population with access to treatment.
Methods
Using a retrospective cohort study design, we followed 485 women aged ≥40 years diagnosed with stage I/II breast cancer within 24 months of a screening mammogram occurring between 1988 and 1993 for 10-year outcomes. BMI before diagnosis was categorized as normal (<25 kg/m2), overweight (25–29.9 kg/m2), and obese (≥30 kg/m2). Tumor marker expression was assessed via immunohistochemistry using tissue collected before adjuvant treatment. Medical records were abstracted to identify treatment, recurrence, and mortality. We used Cox proportional hazards to separately model the hazard ratios (HR) of our three outcomes by BMI while adjusting for age, stage, and tamoxifen use.
Results
Relative to normal-weight women, obese women experienced increased risk of recurrence (HR 2.43; 95 % CI 1.34–4.41) and breast cancer death (HR 2.41; 95 % CI 1.00–5.81) within 10 years of diagnosis. There was no association between BMI and all-cause mortality. Obese women had significantly faster growing tumors, as measured by Ki-67.
Conclusions
Our findings add to the growing evidence that obesity may contribute to poorer breast cancer outcomes, and also suggest that increased tumor proliferation among obese women is a pathway that explains part of their excess risk of adverse outcomes.
Similar content being viewed by others
References
Goodwin PJ, Boyd NF (1990) Body size and breast cancer prognosis: a critical review of the evidence. Breast Cancer Res Treat 16:205–214
Greenberg ER, Vessey MP, McPherson K, Doll R, Yeates D (1985) Body size and survival in premenopausal breast cancer. Br J Cancer 51:691–697
Holmberg L, Lund E, Bergstrom R, Adami HO, Meirik O (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:351–354
Daling JR, Malone KE, Doody DR, Johnson LG, Gralow JR, Porter PL (2001) Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma. Cancer 92:720–729
Zhang S, Folsom AR, Sellers TA, Kushi LH, Potter JD (1995) Better breast cancer survival for postmenopausal women who are less overweight and eat less fat. The Iowa Women’s Health Study. Cancer 76:275–283
Chang S, Alderfer JR, Asmar L, Buzdar AU (2000) Inflammatory breast cancer survival: the role of obesity and menopausal status at diagnosis. Breast Cancer Res Treat 64:157–163
Ewertz M, Jensen MB, Gunnarsdottir KA et al (2011) Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29:25–31
Senie RT, Rosen PP, Rhodes P, Lesser ML, Kinne DW (1992) Obesity at diagnosis of breast carcinoma influences duration of disease-free survival. Ann Intern Med 116:26–32
Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20:1128–1143
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 41:123–130
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 26:484–490
Williams G, Howell A, Jones M (1988) The relationship of body weight to response to endocrine therapy, steroid hormone receptors and survival of patients with advanced cancer of the breast. Br J Cancer 58:631–634
Obermair A, Kurz C, Hanzal E et al (1995) The influence of obesity on the disease-free survival in primary breast cancer. Anticancer Res 15:2265–2269
Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP (2003) Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst 95:1467–1476
den Tonkelaar I, de Waard F, Seidell JC, Fracheboud J (1995) Obesity and subcutaneous fat patterning in relation to survival of postmenopausal breast cancer patients participating in the DOM-project. Breast Cancer Res Treat 34:129–137
Katoh A, Watzlaf VJ, D’Amico F (1994) An examination of obesity and breast cancer survival in post-menopausal women. Br J Cancer 70:928–933
Carmichael AR, Bendall S, Lockerbie L, Prescott RJ, Bates T (2004) Does obesity compromise survival in women with breast cancer? Breast 13:93–96
Caan BJ, Emond JA, Natarajan L et al (2006) Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer. Breast Cancer Res Treat 99:47–57
Taplin SH, Mandelson MT, Anderman C et al (1997) Mammography diffusion and trends in late-stage breast cancer: evaluating outcomes in a population. Cancer Epidemiol Biomarkers Prev 6:625–631
Taplin SH, Thompson RS, Schnitzer F, Anderman C, Immanuel V (1990) Revisions in the risk-based Breast Cancer Screening Program at Group Health Cooperative. Cancer 66:812–818
Taplin SH, Ichikawa L, Yood MU et al (2004) Reason for late-stage breast cancer: absence of screening or detection, or breakdown in follow-up? J Natl Cancer Inst 96:1518–1527
Fleming ID, Cooper JS, Henson DE et al (eds) (1997) AJCC Cancer Staging Manual, 5th edn. Lippincott Williams & Wilkins, Philadelphia
Buist DS, Porter PL, Lehman C, Taplin SH, White E (2004) Factors contributing to mammography failure in women aged 40–49 years. J Natl Cancer Inst 96:1432–1440
Porter PL, El-Bastawissi AY, Mandelson MT et al (1999) Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 91:2020–2028
WHO (2000) Obesity: preventing and managing the global epidemic. World Health Organization, Geneva (Switzerland)
American College of Radiology (ACR) (2003) ACR BI-RADS—mammography ACR Breast Imaging and Reporting and Data System, Breast Imaging Atlas, 4th edn. American College of Radiology, Reston
Rutter CM, Mandelson MT, Laya MB, Seger DJ, Taplin S (2001) Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy. JAMA 285:171–176
Buist DS, Chubak J, Prout M et al (2009) Referral, receipt, and completion of chemotherapy in patients with early-stage breast cancer older than 65 years and at high risk of breast cancer recurrence. J Clin Oncol 27:4508–4514
Geiger AM, Thwin SS, Lash TL et al (2007) Recurrences and second primary breast cancers in older women with initial early-stage disease. Cancer 109:966–974
Yood MU, Owusu C, Buist DS et al (2008) Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg 206:66–75
Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159:702–706
Rosner GL, Hargis JB, Hollis DR et al (1996) Relationship between toxicity and obesity in women receiving adjuvant chemotherapy for breast cancer: results from cancer and leukemia group B study 8541. J Clin Oncol 14:3000–3008
Griggs JJ, Culakova E, Sorbero ME et al (2007) Effect of patient socioeconomic status and body mass index on the quality of breast cancer adjuvant chemotherapy. J Clin Oncol 25:277–284
Mannisto S, Pietinen P, Pyy M, Palmgren J, Eskelinen M, Uusitupa M (1996) Body-size indicators and risk of breast cancer according to menopause and estrogen-receptor status. Int J Cancer 68:8–13
Ruder AM, Lubin F, Wax Y, Geier A, Alfundary E, Chetrit A (1989) Estrogen and progesterone receptors in breast cancer patients. Epidemiologic characteristics and survival differences. Cancer 64:196–202
Giuffrida D, Lupo L, La Porta GA et al (1992) Relation between steroid receptor status and body weight in breast cancer patients. Eur J Cancer 28:112–115
Howson CP, Kinne D, Wynder EL (1986) Body weight, serum cholesterol, and stage of primary breast cancer. Cancer 58:2372–2381
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 9:681–687
Elmore JG, Carney PA, Abraham LA et al (2004) The association between obesity and screening mammography accuracy. Arch Intern Med 164:1140–1147
Carney PA, Harwood BG, Weiss JE, Eliassen MS, Goodrich ME (2002) Factors associated with interval adherence to mammography screening in a population-based sample of New Hampshire women. Cancer 95:219–227
Fontaine KR, Heo M, Allison DB (2001) Body weight and cancer screening among women. J Womens Health Gend Based Med 10:463–470
Wee CC, McCarthy EP, Davis RB, Phillips RS (2000) Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med 132:697–704
Caan BJ, Aragaki A, Thomson CA et al (2009) Vasomotor symptoms, adoption of a low-fat dietary pattern, and risk of invasive breast cancer: a secondary analysis of the Women’s Health Initiative randomized controlled dietary modification trial. J Clin Oncol 27:4500–4507
Kaplan MA, Pekkolay Z, Kucukoner M et al (2012) Type 2 diabetes mellitus and prognosis in early stage breast cancer women. Med Oncol 29:1576–1580
Patterson RE, Flatt SW, Saquib N et al (2010) Medical comorbidities predict mortality in women with a history of early stage breast cancer. Breast Cancer Res Treat 122:859–865
Lipscombe LL, Goodwin PJ, Zinman B, McLaughlin JR, Hux JE (2008) The impact of diabetes on survival following breast cancer. Breast Cancer Res Treat 109:389–395
National Comprehensive Cancer Network (2012) NCCN clinical practice guidelines in oncology (NCCN guidelines) breast cancer version 3, 2012th edn. National Comprehensive Cancer Network, Fort Washington
Nekhlyudov L, Li L, Ross-Degnan D, Wagner AK (2011) Five-year patterns of adjuvant hormonal therapy use, persistence, and adherence among insured women with early-stage breast cancer. Breast Cancer Res Treat 130:681–689
Acknowledgments
This work was supported by a grant from the American Cancer Society (CRTG-03-024-01-CCE) and a cooperative agreement (U01CA63731) and grant (K05CA154337) from the National Cancer Institute.
Conflict of interest
All authors listed on the manuscript have met all three requirements for authorship as stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals and the authors declare that they have no conflicts of interest regarding this work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kamineni, A., Anderson, M.L., White, E. et al. Body mass index, tumor characteristics, and prognosis following diagnosis of early-stage breast cancer in a mammographically screened population. Cancer Causes Control 24, 305–312 (2013). https://doi.org/10.1007/s10552-012-0115-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-012-0115-7