Methodological considerations for disentangling a risk factor's influence on disease incidence versus postdiagnosis survival: The example of obesity and breast and colorectal cancer mortality in the <scp>W</scp>omen's <scp>H</scp>ealth <scp>I</scp>nitiative

Feliciano, Elizabeth M. Cespedes; Prentice, Ross L.; Aragaki, Aaron K.; Neuhouser, Marian L.; Banack, Hailey R.; Ho, Gloria Y.F.; Zaslavsky, Oleg; Strickler, Howard D.; Cheng, Ting; Chlebowski, Rowan T.; Saquib, Nazmus; Nassir, Rami; Anderson, Garnet L.; Caan, Bette J.

doi:10.1002/ijc.30931

Cited by 20 publications

(14 citation statements)

References 27 publications

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“…This is further supported by a study on the relation between BMI and PCa progression in patients with low‐risk PCa on active surveillance 31 . However, it is possible that the net negative association between BMI and the risk of low‐risk PCa, through collider stratification bias (selection bias due to the analysis of cases only), causes spurious positive associations with BMI in prognostic analyses of this tumour group 32,33 . However, the adjustments for many important confounders would reduce the risk of collider bias influencing our results, although uncontrolled factors, such as genetics, could still be involved.…”

Section: Discussionsupporting

confidence: 63%

Height, body mass index and prostate cancer risk and mortality by way of detection and cancer risk category

Jochems

Stattin

Häggström

et al. 2020

Intl Journal of Cancer

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Obesity is a risk factor for advanced, but not localised, prostate cancer (PCa), and for poor prognosis. However, the detection of localised PCa through asymptomatic screening might influence these associations. We investigated height and body mass index (BMI) among 431 902 men in five Swedish cohorts in relation to PCa risk, according to cancer risk category and detection mode, and PCa-specific mortality using Cox regression. Statistical tests were two-sided. Height was positively associated with localised intermediate-risk PCa (HR per 5 cm, 1.03, 95% CI 1.01-1.05), while overweight and obesity were negatively associated with localised low-and intermediate-risk PCa (HRs per 5 kg/m 2 , 0.86, 95% CI 0.81-0.90, and 0.92, 95% CI 0.88-0.97). However, these associations were partially driven by PCa's detected by asymptomatic screening and, for height, also by symptoms unrelated to PCa. The HR of localised PCa's, per 5 kg/m 2 , was 0.88, 95% CI 0.83 to 0.92 for screen-detected PCa's and 0.96, 95% CI 0.90 to 1.01 for PCa's detected through lower urinary tract symptoms. BMI was positively associated with PCa-specific mortality in the full population and in case-only analysis of each PCa risk category (HRs per 5 kg/m 2 , 1.11-1.22, P for heterogeneity = .14). More active health-seeking behaviour among tall and normal-weight men may partially explain their higher risk of localised PCa. The higher PCa-specific mortality among obese men across all PCa risk categories in our study suggests obesity as a potential target to improve the prognosis of obese PCa patients. K E Y W O R D S body mass index, body size, height, observational research, prostate cancer 1 | INTRODUCTION Obesity is an established risk factor for several cancer forms, 1 but the association with prostate cancer (PCa) is complex. While high body mass index (BMI), a marker of general obesity, has been negatively

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Section: Discussionsupporting

confidence: 63%

Height, body mass index and prostate cancer risk and mortality by way of detection and cancer risk category

Jochems

Stattin

Häggström

et al. 2020

Intl Journal of Cancer

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“…Most research studies that have assessed BMI more than about 5 years before diagnosis has reported a positive association with all‐cause mortality and endometrial‐cancer specific mortality 28–30,35,74 . However, these associations between pre‐diagnosis BMI and cancer mortality are often limited by the fact that they cannot differentiate the extent to which the association is driven by the relationship between BMI and cancer incidence versus survival 75 . Few studies have assessed the relationship between obesity and mortality after endometrial cancer diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Obesity and mortality among endometrial cancer survivors: A systematic review and meta‐analysis

et al. 2021

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Summary Excess body fat is a major risk factor for endometrial cancer incidence, but its impact on recurrence and survival remains unclear. The aim of this systematic review and meta‐analysis was to assess the association between excess body fat with recurrence, cancer‐specific, and all‐cause mortality among endometrial cancer survivors. We searched MEDLINE and EMBASE databases up to July 2021. Risk of bias was assessed with the Ottawa Newcastle Scale. Random effects models estimated pooled hazard ratios for the main associations between body mass index (BMI) and survival outcomes and stratified by endometrial cancer type. Potential heterogeneity and publication bias were evaluated with sensitivity analyses, funnel plots, and Egger's test. Forty‐six studies were included, of which 45 estimated body fat with BMI and six used direct waist circumference measures or CT/MRI scans. Higher BMI (≥30 kg/m2) was associated with increased all‐cause mortality (HR = 1.34, 95%CI = 1.12–1.59) and recurrence (HR = 1.28, 95%CI = 1.06–1.56). In sub‐group analysis, associations between higher BMI and all‐cause mortality were observed for both Types I and II survivors, while recurrence associations were only significant among Type I cases. Obesity at endometrial cancer diagnosis was associated with increased cancer recurrence and all‐cause mortality among endometrial cancer survivors but not endometrial cancer‐specific mortality.

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“…In the first approach we used the full‐cohort and follow‐up was from the date of baseline examination. Results from this analysis reflect the influence of the metabolic factors on both the incidence and survival of BC, however, they are unlikely to suffer from selection bias 23,24 . In the second approach, we analyzed the survival of BC cases, which allowed us to adjust for tumor characteristics, co‐morbidities and types of BC‐related treatment; factors that have a large bearing on BC‐specific survival.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies investigated associations either from the time of study enrollment (in the full population), or from the time of diagnosis (among cases only), but not both. Investigating either time‐line has advantages, but may also introduce certain biases that could be mitigated by investigating both time‐lines 21‐24 …”

Section: Introductionmentioning

confidence: 99%

Association between blood pressure and BMI with bladder cancer risk and mortality in 340,000 men in three Swedish cohorts

et al. 2021

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Background The relation between obesity, blood pressure (BP) and bladder cancer (BC) risk and mortality remains unclear, partially due to potential confounding by smoking, the strongest risk factor for BC, and not accounting for tumor stage and grade in such studies. We investigated body mass index (BMI) and BP in relation to BC risk by stage and grade, and BC‐specific mortality, including separately among never‐smokers aimed at minimizing confounding by smoking. Methods We analyzed 338,910 men from three Swedish cohorts, with 4895 incident BC's (940 among never‐smokers) during follow‐up. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals adjusted for smoking status. HRs for BMI and BP were corrected for their regression dilution ratios, calculated from 280,456 individuals with 758,641 observations. Results Body mass index was positively associated with non‐muscle invasive BC (NMIBC, HR per 5 kg/m2, 1.10 [1.02–1.19]) and NMIBC grade 3 (HR 1.17 [1.01–1.34]) in the full cohort, with similar effect sizes, albeit non‐significant, among never‐smokers. Systolic BP was positively associated with muscle‐invasive BC (MIBC, HR per 10 mmHg, 1.25 [1.00–1.55]) and BC‐specific mortality (HR 1.10 [1.01–1.20]) among never‐smokers, with weaker and non‐significant associations in the full cohort. Conclusions In an analyses of BMI, BP and BC risk by stage and grade among men, we found modest positive associations between BMI and NMIBC and NMIBC grade 3. SBP was positively associated with MIBC and BC‐specific mortality in an analysis of never‐smokers, which may reflect the association, un‐confounded by smoking, also in a broader population.

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Methodological considerations for disentangling a risk factor's influence on disease incidence versus postdiagnosis survival: The example of obesity and breast and colorectal cancer mortality in the Women's Health Initiative

Cited by 20 publications

References 27 publications

Height, body mass index and prostate cancer risk and mortality by way of detection and cancer risk category

Height, body mass index and prostate cancer risk and mortality by way of detection and cancer risk category

Obesity and mortality among endometrial cancer survivors: A systematic review and meta‐analysis

Association between blood pressure and BMI with bladder cancer risk and mortality in 340,000 men in three Swedish cohorts

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