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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 2/2012

01-04-2012 | Epidemiology

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

Authors: Marilyn L. Kwan, Wendy Y. Chen, Candyce H. Kroenke, Erin K. Weltzien, Jeannette M. Beasley, Sarah J. Nechuta, Elizabeth M. Poole, Wei Lu, Michelle D. Holmes, Charles P. Quesenberry Jr., John P. Pierce, Xiao Ou Shu, Bette J. Caan

Published in: Breast Cancer Research and Treatment | Issue 2/2012

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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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Metadata
Title
Pre-diagnosis body mass index and survival after breast cancer in the After Breast Cancer Pooling Project
Authors
Marilyn L. Kwan
Wendy Y. Chen
Candyce H. Kroenke
Erin K. Weltzien
Jeannette M. Beasley
Sarah J. Nechuta
Elizabeth M. Poole
Wei Lu
Michelle D. Holmes
Charles P. Quesenberry Jr.
John P. Pierce
Xiao Ou Shu
Bette J. Caan
Publication date
01-04-2012
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2012
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-011-1914-3

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