Body mass and breast cancer: Relationship between method of detection and stage of disease

Reeves, Mathew J.; Newcomb, Polly A.; Remington, Patrick L.; Marcus, Pamela M.; MacKenzie, William R.

doi:10.1002/(sici)1097-0142(19960115)77:2<301::aid-cncr12>3.0.co;2-5

Cited by 65 publications

(49 citation statements)

References 33 publications

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“…Findings from this case -control study provide support for an association between obesity and later stage at diagnosis, as it has been reported in most previous studies, mostly case-series (Daniell, 1988;Ingram et al, 1989;Verreault et al, 1989;Reeves et al, 1996;Jones et al, 1997;Hall et al, 1999;Cui et al, 2002), with a few exceptions (Donegan et al, 1978;Howson et al, 1986). In addition, consideration of all tumour characteristics simultaneously, suggested that obesity is primarily associated with larger tumour size rather than nodal status, particularly among postmenopausal women.…”

Section: Discussionsupporting

confidence: 88%

Established breast cancer risk factors by clinically important tumour characteristics

et al. 2006

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Breast cancer is a morphologically and clinically heterogeneous disease; however, it is less clear how risk factors relate to tumour features. We evaluated risk factors by tumour characteristics (histopathologic type, grade, size, and nodal status) in a populationbased case -control of 2386 breast cancers and 2502 controls in Poland. Use of a novel extension of the polytomous logistic regression permitted simultaneous modelling of multiple tumour characteristics. Late age at first full-term birth was associated with increased risk of large (42 cm) tumours (odds ratios (95% confidence intervals) 1.19 (1.07 -1.33) for a 5-year increase in age), but not smaller tumours (P for heterogeneity adjusting for other tumour features (P het ) ¼ 0.007). On the other hand, multiparity was associated with reduced risk for small tumours (0.76 (0.68 -0.86) per additional birth; P het ¼ 0.004). Consideration of all tumour characteristics simultaneously revealed that current or recent use of combined hormone replacement therapy was associated with risk of small (2.29 (1.66 -3.15)) and grade 1 (3.36 (2.22 -5.08)) tumours (P het ¼ 0.05 for size and 0.0008 for grade 1 vs 3), rather than specific histopathologic types (P het ¼ 0.63 for ductal vs lobular). Finally, elevated body mass index was associated with larger tumour size among both pre-and postmenopausal women (P het ¼ 0.05 and 0.0001, respectively). None of these relationships were explained by hormone receptor status of the tumours. In conclusion, these data support distinctive risk factor relationships by tumour characteristics of prognostic relevance. These findings might be useful in developing targeted prevention efforts.

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Section: Discussionsupporting

confidence: 88%

Established breast cancer risk factors by clinically important tumour characteristics

et al. 2006

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“…This hypothesis is supported by several studies that show a positive relationship between breast size and stage of breast cancer. 11,18,28,30 Second, obesity may be associated with a more advanced stage at diagnosis because of an underlying endocrinologic abnormality related to tumor progression. [43][44][45][46] Some studies suggest that locally increased estrogen levels promote tumor growth.…”

Section: Discussionmentioning

confidence: 99%

Body mass and stage of breast cancer at diagnosis

Cui

Whiteman

Flaws

et al. 2001

Intl Journal of Cancer

156

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Obesity is a well-known risk factor for postmenopausal breast cancer. In contrast, the relationship between obesity and stage of breast cancer at diagnosis is less clear. We hypothesized that increased breast size in obese women may delay discovery of breast tumors. Thus, the purpose of our study was to examine whether there is an association between body mass and stage of breast cancer at diagnosis using hospital medical records. Newly diagnosed breast cancer cases (n ‫؍‬ 966) in the Baltimore metropolitan area from 1991 to 1997 were included in our study. Obesity is a well-known risk factor for breast cancer, with the effect being limited to postmenopausal women. [1][2][3][4][5][6][7][8][9] In premenopausal women, there is an inverse association between body mass and the risk of breast cancer, i.e., obese women are less likely to get breast cancer than nonobese women. In contrast, the relationship between obesity and stage at diagnosis in either premenopausal or postmenopausal women is less clear. This is partially because this relationship has not been studied in detail and the results from existing studies are equivocal. For example, several 10 -20 but not all 21,22 studies report that being overweight is associated with late stage at diagnosis. In addition, some studies report that both large tumor size and lymph node involvement are associated with higher body weight, 16,23,24 whereas other studies report that tumor size, but not lymph node involvement are associated with higher body weight. 17,[25][26][27][28] Furthermore, 1 study has reported that lymph node involvement, but not tumor size, is associated with obesity. 29 In obese women with larger breasts, palpation for lumps may be more difficult, resulting in delay in detection and diagnosis of breast cancer. This idea is supported by studies showing that women with large breasts (or bra size as a surrogate) are more likely to be diagnosed at a later stage of breast cancer than women with small breasts. 18,28,30 A study by Reeves et al. 11 reported that the positive association between body mass index (BMI) and stage was confined to tumors that were detected by women themselves. In a recent study, however, Hall et al. 18 reported that the observed positive association was not modified by method of detection.The purpose of our study was to help clarify the relationship between body mass and breast cancer by determining whether there is an association between obesity and stage of breast cancer at diagnosis. We also wished to determine whether there is a positive association between obesity and each of the 3 components for tumor staging (tumor size, node status and distant metastasis) and to explore whether the association between obesity and tumor stage was modified by age. MATERIAL AND METHODS Study subjectsThis is a case series study of breast cancer using data from hospital medical records. Breast cancer cases were obtained from 2 hospitals in the Baltimore metropolitan area. Although all recorded cases of breast cancer were obtained by the investig...

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“…Although several studies reported an association between increasing body mass index and advanced stage (Ingram et al, 1989;Hunter et al, 1993;Reeves et al, 1996) it is not clear why obese women seem to wait longer to present their breast cancer symptoms to a doctor. The results from our multivariable analyses indicate that the association between body mass index and patient delay is not explained by differences in health behaviour (as measured in our study), social class or education.…”

Section: Clinicalmentioning

confidence: 99%

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

et al. 2002

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Early diagnosis is a tenet in oncology and should enable early treatment with the expectation of improved outcome. Extent and determinants of patient delay of diagnosis in breast cancer patients and its impact on stage of disease were examined in a population based study among female breast cancer patients in Germany. Two hundred and eighty-seven women, aged 18 to 80 years with newly diagnosed invasive symptomatic breast cancer, were interviewed with respect to the diagnostic process. Patient delay was defined as time from onset of first symptoms to first consultation of a doctor. Median patient delay was 16 days among symptomatic patients. Eighteen per cent of all breast cancer patients waited longer than 3 months before consulting a physician. Long patient delay was associated with old age, history of a benign mastopathy, obesity, and indices of health behaviour such as not knowing a gynaecologist for out-patient care and non-participation in general health screening examinations. A strong association between patient delay and stage at diagnosis was observed for poorly differentiated tumours. These results suggest that at risk groups for delaying consultation can be identified and that a substantial proportion of late stage diagnoses of poorly differentiated breast cancer cases could be avoided if all patients with breast cancer symptoms would present to a doctor within 1 month.

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Body mass and breast cancer: Relationship between method of detection and stage of disease

Abstract: Greater body mass was associated with nonlocalized breast cancer; however, this association was restricted to women who detected their own cancer. No association was found between BMI and stage of disease among cases detected by either mammography or CBE.

Cited by 65 publications

References 33 publications

Established breast cancer risk factors by clinically important tumour characteristics

Established breast cancer risk factors by clinically important tumour characteristics

Body mass and stage of breast cancer at diagnosis

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

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