Skip to main content

Advertisement

SpringerLink
Log in

Body size, silhouette trajectory and the risk of breast cancer in a Moroccan case–control study

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Background

There is convincing evidence demonstrating that body size characteristics such as adiposity and height are associated with breast cancer in westernized countries. However, little is known about this relationship in North African countries currently undergoing nutritional transition and industrialization. The aim of this study was to explore associations between various body size characteristics, silhouette trajectories and the risk of breast cancer among Moroccan women.

Methods

In this case–control study conducted in the Fez region (2016–2017), detailed measures of body size were collected for 300 cases of breast cancer and 300 matched controls. Unconditional logistic regression was used to assess the association between body size and breast cancer risk adjusting for confounding factors.

Results

Higher waist circumference and hip circumference were positively associated with breast cancer risk in pre- (highest [T3] vs. lowest tertile [T1]: OR = 2.92, 95% confidence intervals [CI]: 1.33–6.42; OR = 3.00, 95% CI: 1.42–6.33, respectively) and post-menopausal women (T3 vs. T1: OR = 4.46, 95% CI: 1.86–10.66; OR = 4.08, 95% CI: 1.76–9.42, respectively). Body shape at younger ages (6–11 years) was inversely associated with the risk of breast cancer in premenopausal women (large vs. lean silhouette: OR = 0.31, 95% CI: 0.12–0.80). Women with the greatest increase in body shape trajectory had higher risk for both pre- and post-menopausal breast cancer (T3 vs. T1: OR = 2.74, 95% CI: 1.03–7.26; OR = 3.56, 95% CI: 1.34–9.44, respectively).

Conclusion

Our findings suggest that adiposity, body shape at younger ages, and silhouette trajectory may play a role in the development of pre- and post-menopausal breast cancer among Moroccan women. Larger-scale prospective studies are needed to confirm our findings and to explore these associations with breast cancer subtypes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. https://doi.org/10.3322/caac.21492.

    Article  PubMed  Google Scholar 

  2. The International Agency for Research on Cancer (2018) The Global Cancer Observatory (GCO). http://gco.iarc.fr/. Accessed 5 April 2019.

  3. Friedenreich CM. Review of anthropometric factors and breast cancer risk. Eur J Cancer Prev. 2001;10:15–32.

    Article  CAS  PubMed  Google Scholar 

  4. World Cancer Research Fund/American Institute for Cancer Research (2018) Diet, nutrition, physical activity and breast cancer. https://www.wcrf.org/dietandcancer. Accessed 10 Mar 2019.

  5. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78. https://doi.org/10.1016/S0140-6736(08)60269-X.

    Article  PubMed  Google Scholar 

  6. Premenopausal Breast Cancer Collaborative Group, Schoemaker MJ, Nichols HB, et al. Association of body mass index and age with subsequent breast cancer risk in premenopausal women. JAMA Oncol. 2018;4:e181771. https://doi.org/10.1001/jamaoncol.2018.1771.

    Article  Google Scholar 

  7. Chen G-C, Chen S-J, Zhang R, et al. Central obesity and risks of pre- and postmenopausal breast cancer: a dose-response meta-analysis of prospective studies. Obes Rev. 2016;17:1167–77. https://doi.org/10.1111/obr.12443.

    Article  PubMed  Google Scholar 

  8. Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature. BMJ. 2017;356:j477. https://doi.org/10.1136/bmj.j477.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Keum N, Greenwood DC, Lee DH, et al. Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst. 2015. https://doi.org/10.1093/jnci/djv088.

    Article  PubMed  Google Scholar 

  10. Shawon MSR, Eriksson M, Li J. Body size in early life and risk of breast cancer. Breast Cancer Res. 2017;19:84. https://doi.org/10.1186/s13058-017-0875-9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Baer HJ, Tworoger SS, Hankinson SE, Willett WC. Body fatness at young ages and risk of breast cancer throughout life. Am J Epidemiol. 2010;171:1183–94. https://doi.org/10.1093/aje/kwq045.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Haut-Commissariat au Plan du Maroc (2016) Les Indicateurs Sociaux 2013-2014. https://www.hcp.ma/region-drda/attachment/834622/. Accessed 8 April 2019.

  13. Khalis M, Chajès V, Moskal A, et al. Healthy lifestyle and breast cancer risk: a case-control study in Morocco. Cancer Epidemiol. 2018;58:160–6. https://doi.org/10.1016/j.canep.2018.12.012.

    Article  PubMed  Google Scholar 

  14. Townend J, Minelli C, Harrabi I, et al. Development of an international scale of socio-economic position based on household assets. Emerg Themes Epidemiol. 2015;12:13. https://doi.org/10.1186/s12982-015-0035-6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics Books; 1988.

    Google Scholar 

  16. Troy LM, Hunter DJ, Manson JE, et al. The validity of recalled weight among younger women. Int J Obes Relat Metab Disord. 1995;19:570–2.

    CAS  PubMed  Google Scholar 

  17. Stunkard AJ, Sorensen T, Schulsinger F (1983) Use of the Danish adoption register for the study of obesity and thinness. In Kety S (ed) The genetics of neurological and psychiatric disorders. New York, pp 115-20.

  18. Tehard B, van Liere MJ, Com Nougué C, Clavel-Chapelon F. Anthropometric measurements and body silhouette of women: validity and perception. J Am Diet Assoc. 2002;102:1779–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Jones B, Nagin DS. Advances in group-based trajectory modeling and an SAS procedure for estimating them. Stat Methods Res. 2007;35:542–71.

    Article  Google Scholar 

  20. Nagin DS. Analyzing developmental trajectories: a semiparametric, group-based approach. Psychol Methods. 1999;4:139–57.

    Article  Google Scholar 

  21. van den Brandt PA, Spiegelman D, Yaun SS, et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol. 2000;152:514–27.

    Article  PubMed  Google Scholar 

  22. Chen Y, Liu L, Zhou Q, et al. Body mass index had different effects on premenopausal and postmenopausal breast cancer risks: a dose-response meta-analysis with 3,318,796 subjects from 31 cohort studies. BMC Publ Health. 2017;17:936. https://doi.org/10.1186/s12889-017-4953-9.

    Article  Google Scholar 

  23. Cheraghi Z, Poorolajal J, Hashem T, et al. Effect of body mass index on breast cancer during premenopausal and postmenopausal periods: a meta-analysis. PLOS One. 2012;7:e51446. https://doi.org/10.1371/journal.pone.0051446.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Wada K, Nagata C, Tamakoshi A, et al. Body mass index and breast cancer risk in Japan: a pooled analysis of eight population-based cohort studies. Ann Oncol. 2014;25:519–24. https://doi.org/10.1093/annonc/mdt542.

    Article  CAS  PubMed  Google Scholar 

  25. Ogundiran TO, Huo D, Adenipekun A, et al. Case-control study of body size and breast cancer risk in Nigerian women. Am J Epidemiol. 2010;172:682–90. https://doi.org/10.1093/aje/kwq180.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jordan I, Hebestreit A, Swai B, Krawinkel MB. Breast cancer risk among women with long-standing lactation and reproductive parameters at low risk level: a case-control study in Northern Tanzania. Breast Cancer Res Treat. 2013;142:133–41. https://doi.org/10.1007/s10549-010-1255-7.

    Article  PubMed  Google Scholar 

  27. Amadou A, Hainaut P, Romieu I. Role of obesity in the risk of breast cancer: lessons from anthropometry. J Oncol. 2013;2013:906495. https://doi.org/10.1155/2013/906495.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Iyengar NM, Arthur R, Manson JE, et al. Association of body fat and risk of breast cancer in postmenopausal women with normal body mass index: a secondary analysis of a randomized clinical trial and observational study. JAMA Oncol. 2018. https://doi.org/10.1001/jamaoncol.2018.5327.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Argolo DF, Hudis CA, Iyengar NM. The impact of obesity on breast cancer. Curr Oncol Rep. 2018;20:47. https://doi.org/10.1007/s11912-018-0688-8.

    Article  PubMed  Google Scholar 

  30. Yager JD, Davidson NE. Mechanisms of disease: estrogen carcinogenesis in breast cancer. N Engl J Med. 2006;354:270–82.

    Article  CAS  PubMed  Google Scholar 

  31. Eliassen AH, Missmer SA, Tworoger SS, et al. Endogenous steroid hormone concentrations and risk of breast cancer among premenopausal women. J Natl Cancer Inst. 2006;98:1406–15. https://doi.org/10.1093/jnci/djj376.

    Article  CAS  PubMed  Google Scholar 

  32. Green J, Cairns BJ, Casabonne D, et al. 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. 2011;12:785–94. https://doi.org/10.1016/S1470-2045(11)70154-1.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tehard B, Clavel-Chapelon F. Several anthropometric measurements and breast cancer risk: results of the E3N cohort study. Int J Obes (Lond). 2006;30:156–63. https://doi.org/10.1038/sj.ijo.0803133.

    Article  CAS  Google Scholar 

  34. Verla-Tebit E, Chang-Claude J. Anthropometric factors and the risk of premenopausal breast cancer in Germany. Eur J Cancer Prev. 2005;14:419–26.

    Article  CAS  PubMed  Google Scholar 

  35. Silventoinen K. Determinants of variation in adult body height. J Biosoc Sci. 2003;35:263–85.

    Article  PubMed  Google Scholar 

  36. Endogenous Hormones and Breast Cancer Collaborative Group, Key TJ, Appleby PN, et al. 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. 2010;11:530–42. https://doi.org/10.1016/S1470-2045(10)70095-4.

    Article  CAS  Google Scholar 

  37. Huang Z, Willett WC, Colditz GA, et al. Waist circumference, waist:hip ratio, and risk of breast cancer in the Nurses’ Health Study. Am J Epidemiol. 1999;150:1316–24.

    Article  CAS  PubMed  Google Scholar 

  38. Rose DP, Haffner SM, Baillargeon J. Adiposity, the metabolic syndrome, and breast cancer in African-American and white American women. Endocr Rev. 2007;28:763–77. https://doi.org/10.1210/er.2006-0019.

    Article  CAS  PubMed  Google Scholar 

  39. Ogundiran TO, Huo D, Adenipekun A, et al. Body fat distribution and breast cancer risk: findings from the Nigerian breast cancer study. Cancer Causes Control. 2012;23:565–74. https://doi.org/10.1007/s10552-012-9916-y.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Harvie M, Hooper L, Howell AH. Central obesity and breast cancer risk: a systematic review. Obes Rev. 2003;4:157–73.

    Article  CAS  PubMed  Google Scholar 

  41. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body fatness and cancer-viewpoint of the IARC working group. N Engl J Med. 2016;375:794–8. https://doi.org/10.1056/NEJMsr1606602.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rosner B, Eliassen AH, Toriola AT, et al. Weight and weight changes in early adulthood and later breast cancer risk. Int J Cancer. 2017;140:2003–14. https://doi.org/10.1002/ijc.30627.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Ma H, Ursin G, Xu X, et al. Body mass index at age 18 years and recent body mass index in relation to risk of breast cancer overall and ER/PR/HER2-defined subtypes in white women and African-American women: a pooled analysis. Breast Cancer Res. 2018;20:5. https://doi.org/10.1186/s13058-017-0931-5.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bandera EV, Chandran U, Hong C-C, et al. Obesity, body fat distribution, and risk of breast cancer subtypes in African American women participating in the AMBER Consortium. Breast Cancer Res Treat. 2015;150:655–66. https://doi.org/10.1007/s10549-015-3353-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Krishnan K, Bassett JK, MacInnis RJ, et al. Associations between weight in early adulthood, change in weight, and breast cancer risk in postmenopausal women. Cancer Epidemiol Biomark Prev. 2013;22:1409–16. https://doi.org/10.1158/1055-9965.EPI-13-0136.

    Article  Google Scholar 

  46. Robinson WR, Tse CK, Olshan AF, Troester MA. Body size across the life course and risk of premenopausal and postmenopausal breast cancer in Black women, the Carolina Breast Cancer Study, 1993–2001. Cancer Causes Control. 2014;25:1101–17. https://doi.org/10.1007/s10552-014-0411-5.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Cao S, Zhou J, Zhu Z, et al. Adult weight change and the risk of pre- and postmenopausal breast cancer in the Chinese Wuxi Exposure and Breast Cancer Study. Breast Cancer Res Treat. 2018. https://doi.org/10.1007/s10549-018-5016-3.

    Article  PubMed  Google Scholar 

  48. Han D, Nie J, Bonner MR, et al. 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. 2006;119:2931–7. https://doi.org/10.1002/ijc.22236.

    Article  CAS  PubMed  Google Scholar 

  49. Andersen ZJ, Baker JL, Bihrmann K, et al. Birth weight, childhood body mass index, and height in relation to mammographic density and breast cancer: a register-based cohort study. Breast Cancer Res. 2014;16:R4. https://doi.org/10.1186/bcr3596.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Berkey CS, Frazier AL, Gardner JD, Colditz GA. Adolescence and breast carcinoma risk. Cancer. 1999;85:2400–9. https://doi.org/10.1002/(sici)1097-0142(19990601)85:11%3c2400:aid-cncr15%3e3.0.co;2-o.

    Article  CAS  PubMed  Google Scholar 

  51. Amadou A, Torres Mejia G, Fagherazzi G, et al. Anthropometry, silhouette trajectory, and risk of breast cancer in Mexican women. Am J Prev Med. 2014;46:S52–64. https://doi.org/10.1016/j.amepre.2013.10.024.

    Article  PubMed  Google Scholar 

  52. Song M, Willett WC, Hu FB, et al. Trajectory of body shape across the lifespan and cancer risk. Int J Cancer. 2016;138:2383–95. https://doi.org/10.1002/ijc.29981.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Maghous A, Rais F, Ahid S, et al. Factors influencing diagnosis delay of advanced breast cancer in Moroccan women. BMC Cancer. 2016;16:356. https://doi.org/10.1186/s12885-016-2394-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We are very grateful to all women who generously participated in the study. We would like to thank all the staff in the participated centers for their cooperation and for their assistance in data collection.

Funding

This study was financially supported by Moffitt Cancer Center under the NIH International Fogarty Center for the Award number 5D43TW009804, PI Anna Giuliano.

Author information

Authors and Affiliations

  1. School of Public Health, Mohammed VI University of Health Sciences, Anfa City : Bld Mohammed Taïeb Naciri, Hay Hassani, 82 403, Casablanca, Morocco

    Mohamed Khalis & Chakib Nejjari

  2. UCBL, Ifsttar, UMRESTTE, University of Lyon, Lyon, France

    Mohamed Khalis, Emmanuel Fort & Barbara Charbotel

  3. Nutrition and Metabolism Section, International Agency for Research On Cancer, Lyon, France

    Laure Dossus, Sabina Rinaldi, Carine Biessy, Aurélie Moskal, Mathilde His, Isabelle Romieu, Véronique Chajès, Marc J. Gunter & Inge Huybrechts

  4. Department of Research and Development, Hassan II University Hospital of Fez, Fez, Morocco

    Hafida Charaka

  5. Department of Oncology, Hassan II University Hospital of Fez, Fez, Morocco

    Nawfel Mellas

  6. Department of Community Health and Social Medicine, School of Medicine, City University of New York, New York, USA

    Amr S. Soliman

  7. Department of Epidemiology, Faculty of Medicine and Pharmacy, Fez, Morocco

    Karima El Rhazi

Authors
  1. Mohamed Khalis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laure Dossus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sabina Rinaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carine Biessy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aurélie Moskal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hafida Charaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emmanuel Fort
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mathilde His
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nawfel Mellas
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chakib Nejjari
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Barbara Charbotel
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Amr S. Soliman
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Isabelle Romieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Véronique Chajès
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Marc J. Gunter
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Inge Huybrechts
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Karima El Rhazi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed Khalis.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committees. The protocol of the study was approved by the Faculty of Medicine and Pharmacy of Casablanca Research Ethics Committee and the National Control Commission for the Protection of Personal Data (No. A-RS-192-2015).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khalis, M., Dossus, L., Rinaldi, S. et al. Body size, silhouette trajectory and the risk of breast cancer in a Moroccan case–control study. Breast Cancer 27, 748–758 (2020). https://doi.org/10.1007/s12282-020-01072-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-020-01072-5

Keywords

Search

Navigation