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Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer

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Abstract

Objective

We examined the association between body mass index (BMI) around the time of diagnosis, weight change post-diagnosis, and breast cancer prognosis in a prospective cohort study of 1,692 breast cancer survivors.

Methods

Pre-diagnosis weight, weight at study entry, and height was obtained from mailed questionnaires and then weight change and BMI were calculated. After approximately seven years of follow-up, 207 recurrences, 99 deaths due to breast cancer, and 162 deaths due to any cause were reported. Delayed entry Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI), controlling for treatment and known prognostic factors.

Results

Being obese one year before diagnosis was associated with an increased risk of death from any cause (HR = 1.6; 95% CI: 1.1–2.3) and a suggestion of increased risk of death from breast cancer (HR = 1.6; 95% CI: 0.9–2.7). However, weight gain up to four years after a breast cancer diagnosis was not associated with an increased risk of recurrence or death from any cause nor did moderate weight loss (5–10%) decrease risk of these outcomes. There was some evidence that women who had larger weight losses (≥10%) between pre-diagnosis and study entry had an increased risk of recurrence (HR = 1.7; 95% CI 1.0–2.6) and death due to any cause (HR = 2.1; 95% CI 1.3–3.4) compared to being weight stable. This elevated risk was more pronounced among women who were obese before diagnosis (BMI ≥ 30 kg/m2) or who had ER− or PR− tumors.

Conclusion

We found that being obese before breast cancer diagnosis was associated with increased risk of recurrence and poorer survival, corroborating results from previous studies. However, weight gain after diagnosis did not confer additional risk. Body weight pre-diagnosis appears to be the strongest predictor of an adverse breast cancer prognosis.

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Acknowledgments

Funding source: National Cancer Institute (R01 CA80027 and N01 PC67000). This study was funded by the National Cancer Institute (R01 CA80027) and by the Utah Cancer Registry (N01 PC67000), with additional support from the State of Utah Department of Health. We thank all LACE Study staff and participants.

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Authors and Affiliations

  1. Division of Research, Kaiser Permanente Medical Program of Northern California, 2000 Broadway, Oakland, CA, 94612, USA

    Bette J. Caan, Marilyn L. Kwan, Georgina Hartzell, Adrienne Castillo, Barbara Sternfeld & Erin Weltzien

  2. Department of Internal Medicine, University of Utah, 375 Chipeta Way Suite A, Salt Lake City, UT, 84108, USA

    Martha L. Slattery

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  1. Bette J. Caan
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  2. Marilyn L. Kwan
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Correspondence to Bette J. Caan.

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Caan, B.J., Kwan, M.L., Hartzell, G. et al. Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control 19, 1319–1328 (2008). https://doi.org/10.1007/s10552-008-9203-0

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  • DOI: https://doi.org/10.1007/s10552-008-9203-0

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