Top

Published in:

01-10-2012 | Review

Body composition changes in females treated for breast cancer: a review of the evidence

Authors: Patricia M. Sheean, Kent Hoskins, Melinda Stolley

Published in: Breast Cancer Research and Treatment | Issue 3/2012

Abstract

Body composition changes cannot be precisely captured using body weight or body mass index measures. Therefore, the primary purpose of this review was to characterize the patterns of body composition change in females treated for breast cancer including only studies that utilize imaging technologies to quantify adipose tissue and lean body mass (LBM). We reviewed PubMed for studies published between 1971 and 2012 involving females diagnosed with breast cancer where computed axial tomography , dual-energy X-ray absorptiometry, or magnetic resonance imaging were employed for body composition assessment. Of the initial 440 studies, 106 papers were evaluated and 36 papers met all eligibility criteria (15 observational and 21 intervention trials). Results of these studies revealed that body weight did not consistently increase. Importantly, studies also showed that body weight did not accurately depict changes in lean or adipose tissues. Further findings included that sarcopenic obesity as a consequence of breast cancer treatment was not definitive, as menopausal status may be a substantial moderator of body composition. Overall, the behavioral interventions did not exhibit consistent or profound effects on body composition outcomes; approximately half showed favorable influence on adiposity while the effects on LBM were not apparent. The use of tamoxifen had a clear negative impact on body composition. The majority of studies were conducted in predominantly white survivors, highlighting the need for trials in minority populations. Collectively, these studies were limited by age, race, and/or menopause status matched control groups, overall size, and statistical power. Very few studies simultaneously collected diet and exercise data—two potential factors that impact body composition. Future breast cancer trials should prioritize precise body composition methodologies to elucidate how these changes impact recurrence, prognosis, and mortality, and to provide clinicians with appropriate advice regarding lifestyle recommendations in this growing sector of the population.

American Cancer Society. http://www.cancer.org

SEER Cancer Statistics Review, 1975–2007. http://seer.cancer.gov/statfacts/html/mulmy.html#incidence-mortality

Demark-Wahnefried W, Rimer BK, Winer EP (1997) Weight gain in women diagnosed with breast cancer. J Am Dietetic Assoc, 97(5):519–526, 529 (quiz 527–518)

Demark-Wahnefried W, Winer EP, Rimer BK (1993) Why women gain weight with adjuvant chemotherapy for breast cancer. J Clin Oncol 11(7):1418–1429PubMed

Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307(5):491–497PubMedCrossRef

Camoriano JK, Loprinzi CL, Ingle JN, Therneau TM, Krook JE, Veeder MH (1990) Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. J Clin Oncol 8(8):1327–1334PubMed

Chlebowski RT, Weiner JM, Reynolds R, Luce J, Bulcavage L, Bateman JR (1986) Long-term survival following relapse after 5-FU but not CMF adjuvant breast cancer therapy. Breast Cancer Res Treat 7(1):23–30PubMedCrossRef

Gillum RF, Sempos CT (2005) Ethnic variation in validity of classification of overweight and obesity using self-reported weight and height in American women and men: the Third National Health and Nutrition Examination Survey. Nutr J 4:27PubMedCrossRef

Cheney CL, Mahloch J, Freeny P (1997) Computerized tomography assessment of women with weight changes associated with adjuvant treatment for breast cancer. Am J Clin Nutr 66(1):141–146PubMed

10.

Demark-Wahnefried W, Hars V, Conaway MR, Havlin K, Rimer BK, McElveen G, Winer EP (1997) Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. Am J Clin Nutr 65(5):1495–1501PubMed

11.

Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, Blackwell K, Rimer BK (2001) Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 19(9):2381–2389PubMed

12.

Aslani A, Smith RC, Allen BJ, Pavlakis N, Levi JA (1999) Changes in body composition during breast cancer chemotherapy with the CMF-regimen. Breast Cancer Res Treat 57(3):285–290PubMedCrossRef

13.

Rose DP, Haffner SM, Baillargeon J (2007) Adiposity, the metabolic syndrome, and breast cancer in African-American and white American women. Endocr Rev 28(7):763–777PubMedCrossRef

14.

McTiernan A, Rajan KB, Tworoger SS, Irwin M, Bernstein L, Baumgartner R, Gilliland F, Stanczyk FZ, Yasui Y, Ballard-Barbash R (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 21(10):1961–1966PubMedCrossRef

15.

Thomson CA, Thompson PA, Wright-Bea J, Nardi E, Frey GR, Stopeck A (2009) Metabolic syndrome and elevated C-reactive protein in breast cancer survivors on adjuvant hormone therapy. J Womens Health (Larchmt) 18(12):2041–2047CrossRef

16.

Medicine ACoS (ed) (2007) ACSM’s Health-Related Physical Fitness Assessment Manual. Williams & Wilkins, Lippincott

17.

Ali PA, al-Ghorabie FH, Evans CJ, el-Sharkawi AM, Hancock DA (1998) Body composition measurements using DXA and other techniques in tamoxifen-treated patients. Appl Radiat Isot 49(5–6):643–645PubMedCrossRef

18.

Nguyen MC, Stewart RB, Banerji MA, Gordon DH, Kral JG (2001) Relationships between tamoxifen use, liver fat and body fat distribution in women with breast cancer. Int J Obes Relat Metab Disord 25(2):296–298PubMedCrossRef

19.

Campbell KL, Lane K, Martin AD, Gelmon KA, McKenzie DC (2007) Resting energy expenditure and body mass changes in women during adjuvant chemotherapy for breast cancer. Cancer Nurs 30(2):95–100PubMedCrossRef

20.

Freedman RJ, Aziz N, Albanes D, Hartman T, Danforth D, Hill S, Sebring N, Reynolds JC, Yanovski JA (2004) Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab 89(5):2248–2253PubMedCrossRef

21.

Gordon AM, Hurwitz S, Shapiro CL, LeBoff MS (2011) Premature ovarian failure and body composition changes with adjuvant chemotherapy for breast cancer. Menopause 18(11):1244–1248PubMedCrossRef

22.

Irwin ML, McTiernan A, Baumgartner RN, Baumgartner KB, Bernstein L, Gilliland FD, Ballard-Barbash R (2005) Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol 23(4):774–782PubMedCrossRef

23.

Kutynec CL, McCargar L, Barr SI, Hislop TG (1999) Energy balance in women with breast cancer during adjuvant treatment. J Am Diet Assoc 99(10):1222–1227PubMedCrossRef

24.

Nissen MJ, Shapiro A, Swenson KK (2011) Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clin Breast Cancer 11(1):52–60PubMed

25.

Winters-Stone KM, Nail L, Bennett JA, Schwartz A (2009) Bone health and falls: fracture risk in breast cancer survivors with chemotherapy-induced amenorrhea. Oncol Nurs Forum 36(3):315–325PubMedCrossRef

26.

Courneya KS, McKenzie DC, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, Ladha AB, Proulx C, Vallance JK, Lane K et al (2008) Moderators of the effects of exercise training in breast cancer patients receiving chemotherapy: a randomized controlled trial. Cancer 112(8):1845–1853PubMedCrossRef

27.

Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, Ladha AB, Proulx C, Vallance JK, Lane K et al (2007) Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol 25(28):4396–4404PubMedCrossRef

28.

Demark-Wahnefried W, Case LD, Blackwell K, Marcom PK, Kraus W, Aziz N, Snyder DC, Giguere JK, Shaw E (2008) Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. Clin Breast Cancer 8(1):70–79PubMedCrossRef

29.

Demark-Wahnefried W, Kenyon AJ, Eberle P, Skye A, Kraus WE (2002) Preventing sarcopenic obesity among breast cancer patients who receive adjuvant chemotherapy: results of a feasibility study. Clin Exerc Physiol 4(1):44–49PubMed

30.

DeNysschen CA, Brown JK, Cho MH, Dodd MJ (2011) Nutritional symptom and body composition outcomes of aerobic exercise in women with breast cancer. Clin Nurs Res 20(1):29–46PubMedCrossRef

31.

Djuric Z, Ellsworth JS, Weldon AL, Ren J, Richardson CR, Resnicow K, Newman LA, Hayes DF, Sen A (2011) A diet and exercise intervention during chemotherapy for breast cancer. Open Obes J 3:87–97PubMedCrossRef

32.

Matthews CE, Wilcox S, Hanby CL, Der Ananian C, Heiney SP, Gebretsadik T, Shintani A (2007) Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Support Care Cancer 15(2):203–211PubMedCrossRef

33.

Irwin ML, Alvarez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, Chung GG, Jones B, Knobf MT, DiPietro L (2009) Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity (Silver Spring) 17(8):1534–1541CrossRef

34.

Knobf MT, Insogna K, DiPietro L, Fennie C, Thompson AS (2008) An aerobic weight-loaded pilot exercise intervention for breast cancer survivors: bone remodeling and body composition outcomes. Biol Res Nurs 10(1):34–43PubMedCrossRef

35.

Mefferd K, Nichols JF, Pakiz B, Rock CL (2007) A cognitive behavioral therapy intervention to promote weight loss improves body composition and blood lipid profiles among overweight breast cancer survivors. Breast Cancer Res Treat 104(2):145–152PubMedCrossRef

36.

Pakiz B, Flatt SW, Bardwell WA, Rock CL, Mills PJ (2011) Effects of a weight loss intervention on body mass, fitness, and inflammatory biomarkers in overweight or obese breast cancer survivors. Int J Behav Med 18(4):333–341

37.

Rogers LQ, Hopkins-Price P, Vicari S, Markwell S, Pamenter R, Courneya KS, Hoelzer K, Naritoku C, Edson B, Jones L et al (2009) Physical activity and health outcomes three months after completing a physical activity behavior change intervention: persistent and delayed effects. Cancer Epidemiol Biomarkers Prev 18(5):1410–1418PubMedCrossRef

38.

Rogers LQ, Hopkins-Price P, Vicari S, Pamenter R, Courneya KS, Markwell S, Verhulst S, Hoelzer K, Naritoku C, Jones L et al (2009) A randomized trial to increase physical activity in breast cancer survivors. Med Sci Sports Exerc 41(4):935–946PubMedCrossRef

39.

Schmitz KH, Ahmed RL, Hannan PJ, Yee D (2005) Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiol Biomarkers Prev 14(7):1672–1680PubMedCrossRef

40.

Stendell-Hollis NR, Thomson CA, Thompson PA, Bea JW, Cussler EC, Hakim IA (2010) Green tea improves metabolic biomarkers, not weight or body composition: a pilot study in overweight breast cancer survivors. J Hum Nutr Diet 23(6):590–600PubMedCrossRef

41.

Thomson CA, Stopeck AT, Bea JW, Cussler E, Nardi E, Frey G, Thompson PA (2010) Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets. Nutr Cancer 62(8):1142–1152PubMedCrossRef

42.

Winters-Stone KM, Dobek J, Nail L, Bennett JA, Leo MC, Naik A, Schwartz A (2011) Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast Cancer Res Treat 127(2):447–456PubMedCrossRef

43.

Campbell KL, Van Patten CL, Neil SE, Kirkham AA, Gotay CC, Gelmon KA, McKenzie DC (2012) Feasibility of a lifestyle intervention on body weight and serum biomarkers in breast cancer survivors with overweight and obesity. J Acad Nutr Diet 112(4):559–567PubMedCrossRef

44.

Francini G, Petrioli R, Montagnani A, Cadirni A, Campagna S, Francini E, Gonnelli S (2006) Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids. Br J Cancer 95(2):153–158PubMedCrossRef

45.

Montagnani A, Gonnelli S, Cadirni A, Caffarelli C, Del Santo K, Pieropan C, Campagna MS, Montomoli M, Petrioli R, Nuti R (2008) The effects on lipid serum levels of a 2-year adjuvant treatment with exemestane after tamoxifen in postmenopausal women with early breast cancer. Eur J Intern Med 19(8):592–597PubMedCrossRef

46.

van Londen GJ, Perera S, Vujevich K, Rastogi P, Lembersky B, Brufsky A, Vogel V, Greenspan SL (2011) The impact of an aromatase inhibitor on body composition and gonadal hormone levels in women with breast cancer. Breast Cancer Res Treat 125(2):441–446PubMedCrossRef

47.

Prado CM, Lima IS, Baracos VE, Bies RR, McCargar LJ, Reiman T, Mackey JR, Kuzma M, Damaraju VL, Sawyer MB (2011) An exploratory study of body composition as a determinant of epirubicin pharmacokinetics and toxicity. Cancer Chemother Pharmacol 67(1):93–101PubMedCrossRef

48.

Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB (2009) Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 15(8):2920–2926PubMedCrossRef

49.

Vance V, Mourtzakis M, McCargar L, Hanning R (2011) Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev 12(4):282–294PubMedCrossRef

50.

Rock CL, Demark-Wahnefried W (2002) Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 20(15):3302–3316PubMedCrossRef

51.

Barnett GC, Shah M, Redman K, Easton DF, Ponder BA, Pharoah PD (2008) Risk factors for the incidence of breast cancer: do they affect survival from the disease? J Clin Oncol 26(20):3310–3316PubMedCrossRef

52.

Dawood S, Broglio K, Gonzalez-Angulo AM, Kau SW, Islam R, Hortobagyi GN, Cristofanilli M (2008) Prognostic value of body mass index in locally advanced breast cancer. Clin Cancer Res 14(6):1718–1725PubMedCrossRef

53.

de Azambuja E, McCaskill-Stevens W, Francis P, Quinaux E, Crown JP, Vicente M, Giuliani R, Nordenskjold B, Gutierez J, Andersson M et al (2010) The effect of body mass index on overall and disease-free survival in node-positive breast cancer patients treated with docetaxel and doxorubicin-containing adjuvant chemotherapy: the experience of the BIG 02-98 trial. Breast Cancer Res Treat 119(1):145–153PubMedCrossRef

54.

Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP (2003) Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst 95(19):1467–1476PubMedCrossRef

55.

Dignam JJ, Wieand K, Johnson KA, Raich P, Anderson SJ, Somkin C, Wickerham DL (2006) Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Res Treat 97(3):245–254PubMedCrossRef

56.

Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378PubMedCrossRef

57.

Majed B, Moreau T, Asselain B (2009) Overweight, obesity and breast cancer prognosis: optimal body size indicator cut-points. Breast Cancer Res Treat 115(1):193–203PubMedCrossRef

58.

Grant B, Bloch AS, Hamilton KK, Thompson CA (2010) American Cancer Society Complete Guide to Nutrition for Cancer Survivors: eating well, staying well during and after cancer. American Cancer Society, Atlanta, Georgia

59.

Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9(7):629–635PubMedCrossRef

60.

Tan BH, Birdsell LA, Martin L, Baracos VE, Fearon KC (2009) Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res 15(22):6973–6979PubMedCrossRef

61.

Wang Q, Hassager C, Ravn P, Wang S, Christiansen C (1994) Total and regional body-composition changes in early postmenopausal women: age-related or menopause-related? Am J Clin Nutr 60(6):843–848PubMed

62.

Aloia JF, McGowan DM, Vaswani AN, Ross P, Cohn SH (1991) Relationship of menopause to skeletal and muscle mass. Am J Clin Nutr 53(6):1378–1383PubMed

63.

Walshe JM, Denduluri N, Swain SM (2006) Amenorrhea in premenopausal women after adjuvant chemotherapy for breast cancer. J Clin Oncol 24(36):5769–5779PubMedCrossRef

64.

http://www.seer.cancer.gov/. Accessed 15 March 2012

65.

Foster-Schubert KE, Alfano CM, Duggan CR, Xiao L, Campbell KL, Kong A, Bain CE, Wang CY, Blackburn GL, McTiernan A (2012) Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Obesity (Silver Spring) 20(8):1628–1638

66.

Witham MD, Avenell A (2010) Interventions to achieve long-term weight loss in obese older people: a systematic review and meta-analysis. Age Ageing 39(2):176–184PubMedCrossRef

67.

Kumar NB, Allen K, Cantor A, Cox CE, Greenberg H, Shah S, Lyman GH (1997) Weight gain associated with adjuvant tamoxifen therapy in stage I and II breast cancer: fact or artifact? Breast Cancer Res Treat 44(2):135–143PubMedCrossRef

68.

Osborne CR, Duncan A, Sedlacek S, Paul D, Holmes F, Vukelja S, Kasper M, Wilks S, Schneider A, McGee R et al (2009) The addition of hormone therapy to tamoxifen does not prevent hot flashes in women at high risk for developing breast cancer. Breast Cancer Res Treat 116(3):521–527PubMedCrossRef

69.

McCullough ML, Feigelson HS, Diver WR, Patel AV, Thun MJ, Calle EE (2005) Risk factors for fatal breast cancer in African-American women and white women in a large US prospective cohort. Am J Epidemiol 162(8):734–742PubMedCrossRef

70.

Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D (2005) Comorbidity and survival disparities among black and white patients with breast cancer. JAMA 294(14):1765–1772PubMedCrossRef

Title: Body composition changes in females treated for breast cancer: a review of the evidence
Authors: Patricia M. Sheean
Kent Hoskins
Melinda Stolley
Publication date: 01-10-2012
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2012
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-012-2200-8

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2012

The importance of HER2 signaling in the tumor-initiating cell population in aromatase inhibitor-resistant breast cancer

Recommendations for the aesthetic evaluation of breast cancer conservative treatment

Erratum to: Pilot and feasibility study: prospective proteomic profiling of mammary epithelial cells from high-risk women provides evidence of activation of pro-survival pathways

An essential role of metalloprotease-disintegrin ADAM12 in triple-negative breast cancer

Excess body weight and second primary cancer risk after breast cancer: a systematic review and meta-analysis of prospective studies

Erratum to: 25-Hydroxy vitamin-D, obesity, and associated variables as predictors of breast cancer risk and tamoxifen benefit in NSABP-P1

Keynote webinar | Spotlight on antibody–drug conjugates in cancer