Abstract
Purpose
To evaluate how the association between body size and breast cancer risk varies by tumor receptor subtype, host factors, and other exposures among women in the California Teachers Study cohort.
Methods
Among 52,642 postmenopausal women, 2,321 developed invasive breast cancer with known estrogen- and progesterone-receptor status (1,652 ER+PR+, 338 ER+PR−, and 312 ER−PR−) between 1995 and 2007. In a subset of 35,529 with waist circumference data, 1,377 developed invasive breast cancer with known ERPR status (991 ER+PR+, 208 ER+PR−, 169 ER−PR−) between 1997 and 2007. Multivariate Cox regression was performed to estimate relative risks (RR) and 95% confidence intervals (CI).
Results
Obesity, adult weight gain of ≥40 pounds, greater abdominal adiposity, and greater height increased the risk of ER+PR+ breast cancer. The increased risk associated with postmenopausal obesity was limited to those who did not use hormone therapy (HT) at cohort entry (RR = 1.37; 95% CI, 1.05–1.78 for BMI ≥ 30 vs. < 25 kg/m2; p-interaction = 0.14) and those who were not overweight or obese at age 18 (p-interaction = 0.06). The increased risk associated with greater abdominal adiposity was limited to those who were not also overweight or obese (p-interaction = 0.01). Neither obesity, abdominal adiposity, nor height was associated with the risk of ER−PR− tumors.
Conclusions
The effects of body size on postmenopausal breast cancer risk differed by hormone receptor subtype, and among women with ER+PR+ tumors, by HT use and early adult body size.
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Abbreviations
- BMI:
-
Body mass index
- CTS:
-
California Teachers Study
- EPT:
-
Combined estrogen plus progesterone therapy
- ER:
-
Estrogen receptor
- ET:
-
Estrogen-only therapy
- HT:
-
Hormone therapy
- PR:
-
Progesterone receptor
References
World Cancer Research Fund and the American Institute for Cancer Research (2007) Food, nutrition, physical activity and the prevention of cancer: a global perspective. AICR, Washington, DC
Calle EE, Kaaks R (2004) Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 4:579–591
Key T, Appleby P, Barnes I, Reeves G (2002) Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst 94:606–616
Ahn J, Schatzkin A, Lacey JV Jr et al (2007) Adiposity, adult weight change, and postmenopausal breast cancer risk. Arch Intern Med 167:2091–2102
Ballard-Barbash R, Schatzkin A, Carter CL (1990) Body fat distribution and breast cancer in the Framingham study. J Natl Cancer Inst 82:286–290
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 Biomark Prev 13:220–224
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 13:1558–1568
Anderson WF, Jatoi I, Devesa SS (2005) Distinct breast cancer incidence and prognostic patterns in the NCI’s SEER program: suggesting a possible link between etiology and outcome. Breast Cancer Res Treat 90:127–137
Yang XR, Chang-Claude J, Goode EL et al (2011) Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the breast cancer association consortium studies. J Natl Cancer Inst 103:250–263
Cotterchio M, Kreiger N, Theis B, Sloan M, Bahl S (2003) Hormonal factors and the risk of breast cancer according to estrogen- and progesterone-receptor subgroup. Cancer Epidemiol Biomark Prev 12:1053–1060
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 Biomark Prev 9:681–687
Feigelson HS, Patel AV, Teras LR, Gansler T, Thun MJ, Calle EE (2006) Adult weight gain and histopathologic characteristics of breast cancer among postmenopausal women. Cancer 107:12–21
Huang WY, Newman B, Millikan RC, Schell MJ, Hulka BS, Moorman PG (2000) Hormone-related factors and risk of breast cancer in relation to estrogen receptor and progesterone receptor status. Am J Epidemiol 151:703–714
Li CI, Malone KE, Daling JR (2006) Interactions between body mass index and hormone therapy and postmenopausal breast cancer risk (United States). Cancer Causes Control 17:695–703
Rosenberg LU, Einarsdottir K, Friman EI et al (2006) Risk factors for hormone receptor-defined breast cancer in postmenopausal women. Cancer Epidemiol Biomark Prev 15:2482–2488
Setiawan VW, Monroe KR, Wilkens LR, Kolonel LN, Pike MC, Henderson BE (2009) Breast cancer risk factors defined by estrogen and progesterone receptor status: the multiethnic cohort study. Am J Epidemiol 169:1251–1259
Suzuki R, Rylander-Rudqvist T, Ye W, Saji S, Wolk A (2006) Body weight and postmenopausal breast cancer risk defined by estrogen and progesterone receptor status among Swedish women: a prospective cohort study. Int J Cancer 119:1683–1689
Wenten M, Gilliland FD, Baumgartner K, Samet JM (2002) Associations of weight, weight change, and body mass with breast cancer risk in hispanic and non-hispanic white women. Ann Epidemiol 12:435–440
Berstad P, Coates RJ, Bernstein L et al (2010) A case-control study of body mass index and breast cancer risk in white and African-American women. Cancer Epidemiol Biomark Prev 19:1532–1544
Lahmann PH, Hoffmann K, Allen N et al (2004) Body size and breast cancer risk: findings from the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer 111:762–771
Morimoto LM, White E, Chen Z et al (2002) Obesity, body size, and risk of postmenopausal breast cancer: the women’s health initiative (United States). Cancer Causes Control 13:741–751
Trentham-Dietz A, Newcomb PA, Egan KM et al (2000) Weight change and risk of postmenopausal breast cancer (United States). Cancer Causes Control 11:533–542
Meijer K, de Vries M, Al-Lahham S et al (2011) Human primary adipocytes exhibit immune cell function: adipocytes prime inflammation independent of macrophages. PLoS One 6:e17154
Rodriguez-Acebes S, Palacios N, Botella-Carretero J et al (2010) Gene expression profiling of subcutaneous adipose tissue in morbid obesity using a focused microarray: distinct expression of cell-cycle- and differentiation-related genes. BMC Med Genomics 3:1–15
Srdic B, Stokic E, Korac A, Ukropina M, Velickovic K, Breberina M (2010) Morphological characteristics of abdominal adipose tissue in normal-weight and obese women of different metabolic profiles. Exp Clin Endocrinol Diabetes 118:713–718
Villa J, Pratley RE (2011) Adipose tissue dysfunction in polycystic ovary syndrome. Curr Diab Rep 11:179–184
Friedenreich CM, Courneya KS, Bryant HE (2002) Case-control study of anthropometric measures and breast cancer risk. Int J Cancer 99:445–452
Huang Z, Willett WC, Colditz GA et al (1999) Waist circumference, waist: hip ratio, and risk of breast cancer in the nurses’ health study. Am J Epidemiol 150:1316–1324
Bernstein L, Allen M, Anton-Culver H et al (2002) High breast cancer incidence rates among California teachers: results from the California teachers study (United States). Cancer Causes Control 13:625–635
Molarius A, Seidell JC (1998) Selection of anthropometric indicators for classification of abdominal fatness–a critical review. Int J Obes Relat Metab Disord 22:719–727
Horn-Ross PL, Lee VS, Collins CN et al (2008) Dietary assessment in the California teachers study: reproducibility and validity. Cancer Causes Control 19:595–603
Kushi LH, Kaye SA, Folsom AR, Soler JT, Prineas RJ (1988) Accuracy and reliability of self-measurement of body girths. Am J Epidemiol 128:740–748
Hofer BM, Kwong SL, Allen M, Bates JM, Snipes KP (2010) Cancer in California, 1988–2007. California Department of Public Health, Cancer Surveillance Section, Sacramento, CA
Allison PD (1995) Survival analysis using SAS: a practical guide. SAS Institute Inc, Cary, NC
Potter JD, Cerhan JR, Sellers TA et al (1995) Progesterone and estrogen receptors and mammary neoplasia in the Iowa women’s health study: how many kinds of breast cancer are there? Cancer Epidemiol Biomark Prev 4:319–326
Palmer JR, Adams-Campbell LL, Boggs DA, Wise LA, Rosenberg L (2007) A prospective study of body size and breast cancer in black women. Cancer Epidemiol Biomark Prev 16:1795–1802
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 124:698–712
Vrieling A, Buck K, Kaaks R, Chang-Claude J (2010) Adult weight gain in relation to breast cancer risk by estrogen and progesterone receptor status: a meta-analysis. Breast Cancer Res Treat 123:641–649
Colditz GA, Rosner B (2000) Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the nurses’ health study. Am J Epidemiol 152:950–964
Green J, Cairns BJ, Casabonne D et al (2011) Height and cancer incidence in the million women study: prospective cohort, and meta-analysis of prospective studies of height and total cancer risk. Lancet Oncol 12:785–794
Bao PP, Shu XO, Gao YT et al (2011) Association of hormone-related characteristics and breast cancer risk by estrogen receptor/progesterone receptor status in the shanghai breast cancer study. Am J Epidemiol 174:661–671
Pinheiro RL, Sarian LO, Pinto-Neto AM, Morais S, Costa-Paiva L (2010) Waist circumference and waist to hip ratio do not contribute additional information on hormone receptor status of breast tumors in obese women. Breast J 16:323–324
Ma H, Wang Y, Sullivan-Halley J et al (2009) Breast cancer receptor status: do results from a centralized pathology laboratory agree with SEER registry reports? Cancer Epidemiol Biomark Prev 18:2214–2220
Marshall SF, Clarke CA, Deapen D, et al. (2010) Recent breast cancer incidence trends according to hormone therapy use: the California teachers study. Breast Cancer Res 12:R4
Acknowledgments
This research was supported by grant R01 CA77398 from the National Cancer Institute and contract 97-10500 from the California Breast Cancer Research Fund. The funding sources did not contribute to the design or conduct of the study, nor to the writing or submission of this manuscript. The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000036C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement # 1U58 DP000807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred. The authors would like to thank Jane Sullivan-Halley for substantial technical assistance with quality control work on the height and weight variables and the CTS Steering Committee who are responsible for the formation and maintenance of the cohort within which this study was conducted but who are not included as authors on the current paper: Ellen T. Chang, Dennis Deapen, James Lacey, Jr, David Nelson, Susan Neuhausen, Peggy Reynolds, Frederick Schumacher, Sophia Wang, and Argyrios Ziogas.
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The authors declare that they have no conflict of interest.
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Canchola, A.J., Anton-Culver, H., Bernstein, L. et al. Body size and the risk of postmenopausal breast cancer subtypes in the California Teachers Study cohort. Cancer Causes Control 23, 473–485 (2012). https://doi.org/10.1007/s10552-012-9897-x
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DOI: https://doi.org/10.1007/s10552-012-9897-x