General and Abdominal Obesity and Survival among Young Women with Breast Cancer

Abstract

Among postmenopausal women, obesity is linked to increased risk of breast cancer and poorer subsequent survival. For premenopausal women, obesity may reduce incidence, but less is known about its effect on prognosis, particularly for abdominal obesity. This study investigated whether general or abdominal obesity at diagnosis influenced survival in a cohort of young women with breast cancer. A population-based follow-up study was conducted among 1,254 women ages 20 to 54 who were diagnosed with invasive breast cancer between 1990 and 1992 in Atlanta or New Jersey. Women were interviewed within several months of diagnosis and asked about their weight and height at age 20 and in the year before diagnosis. Study personnel did anthropometric measures at the interview. With 8 to 10 years of follow-up, all-cause mortality status was determined using the National Death Index (n = 290 deaths). Increased mortality was observed for women who were obese [body mass index (BMI), z30] at the time of interview compared with women of ideal weight [BMI,; stage-and income-adjusted hazard ratio (HR), 1.48; 95% confidence interval (95% CI), 1.09-2.01]. A similar result was seen for the highest versus lowest quartile of waist-to-hip ratio (HR, 1.52; 95% CI, 1.05-2.19). Strong associations with mortality were found for women who were obese at age 20 (HR, 2.49; 95% CI, 1.15-5.37) or who were overweight/obese (BMI, z25) at both age 20 and the time of interview (HR, 2.22; 95% CI, 1. 45-3.40). This study provides evidence that breast cancer survival is reduced among younger women with general or abdominal obesity.

Body weight and risk of breast cancer in BRCA1/2 mutation carriers

“…The association between obesity and poor overall survival [18,[24][25][26] or prognosis of breast cancer [17,[27][28][29], might, if also true for BRCA1/2 carriers, have influenced our study results. The inclusion of prevalent cases, may have led toward bias to the null, overweight/obese prevalent cases may have been underrepresented because they had died prior to study entry [24,27,28].…”

“…The inclusion of prevalent cases, may have led toward bias to the null, overweight/obese prevalent cases may have been underrepresented because they had died prior to study entry [24,27,28]. We reduced this potential survival bias by restricting the analyses to personyears within 10 years prior to questionnaire completion.…”

“…Previous studies showed that excess body weight (defined as overweight (BMI between 25.0 and 29.9 kg/m 2 ) or obesity (BMI C 30.0 kg/m 2 ) decreases overall survival [18,[24][25][26] and breast cancer-specific survival [17,[27][28][29]. The association between obesity and poor prognosis of breast cancer was present in both pre-and postmenopausal carriers.…”

Obesity and Ovarian Cancer Survival: A Systematic Review and Meta-analysis

“…To date, no studies have examined other measures of obesity, such as waist-hip ratio (WHR), which has been shown to be associated with reduced survival in women with breast cancer (45,46). WHR considers the anatomic distribution of adipose tissue, which is a more accurate indicator of metabolic stress associated with increased adiposity, particularly when compared with BMI, which is unable to distinguish lean muscle mass from fat mass (47)(48)(49).…”

The molecular contribution of TNF-α in the link between obesity and breast cancer

“…Obesity is a risk factor for the development of postmenopausal breast cancer (1)(2)(3). Despite numerous studies, the molecular mechanism by which obesity may contribute to breast cancer aetiology and progression is still poorly understood, suggesting a complex multi-mechanism of interaction.…”