Summary To examine the relationship between body weight and vascular invasion (VI) around tumours in post-menopausal women with operable breast cancer, a retrospective study was conducted of 393 patients treated in a breast unit between 1987 and 1991. Weight was measured at the time of diagnosis. Vascular invasion was recorded as being present or absent. Vascular invasion was seen in slightly more of the 50 perimenopausal patients than in the 343 post-menopausal women (44% vs 36%). In the tumour specimens from post-menopausal patients weighing <50 kg, VI was observed in 11% compared with 45% of those weighing more than 80 kg (P = 0.02). Furthermore, the 5-year survival of those with VI was 74% compared with 91% for those without (P < 0.0001). Menopausal status and body weight may influence survival in patients with breast cancer, possibly as a result of the presence of unopposed circulating oestrogens at the time of surgery. Oestrogens may alter cohesiveness of breast cancer cells and modulate secretion of proteases, thereby influencing invasive potential.Excision of tumours in such an environment may have a deleterious impact on survival.Keywords: breast cancer; prognosis; weight; post-menopausal women; vascular invasionThe prognosis of women with operable breast cancer depends upon tumour type, axillary nodal involvement and also menopausal status (Adami et al, 1986;Caleffi et al, 1989). Premenopausal cases have the lowest hazard rates for relapse and death. Rates are intermediate in post-menopausal women and the highest rates are found in perimenopausal women, that is those within 5 years of last menstrual period (Langlands et al, 1989). The observed differences may be due to the different hormonal environment to which tumours are exposed in these three groups of women.Survival has been shown to be inversely related to body weight in the majority of studies (Boyd et al, 1981; Tartter et al, 1981;Newman et al, 1986;Tretli et al, 1990; Senie et al, 199 la;Vatten et al, 1991), but such a relationship is less obvious in premenopausal women (Greenberg et al, 1985). Although there is a relation between body weight and other prognostic factors, such as tumour size and axillary lymph node involvement, the effect of obesity remains an independent factor in multivariate analysis (Tarttar et al, 1981;Vatten et al, 1991). The mechanism through which menopausal status and body weight influence survival is uncertain, although it is known that most circulating oestrogens in postmenopausal women are derived from peripheral aromatization of adrenal androgens in subcutaneous fat. Thus, more obese women have higher plasma levels of oestrogens (Grodin et al, 1973).Additionally, the impact of obesity on survival is more pronounced among those women with oestrogen receptor-positive breast cancers (Verreault et al, 1989).The risk of relapse and death also depends upon the metastatic potential of the tumour as manifested by the presence of malignant Correspondence to: IS Fentiman cells in lymphatic channels and blood vessels (vascu...