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Is obesity an independent prognosis factor in woman breast cancer?

  • Epidemiology
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Abstract

Background Breast cancer and obesity represent important public health issues in most western countries. A number of studies found a negative prognosis effect of obesity or excess of weight in woman breast cancer. However, to date, this issue remains controversial. The objectives of this study were to confirm the prognosis role of obesity on a large cohort of patients and to investigate a potential independent effect. Materials and methods We constituted a cohort of 14,709 patients who were recruited and treated at the Curie Institute (Paris) from 1981 to 1999. These patients were followed prospectively for a first unilateral invasive breast cancer without distant metastasis. Obesity was defined by a Body Mass Index (BMI) above 30 kg/m2 according to the World Health Organization recommendations. Results Obese patients (8%) presented more extended tumors at diagnosis time suggesting a delayed breast cancer diagnosis. However, obesity appeared as a negative prognosis factor for several events in respectively univariate and multivariate survival analysis: metastasis recurrence (HR = 1.32[1.19–1.48]; HR = 1.12[1.00–1.26]), disease free interval (1.20[1.08–1.32]; 1.10[0.99–1.22]), overall survival (1.43[1.28–1.60]; 1.12[0.99–1.25]) and second primary cancer outcome (1.57[1.19–2.07]; 1.43[1.09–1.89]). Even if obese patients presented more advanced tumors at diagnosis time, multivariate analysis showed that there was a relevant independent effect. Other BMI codings, distinguishing overweight patients or using BMI as a continuous variable, showed a consistent correlation between BMI’s value and prognosis effect. Interaction analysis revealed a more important obesity effect in the presence of tumor estrogen receptors and among limited extent tumors. Conclusions This survey confirms the prognosis role of obesity on one of the largest cohort by investigating several prognosis events. While independent obesity effect linked to hormonal disorders appeared consistent as obesity’s mechanism, we stress that obesity prognosis effect was also related to breast cancer presentation at diagnosis time.

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Acknowledgements

The author would like to thank Foundation of France (Fondation de France) and FNCLCC (Fédération Nationale des Centres de Lutte Contre le Cancer) for their financial support that permitted this research. The author is also grateful to Chantal Gautier and René ESSER for their constant support.

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Authors and Affiliations

  1. Biostatistics Department, Curie Institute, 26 rue d’Ulm, 75005, Paris, France

    Bilal Majed & Bernard Asselain

  2. 12 rue Dambrine, 62000, Arras, France

    Bilal Majed

  3. INSERM UNIT 780: Epidemiology and Biostatistics, Paul-Brousse Hospital, 16 avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France

    Thierry Moreau

  4. WHO, Lyon, France

    Kamel Senouci

  5. Breast Cancer Group, Curie Institute, 26 rue d’Ulm, 75005, Paris, France

    Rémi J. Salmon & Alain Fourquet

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Majed, B., Moreau, T., Senouci, K. et al. Is obesity an independent prognosis factor in woman breast cancer?. Breast Cancer Res Treat 111, 329–342 (2008). https://doi.org/10.1007/s10549-007-9785-3

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