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Pre-diagnosis body mass index and survival after breast cancer in the After Breast Cancer Pooling Project

  • Epidemiology
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Abstract

Obese and underweight women who develop breast cancer may have poorer survival compared with normal-weight women. However, the optimal weight for best prognosis is still under study. We conducted a prospective investigation of pre-diagnosis body mass index (BMI) and mortality among 14,948 breast cancer patients in the After Breast Cancer Pooling Project. Breast cancer patients diagnosed from 1990 to 2006 with AJCC Stage I–III breast tumors were drawn from four prospective cohorts. Hazard ratios (HR) and 95% confidence intervals (CI) representing the associations of BMI categories (World Health Organization international classifications) with recurrence and mortality were estimated using delayed entry Cox proportional hazards models. Obese (30 to <35 kg/m2), severely obese (35 to <40 kg/m2), and morbidly obese (≥40 kg/m2) were examined. After a mean follow-up of 7.8 years, 2,140 deaths and 2,065 recurrences were documented. Both underweight (HR = 1.59; 95% CI: 1.18, 2.13) and morbidly obese women (HR = 1.81; 95% CI: 1.42, 2.32) had the greatest risk of overall mortality compared with normal weight (18.5–24.9 kg/m2) women. Severe obesity (HR = 1.09; 95% CI: 0.88, 1.36) and obesity (HR = 1.11; 95% CI: 0.97, 1.27) were related to small non-significant increased risks. Overweight (25.0–29.9 kg/m2) was not associated with any excess risk compared with normal weight. Similar associations were found for breast cancer death and non-breast cancer death but not recurrence. Women who were underweight and morbidly obese before breast cancer diagnosis were at the greatest risk of all-cause mortality. Morbidly obese women were also at increased risk of death from breast cancer. These results suggest that degree of obesity confers differential risk on survival.

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Abbreviations

ABCPP:

After Breast Cancer Pooling Project

SBCSS:

Shanghai Breast Cancer Survival Study

LACE:

Life After Cancer Epidemiology

WHEL:

Women’s Healthy Eating and Living

NHS:

Nurses’ Health Study

KPNC:

Kaiser Permanente Northern California

IRB:

Institutional review board

BMI:

Body mass index

MET:

Metabolic equivalents

MI:

Myocardial infarction

ER:

Estrogen receptor

PR:

Progesterone receptor

HR:

Hazard ratio

CI:

Confidence interval

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Acknowledgments

This work was supported by the National Cancer Institute (3R01CA118229-03S1). Funding for each individual cohort participating in the After Breast Cancer Pooling Project is as follows: The SBCSS was supported by the Department of Defense (DAMD 17-02-1-0607) and the National Cancer Institute (R01 CA118229). The WHEL Study was supported by the Susan G. Komen Foundation (#KG100988). The LACE Study was supported by the National Cancer Institute (R01 CA129059). The NHS was supported by the National Cancer Institute (P01 CA87969). We thank Dr. Shannon M. Conroy at the University of Hawaii Cancer Center for her expertise on creating the cubic spline curves.

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Authors and Affiliations

  1. Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA, 94612, USA

    Marilyn L. Kwan, Candyce H. Kroenke, Erin K. Weltzien, Charles P. Quesenberry Jr. & Bette J. Caan

  2. Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 02115, USA

    Wendy Y. Chen, Elizabeth M. Poole & Michelle D. Holmes

  3. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02115, USA

    Wendy Y. Chen

  4. Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA

    Jeannette M. Beasley

  5. Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA

    Sarah J. Nechuta & Xiao Ou Shu

  6. Shanghai Institute for Preventive Medicine, Shanghai, China

    Wei Lu

  7. Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, San Diego, CA, 92093-0901, USA

    John P. Pierce

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  1. Marilyn L. Kwan
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  2. Wendy Y. Chen
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  3. Candyce H. Kroenke
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  8. Wei Lu
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Correspondence to Marilyn L. Kwan.

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Kwan, M.L., Chen, W.Y., Kroenke, C.H. et al. Pre-diagnosis body mass index and survival after breast cancer in the After Breast Cancer Pooling Project. Breast Cancer Res Treat 132, 729–739 (2012). https://doi.org/10.1007/s10549-011-1914-3

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