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Published in: Current Treatment Options in Oncology 5/2015

01-05-2015 | Breast Cancer (P Neven, Section Editor)

Obesity and Breast Cancer: Not Only a Risk Factor of the Disease

Authors: Doris S. M. Chan, M.Sc., Teresa Norat, Ph.D.

Published in: Current Treatment Options in Oncology | Issue 5/2015

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Opinion statement

Obesity not only is an independent risk factor of postmenopausal breast cancer (BC), and in particular estrogen receptor-positive/progesterone receptor-positive BC, it is also a prognostic factor of the disease. Substantial evidence has shown that obesity, as measured by body mass index (BMI) is linked to BC outcomes. All-cause and BC-specific mortality risk increase for each BMI unit increase in pre- and postmenopausal BC survivors is estimated to range from 8 to 29 %, depending on when BMI is ascertained. The positive associations in pre- and postmenopausal BC and in hormone receptor-positive and hormone receptor-negative BC are not significantly different. Furthermore, the negative impact of abdominal obesity on BC survival highlights the need of using fat distribution (waist circumference, waist-hip-ratio) as well as general obesity (BMI) to evaluate prognosis in the clinical setting. More research is needed to elucidate possible differential associations in pre- and postmenopausal BC that are defined by hormone receptor and/or human epidermal growth factor receptor (HER), and in advanced tumors; for which the data are limited and less clear. Current evidence on treatment toxicity supports the guidelines from the American Society for Clinical Oncology, which recommends the use of full weight-based chemotherapy to treat obese cancer patients. Several studies have shown that lifestyle interventions are feasible and safe; more research is needed on specific diets for health maintenance and weight loss in BC survivors. Being physically active (≥150 min/week of moderate intensity activity) helps manage body weight (normal BMI 18.5–24.9 kg/m2), improves survival, and has secondary health benefits. Oncologists should recommend their patients to be physically active and control body weight when the conditions of the patient allow it.
Literature
2.
go back to reference American Cancer Society. Cancer treatment and survivorship facts & figures 2014–2015. Atlanta: American Cancer Society; 2014. American Cancer Society. Cancer treatment and survivorship facts & figures 2014–2015. Atlanta: American Cancer Society; 2014.
3.
go back to reference Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491–7.PubMedCrossRef Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491–7.PubMedCrossRef
4.
go back to reference McCormack VA, Boffetta P. Today’s lifestyles, tomorrow’s cancers: trends in lifestyle risk factors for cancer in low- and middle-income countries. Ann Oncol. 2011;22:2349–57.PubMedCrossRef McCormack VA, Boffetta P. Today’s lifestyles, tomorrow’s cancers: trends in lifestyle risk factors for cancer in low- and middle-income countries. Ann Oncol. 2011;22:2349–57.PubMedCrossRef
5.
go back to reference World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007. World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007.
6.
go back to reference Demark-Wahnefried W, Rimer BK, Winer EP. Weight gain in women diagnosed with breast cancer. J Am Diet Assoc. 1997;97:519–26.PubMedCrossRef Demark-Wahnefried W, Rimer BK, Winer EP. Weight gain in women diagnosed with breast cancer. J Am Diet Assoc. 1997;97:519–26.PubMedCrossRef
7.
go back to reference Vance V, Mourtzakis M, McCargar L, et al. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12:282–94.PubMedCrossRef Vance V, Mourtzakis M, McCargar L, et al. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12:282–94.PubMedCrossRef
8.
go back to reference Sheean PM, Hoskins K, Stolley M. Body composition changes in females treated for breast cancer: a review of the evidence. Breast Cancer Res Treat. 2012;135:663–80.PubMedCentralPubMedCrossRef Sheean PM, Hoskins K, Stolley M. Body composition changes in females treated for breast cancer: a review of the evidence. Breast Cancer Res Treat. 2012;135:663–80.PubMedCentralPubMedCrossRef
9.
go back to reference Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. J Clin Oncol. 2002;20:1128–43.PubMedCrossRef Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. J Clin Oncol. 2002;20:1128–43.PubMedCrossRef
10.
go back to reference Niraula S, Ocana A, Ennis M, et al. Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat. 2012;134:769–81.PubMedCrossRef Niraula S, Ocana A, Ennis M, et al. Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat. 2012;134:769–81.PubMedCrossRef
11.
go back to reference Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123:627–35.PubMedCrossRef Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123:627–35.PubMedCrossRef
12.
go back to reference Druesne-Pecollo N, Touvier M, Barrandon E, et al. Excess body weight and second primary cancer risk after breast cancer: a systematic review and meta-analysis of prospective studies. Breast Cancer Res Treat. 2012;135:647–54.PubMedCrossRef Druesne-Pecollo N, Touvier M, Barrandon E, et al. Excess body weight and second primary cancer risk after breast cancer: a systematic review and meta-analysis of prospective studies. Breast Cancer Res Treat. 2012;135:647–54.PubMedCrossRef
13.
go back to reference Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008;27:32.PubMedCentralPubMedCrossRef Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008;27:32.PubMedCentralPubMedCrossRef
14.
go back to reference Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg. 1999;177:184–7.PubMedCrossRef Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg. 1999;177:184–7.PubMedCrossRef
15.
go back to reference Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120:104–10.PubMedCrossRef Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120:104–10.PubMedCrossRef
16.
go back to reference Rose DP, Komninou D, Stephenson GD. Obesity, adipocytokines, and insulin resistance in breast cancer. Obes Rev. 2004;5:153–65.PubMedCrossRef Rose DP, Komninou D, Stephenson GD. Obesity, adipocytokines, and insulin resistance in breast cancer. Obes Rev. 2004;5:153–65.PubMedCrossRef
19.
go back to reference Goodwin PJ, Ennis M, Pritchard KI, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol. 2002;20:42–51.PubMedCrossRef Goodwin PJ, Ennis M, Pritchard KI, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol. 2002;20:42–51.PubMedCrossRef
20.
go back to reference van Kruijsdijk RC, van der Wall E, Visseren FL. Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev. 2009;18:2569–78.PubMedCrossRef van Kruijsdijk RC, van der Wall E, Visseren FL. Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev. 2009;18:2569–78.PubMedCrossRef
21.
go back to reference Cui Y, Whiteman MK, Flaws JA, et al. Body mass and stage of breast cancer at diagnosis. Int J Cancer. 2002;98:279–83.PubMedCrossRef Cui Y, Whiteman MK, Flaws JA, et al. Body mass and stage of breast cancer at diagnosis. Int J Cancer. 2002;98:279–83.PubMedCrossRef
22.
go back to reference Kaidar-Person O, Bar-Sela G, Person B. The two major epidemics of the twenty-first century: obesity and cancer. Obes Surg. 2011;21:1792–7.PubMedCrossRef Kaidar-Person O, Bar-Sela G, Person B. The two major epidemics of the twenty-first century: obesity and cancer. Obes Surg. 2011;21:1792–7.PubMedCrossRef
23.
go back to reference Griggs JJ, Sorbero ME, Lyman GH. Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med. 2005;165:1267–73.PubMedCrossRef Griggs JJ, Sorbero ME, Lyman GH. Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med. 2005;165:1267–73.PubMedCrossRef
24.
go back to reference Makari-Judson G, Braun B, Jerry DJ, et al. Weight gain following breast cancer diagnosis: implication and proposed mechanisms. World J Clin Oncol. 2014;5:272–82.PubMedCentralPubMedCrossRef Makari-Judson G, Braun B, Jerry DJ, et al. Weight gain following breast cancer diagnosis: implication and proposed mechanisms. World J Clin Oncol. 2014;5:272–82.PubMedCentralPubMedCrossRef
25.
26.•
go back to reference Ligibel JA, Alfano CM, Courneya KS, et al. American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol. 2014;32:3568–74. In recognition of the significance of obesity in cancer prognosis, ASCO has released this position statement to feature the multipronged initiative to combat obesity.PubMedCrossRef Ligibel JA, Alfano CM, Courneya KS, et al. American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol. 2014;32:3568–74. In recognition of the significance of obesity in cancer prognosis, ASCO has released this position statement to feature the multipronged initiative to combat obesity.PubMedCrossRef
29.•
go back to reference Chan DS, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25:1901–14. This systematic review provided supporting evidence that higher BMI is consistently associated with lower survival in BC survivors before and after cancer diagnosis.PubMedCentralPubMedCrossRef Chan DS, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25:1901–14. This systematic review provided supporting evidence that higher BMI is consistently associated with lower survival in BC survivors before and after cancer diagnosis.PubMedCentralPubMedCrossRef
30.
go back to reference Kwan ML, John EM, Caan BJ, et al. Obesity and mortality after breast cancer by race/ethnicity: The California Breast Cancer Survivorship Consortium. Am J Epidemiol. 2014;179:95–111.PubMedCentralPubMedCrossRef Kwan ML, John EM, Caan BJ, et al. Obesity and mortality after breast cancer by race/ethnicity: The California Breast Cancer Survivorship Consortium. Am J Epidemiol. 2014;179:95–111.PubMedCentralPubMedCrossRef
31.
go back to reference Pan H, Gray RG, Early Breast Cancer Trialists’ Collaborative Group. Effect of obesity in premenopausal ER+ early breast cancer: EBCTCG data on 80,000 patients in 70 trials. J Clin Oncol. 2014;32:5s (suppl; abstr 503).CrossRef Pan H, Gray RG, Early Breast Cancer Trialists’ Collaborative Group. Effect of obesity in premenopausal ER+ early breast cancer: EBCTCG data on 80,000 patients in 70 trials. J Clin Oncol. 2014;32:5s (suppl; abstr 503).CrossRef
32.
go back to reference Copson ER, Cutress RI, Maishman T, et al. Obesity and the outcome of young breast cancer patients in the UK: the POSH study. Ann Oncol. 2015;26:101–12.PubMedCrossRef Copson ER, Cutress RI, Maishman T, et al. Obesity and the outcome of young breast cancer patients in the UK: the POSH study. Ann Oncol. 2015;26:101–12.PubMedCrossRef
33.
go back to reference Wolff AC, Hammond ME, Hicks DG, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31:3997–4013.PubMedCrossRef Wolff AC, Hammond ME, Hicks DG, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31:3997–4013.PubMedCrossRef
34.
go back to reference Van Mieghem T, Leunen K, Pochet N, et al. Body mass index and HER-2 overexpression in breast cancer patients over 50 years of age. Breast Cancer Res Treat. 2007;106:127–33.PubMedCrossRef Van Mieghem T, Leunen K, Pochet N, et al. Body mass index and HER-2 overexpression in breast cancer patients over 50 years of age. Breast Cancer Res Treat. 2007;106:127–33.PubMedCrossRef
36.
go back to reference Sparano JA, Wang M, Zhao F, et al. Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer. 2012;118:5937–46.PubMedCentralPubMedCrossRef Sparano JA, Wang M, Zhao F, et al. Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer. 2012;118:5937–46.PubMedCentralPubMedCrossRef
37.
go back to reference Robinson PJ, Bell RJ, Davis SR. Obesity is associated with a poorer prognosis in women with hormone receptor positive breast cancer. Maturitas. 2014;79:279–86.PubMedCrossRef Robinson PJ, Bell RJ, Davis SR. Obesity is associated with a poorer prognosis in women with hormone receptor positive breast cancer. Maturitas. 2014;79:279–86.PubMedCrossRef
38.
go back to reference Crozier JA, Moreno-Aspitia A, Ballman KV, et al. Effect of body mass index on tumor characteristics and disease-free survival in patients from the HER2-positive adjuvant trastuzumab trial N9831. Cancer. 2013;119:2447–54.PubMedCentralPubMedCrossRef Crozier JA, Moreno-Aspitia A, Ballman KV, et al. Effect of body mass index on tumor characteristics and disease-free survival in patients from the HER2-positive adjuvant trastuzumab trial N9831. Cancer. 2013;119:2447–54.PubMedCentralPubMedCrossRef
39.
go back to reference Jiralerspong S, Kim ES, Dong W, et al. Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients. Ann Oncol. 2013;24:2506–14.PubMedCentralPubMedCrossRef Jiralerspong S, Kim ES, Dong W, et al. Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients. Ann Oncol. 2013;24:2506–14.PubMedCentralPubMedCrossRef
40.
go back to reference Mazzarella L, Disalvatore D, Bagnardi V, et al. Obesity increases the incidence of distant metastases in oestrogen receptor-negative human epidermal growth factor receptor 2-positive breast cancer patients. Eur J Cancer. 2013;49:3588–97.PubMedCrossRef Mazzarella L, Disalvatore D, Bagnardi V, et al. Obesity increases the incidence of distant metastases in oestrogen receptor-negative human epidermal growth factor receptor 2-positive breast cancer patients. Eur J Cancer. 2013;49:3588–97.PubMedCrossRef
41.
go back to reference Adamo V, Ricciardi GR, Adamo B, et al. The risk of toxicities from trastuzumab, alone or in combination, in an elderly breast cancer population. Oncology. 2014;86:16–21.PubMedCrossRef Adamo V, Ricciardi GR, Adamo B, et al. The risk of toxicities from trastuzumab, alone or in combination, in an elderly breast cancer population. Oncology. 2014;86:16–21.PubMedCrossRef
42.
go back to reference Yu AF, Yadav NU, Lung BY, et al. Trastuzumab interruption and treatment-induced cardiotoxicity in early HER2-positive breast cancer. Breast Cancer Res Treat. 2015;149:489–95.PubMedCrossRef Yu AF, Yadav NU, Lung BY, et al. Trastuzumab interruption and treatment-induced cardiotoxicity in early HER2-positive breast cancer. Breast Cancer Res Treat. 2015;149:489–95.PubMedCrossRef
43.
go back to reference Cleator S, Heller W, Coombes RC. Triple-negative breast cancer: therapeutic options. Lancet Oncol. 2007;8:235–44.PubMedCrossRef Cleator S, Heller W, Coombes RC. Triple-negative breast cancer: therapeutic options. Lancet Oncol. 2007;8:235–44.PubMedCrossRef
44.
go back to reference Sturtz LA, Melley J, Mamula K, et al. Outcome disparities in African American women with triple negative breast cancer: a comparison of epidemiological and molecular factors between African American and Caucasian women with triple negative breast cancer. BMC Cancer. 2014;14:62.PubMedCentralPubMedCrossRef Sturtz LA, Melley J, Mamula K, et al. Outcome disparities in African American women with triple negative breast cancer: a comparison of epidemiological and molecular factors between African American and Caucasian women with triple negative breast cancer. BMC Cancer. 2014;14:62.PubMedCentralPubMedCrossRef
45.
go back to reference Schmitz KH, Neuhouser ML, Agurs-Collins T, et al. Impact of obesity on cancer survivorship and the potential relevance of race and ethnicity. J Natl Cancer Inst. 2013;105:1344–54.PubMedCentralPubMedCrossRef Schmitz KH, Neuhouser ML, Agurs-Collins T, et al. Impact of obesity on cancer survivorship and the potential relevance of race and ethnicity. J Natl Cancer Inst. 2013;105:1344–54.PubMedCentralPubMedCrossRef
46.
go back to reference Gluz O, Liedtke C, Gottschalk N, et al. Triple-negative breast cancer—current status and future directions. Ann Oncol. 2009;20:1913–27.PubMedCrossRef Gluz O, Liedtke C, Gottschalk N, et al. Triple-negative breast cancer—current status and future directions. Ann Oncol. 2009;20:1913–27.PubMedCrossRef
47.
go back to reference Swisher AK, Abraham J, Bonner D, et al. Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Support Care Cancer. 2015. doi:10.1007/s00520-015-2667-z.PubMed Swisher AK, Abraham J, Bonner D, et al. Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Support Care Cancer. 2015. doi:10.​1007/​s00520-015-2667-z.PubMed
48.
go back to reference Ademuyiwa FO, Groman A, O’Connor T, et al. Impact of body mass index on clinical outcomes in triple-negative breast cancer. Cancer. 2011;117:4132–40.PubMedCrossRef Ademuyiwa FO, Groman A, O’Connor T, et al. Impact of body mass index on clinical outcomes in triple-negative breast cancer. Cancer. 2011;117:4132–40.PubMedCrossRef
49.
go back to reference Christiansen N, Chen L, Gilmore J, et al. Association between African American race and outcomes in patients with nonmetastatic triple-negative breast cancer: a retrospective analysis by using results from the Georgia Cancer Specialist Database. Clin Breast Cancer. 2012;12:270–5.PubMedCrossRef Christiansen N, Chen L, Gilmore J, et al. Association between African American race and outcomes in patients with nonmetastatic triple-negative breast cancer: a retrospective analysis by using results from the Georgia Cancer Specialist Database. Clin Breast Cancer. 2012;12:270–5.PubMedCrossRef
50.
go back to reference Dawood S, Lei X, Litton JK, et al. Impact of body mass index on survival outcome among women with early stage triple-negative breast cancer. Clin Breast Cancer. 2012;12:364–72.PubMedCrossRef Dawood S, Lei X, Litton JK, et al. Impact of body mass index on survival outcome among women with early stage triple-negative breast cancer. Clin Breast Cancer. 2012;12:364–72.PubMedCrossRef
51.
go back to reference Mowad R, Chu QD, Li BD, et al. Does obesity have an effect on outcomes in triple-negative breast cancer? J Surg Res. 2013;184:253–9.PubMedCrossRef Mowad R, Chu QD, Li BD, et al. Does obesity have an effect on outcomes in triple-negative breast cancer? J Surg Res. 2013;184:253–9.PubMedCrossRef
52.
go back to reference Tait S, Pacheco JM, Gao F, et al. Body mass index, diabetes, and triple-negative breast cancer prognosis. Breast Cancer Res Treat. 2014;146:189–97.PubMedCrossRef Tait S, Pacheco JM, Gao F, et al. Body mass index, diabetes, and triple-negative breast cancer prognosis. Breast Cancer Res Treat. 2014;146:189–97.PubMedCrossRef
53.
go back to reference Perez CA, Zumsteg ZS, Gupta G, et al. Black race as a prognostic factor in triple-negative breast cancer patients treated with breast-conserving therapy: a large, single-institution retrospective analysis. Breast Cancer Res Treat. 2013;139:497–506.PubMedCrossRef Perez CA, Zumsteg ZS, Gupta G, et al. Black race as a prognostic factor in triple-negative breast cancer patients treated with breast-conserving therapy: a large, single-institution retrospective analysis. Breast Cancer Res Treat. 2013;139:497–506.PubMedCrossRef
54.
go back to reference Turkoz FP, Solak M, Petekkaya I, et al. The prognostic impact of obesity on molecular subtypes of breast cancer in premenopausal women. J BUON. 2013;18:335–41.PubMed Turkoz FP, Solak M, Petekkaya I, et al. The prognostic impact of obesity on molecular subtypes of breast cancer in premenopausal women. J BUON. 2013;18:335–41.PubMed
55.
go back to reference Gennari A, Nanni O, Puntoni M, et al. Body mass index and prognosis of metastatic breast cancer patients receiving first-line chemotherapy. Cancer Epidemiol Biomarkers Prev. 2013;22:1862–7.PubMedCrossRef Gennari A, Nanni O, Puntoni M, et al. Body mass index and prognosis of metastatic breast cancer patients receiving first-line chemotherapy. Cancer Epidemiol Biomarkers Prev. 2013;22:1862–7.PubMedCrossRef
56.
go back to reference Jung SY, Rosenzweig M, Sereika SM, et al. Factors associated with mortality after breast cancer metastasis. Cancer Causes Control. 2012;23:103–12.PubMedCrossRef Jung SY, Rosenzweig M, Sereika SM, et al. Factors associated with mortality after breast cancer metastasis. Cancer Causes Control. 2012;23:103–12.PubMedCrossRef
57.
go back to reference von Drygalski A, Tran TB, Messer K, et al. Obesity is an independent predictor of poor survival in metastatic breast cancer: retrospective analysis of a patient cohort whose treatment included high-dose chemotherapy and autologous stem cell support. Int J Breast Cancer. 2011;2011:523276. doi:10.4061/2011/523276. von Drygalski A, Tran TB, Messer K, et al. Obesity is an independent predictor of poor survival in metastatic breast cancer: retrospective analysis of a patient cohort whose treatment included high-dose chemotherapy and autologous stem cell support. Int J Breast Cancer. 2011;2011:523276. doi:10.​4061/​2011/​523276.
58.
go back to reference World Health Organization. Waist circumference and waist-hip ratio: report of a WHO Expert Consultation. Geneva; 2008. World Health Organization. Waist circumference and waist-hip ratio: report of a WHO Expert Consultation. Geneva; 2008.
59.••
go back to reference World Cancer Research Fund International. Continuous Update Project Report: diet, nutrition, physical activity, and breast cancer survivors; 2014. This report published by WCRF contains lifestyle recommendations to BC survivors, based on evidence of body fatness and physical activity along with other dietary factors and survival in women with BC. World Cancer Research Fund International. Continuous Update Project Report: diet, nutrition, physical activity, and breast cancer survivors; 2014. This report published by WCRF contains lifestyle recommendations to BC survivors, based on evidence of body fatness and physical activity along with other dietary factors and survival in women with BC.
60.•
go back to reference George SM, Bernstein L, Smith AW, et al. Central adiposity after breast cancer diagnosis is related to mortality in the Health, Eating, Activity, and Lifestyle study. Breast Cancer Res Treat. 2014;146:647–55. Results from the HEAL study support the role of body fat distribution in BC survival. The association may be mediated by insulin resistance and inflammation.PubMedCrossRef George SM, Bernstein L, Smith AW, et al. Central adiposity after breast cancer diagnosis is related to mortality in the Health, Eating, Activity, and Lifestyle study. Breast Cancer Res Treat. 2014;146:647–55. Results from the HEAL study support the role of body fat distribution in BC survival. The association may be mediated by insulin resistance and inflammation.PubMedCrossRef
61.
go back to reference Thompson AM, Moulder-Thompson SL. Neoadjuvant treatment of breast cancer. Ann Oncol. 2012;23 Suppl 10:x231–6.PubMedCrossRef Thompson AM, Moulder-Thompson SL. Neoadjuvant treatment of breast cancer. Ann Oncol. 2012;23 Suppl 10:x231–6.PubMedCrossRef
62.•
go back to reference Fontanella C, Lederer B, Gade S, et al. Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials. Breast Cancer Res Treat. 2015;150:127–39. Results from this pooled analysis of 8,872 BC patients in 8 neoadjuvant trials show that higher BMI was associated with lower pCR and a detrimental impact on survival; chemotherapy compliance and dosage may partly explain the results.PubMedCrossRef Fontanella C, Lederer B, Gade S, et al. Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials. Breast Cancer Res Treat. 2015;150:127–39. Results from this pooled analysis of 8,872 BC patients in 8 neoadjuvant trials show that higher BMI was associated with lower pCR and a detrimental impact on survival; chemotherapy compliance and dosage may partly explain the results.PubMedCrossRef
63.
go back to reference Budman DR, Berry DA, Cirrincione CT, et al. Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B. J Natl Cancer Inst. 1998;90:1205–11.PubMedCrossRef Budman DR, Berry DA, Cirrincione CT, et al. Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B. J Natl Cancer Inst. 1998;90:1205–11.PubMedCrossRef
64.•
go back to reference Hourdequin KC, Schpero WL, McKenna DR, et al. Toxic effect of chemotherapy dosing using actual body weight in obese versus normal-weight patients: a systematic review and meta-analysis. Ann Oncol. 2013;24:2952–62. This systematic review supports the use of full weight-based chemotherapy doses in obese patients with solid tumors, based on the findings of 12 relevant studies that showed similar or lower rates of toxic effects, and similar survival outcomes compared with normal weight patients.PubMedCrossRef Hourdequin KC, Schpero WL, McKenna DR, et al. Toxic effect of chemotherapy dosing using actual body weight in obese versus normal-weight patients: a systematic review and meta-analysis. Ann Oncol. 2013;24:2952–62. This systematic review supports the use of full weight-based chemotherapy doses in obese patients with solid tumors, based on the findings of 12 relevant studies that showed similar or lower rates of toxic effects, and similar survival outcomes compared with normal weight patients.PubMedCrossRef
66.
go back to reference Griggs JJ, Mangu PB, Anderson H, et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2012;30:1553–61.PubMedCrossRef Griggs JJ, Mangu PB, Anderson H, et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2012;30:1553–61.PubMedCrossRef
67.
go back to reference Burstein HJ, Temin S, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline focused update. J Clin Oncol. 2014;32:2255–69.PubMedCrossRef Burstein HJ, Temin S, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline focused update. J Clin Oncol. 2014;32:2255–69.PubMedCrossRef
68.
go back to reference Pfeiler G, Stoger H, Dubsky P, et al. Efficacy of tamoxifen +/- aminoglutethimide in normal weight and overweight postmenopausal patients with hormone receptor-positive breast cancer: an analysis of 1509 patients of the ABCSG-06 trial. Br J Cancer. 2013;108:1408–14.PubMedCentralPubMedCrossRef Pfeiler G, Stoger H, Dubsky P, et al. Efficacy of tamoxifen +/- aminoglutethimide in normal weight and overweight postmenopausal patients with hormone receptor-positive breast cancer: an analysis of 1509 patients of the ABCSG-06 trial. Br J Cancer. 2013;108:1408–14.PubMedCentralPubMedCrossRef
69.
go back to reference Fabian CJ. The what, why and how of aromatase inhibitors: hormonal agents for treatment and prevention of breast cancer. Int J Clin Pract. 2007;61:2051–63.PubMedCentralPubMedCrossRef Fabian CJ. The what, why and how of aromatase inhibitors: hormonal agents for treatment and prevention of breast cancer. Int J Clin Pract. 2007;61:2051–63.PubMedCentralPubMedCrossRef
70.
go back to reference Sestak I, Distler W, Forbes JF, et al. Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol. 2010;28:3411–5.PubMedCrossRef Sestak I, Distler W, Forbes JF, et al. Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol. 2010;28:3411–5.PubMedCrossRef
71.
go back to reference Goodwin PJ, Pritchard KI. Obesity and hormone therapy in breast cancer: an unfinished puzzle. J Clin Oncol. 2010;28:3405–7.PubMedCrossRef Goodwin PJ, Pritchard KI. Obesity and hormone therapy in breast cancer: an unfinished puzzle. J Clin Oncol. 2010;28:3405–7.PubMedCrossRef
72.
go back to reference Ioannides SJ, Barlow PL, Elwood JM, et al. Effect of obesity on aromatase inhibitor efficacy in postmenopausal, hormone receptor-positive breast cancer: a systematic review. Breast Cancer Res Treat. 2014;147:237–48.PubMedCrossRef Ioannides SJ, Barlow PL, Elwood JM, et al. Effect of obesity on aromatase inhibitor efficacy in postmenopausal, hormone receptor-positive breast cancer: a systematic review. Breast Cancer Res Treat. 2014;147:237–48.PubMedCrossRef
73.
go back to reference Dixon JM, Renshaw L, Young O, et al. Letrozole suppresses plasma estradiol and estrone sulphate more completely than anastrozole in postmenopausal women with breast cancer. J Clin Oncol. 2008;26:1671–6.PubMedCrossRef Dixon JM, Renshaw L, Young O, et al. Letrozole suppresses plasma estradiol and estrone sulphate more completely than anastrozole in postmenopausal women with breast cancer. J Clin Oncol. 2008;26:1671–6.PubMedCrossRef
74.
go back to reference Folkerd EJ, Dixon JM, Renshaw L, et al. Suppression of plasma estrogen levels by letrozole and anastrozole is related to body mass index in patients with breast cancer. J Clin Oncol. 2012;30:2977–80.PubMedCrossRef Folkerd EJ, Dixon JM, Renshaw L, et al. Suppression of plasma estrogen levels by letrozole and anastrozole is related to body mass index in patients with breast cancer. J Clin Oncol. 2012;30:2977–80.PubMedCrossRef
75.
go back to reference Ewertz M, Gray KP, Regan MM, et al. Obesity and risk of recurrence or death after adjuvant endocrine therapy with letrozole or tamoxifen in the breast international group 1-98 trial. J Clin Oncol. 2012;30:3967–75.PubMedCentralPubMedCrossRef Ewertz M, Gray KP, Regan MM, et al. Obesity and risk of recurrence or death after adjuvant endocrine therapy with letrozole or tamoxifen in the breast international group 1-98 trial. J Clin Oncol. 2012;30:3967–75.PubMedCentralPubMedCrossRef
77.•
go back to reference Goodwin PJ. Obesity and endocrine therapy: host factors and breast cancer outcome. Breast. 2013;22 Suppl 2:S44–7. This article is a concise review of the RCTs that evaluated the impact of BMI in the aromatase inhibitor (AI) efficacy in BC patients and concluded that the findings do not support the use of BMI as a predictor of AI vs. tamoxifen benefit in the adjuvant setting in postmenopausal BC.PubMedCrossRef Goodwin PJ. Obesity and endocrine therapy: host factors and breast cancer outcome. Breast. 2013;22 Suppl 2:S44–7. This article is a concise review of the RCTs that evaluated the impact of BMI in the aromatase inhibitor (AI) efficacy in BC patients and concluded that the findings do not support the use of BMI as a predictor of AI vs. tamoxifen benefit in the adjuvant setting in postmenopausal BC.PubMedCrossRef
78.
go back to reference Burstein HJ, Prestrud AA, Seidenfeld J, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol. 2010;28:3784–96.PubMedCrossRef Burstein HJ, Prestrud AA, Seidenfeld J, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol. 2010;28:3784–96.PubMedCrossRef
79.
go back to reference Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790–7.PubMedCrossRef Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790–7.PubMedCrossRef
80.
go back to reference Gandini S, Puntoni M, Heckman-Stoddard BM, et al. Metformin and cancer risk and mortality: a systematic review and meta-analysis taking into account biases and confounders. Cancer Prev Res (Phila). 2014;7:867–85.CrossRef Gandini S, Puntoni M, Heckman-Stoddard BM, et al. Metformin and cancer risk and mortality: a systematic review and meta-analysis taking into account biases and confounders. Cancer Prev Res (Phila). 2014;7:867–85.CrossRef
81.
go back to reference Goodwin PJ, Stambolic V, Lemieux J, et al. Evaluation of metformin in early breast cancer: a modification of the traditional paradigm for clinical testing of anti-cancer agents. Breast Cancer Res Treat. 2011;126:215–20.PubMedCrossRef Goodwin PJ, Stambolic V, Lemieux J, et al. Evaluation of metformin in early breast cancer: a modification of the traditional paradigm for clinical testing of anti-cancer agents. Breast Cancer Res Treat. 2011;126:215–20.PubMedCrossRef
82.
go back to reference Yin M, Zhou J, Gorak EJ, et al. Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: a systematic review and meta-analysis. Oncologist. 2013;18:1248–55.PubMedCentralPubMedCrossRef Yin M, Zhou J, Gorak EJ, et al. Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: a systematic review and meta-analysis. Oncologist. 2013;18:1248–55.PubMedCentralPubMedCrossRef
83.••
go back to reference Goodwin PJ, Parulekar WR, Gelmon KA, et al. Effect of metformin versus placebo on weight and metabolic factors in initial patients enrolled onto NCIC CTG MA.32, a multicenter adjuvant randomized controlled trial in early-stage breast cancer (BC). J Clin Oncol. 2013;31. NCIC CTG MA.32 published promising preliminary results that showed non-diabetics early-stage BC patients using metformin had improved body weight and obesity-related biomarkers compared with placebo. Goodwin PJ, Parulekar WR, Gelmon KA, et al. Effect of metformin versus placebo on weight and metabolic factors in initial patients enrolled onto NCIC CTG MA.32, a multicenter adjuvant randomized controlled trial in early-stage breast cancer (BC). J Clin Oncol. 2013;31. NCIC CTG MA.32 published promising preliminary results that showed non-diabetics early-stage BC patients using metformin had improved body weight and obesity-related biomarkers compared with placebo.
84.
go back to reference Chlebowski RT, Blackburn GL, Thomson CA, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst. 2006;98:1767–76.PubMedCrossRef Chlebowski RT, Blackburn GL, Thomson CA, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst. 2006;98:1767–76.PubMedCrossRef
85.
go back to reference Pierce JP, Natarajan L, Caan BJ, et al. Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA. 2007;298:289–98.PubMedCentralPubMedCrossRef Pierce JP, Natarajan L, Caan BJ, et al. Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA. 2007;298:289–98.PubMedCentralPubMedCrossRef
86.
go back to reference Demark-Wahnefried W, Campbell KL, Hayes SC. Weight management and its role in breast cancer rehabilitation. Cancer. 2012;118:2277–87.PubMedCrossRef Demark-Wahnefried W, Campbell KL, Hayes SC. Weight management and its role in breast cancer rehabilitation. Cancer. 2012;118:2277–87.PubMedCrossRef
87.
go back to reference Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 2014;25:1293–311.PubMedCrossRef Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 2014;25:1293–311.PubMedCrossRef
88.••
go back to reference Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:243–74. This report published by the ACS summarizes the findings on the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer and contains useful lifestyle recommendations for cancer survivors.PubMedCrossRef Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:243–74. This report published by the ACS summarizes the findings on the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer and contains useful lifestyle recommendations for cancer survivors.PubMedCrossRef
89.••
go back to reference Courneya KS, Segal RJ, McKenzie DC, et al. Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Med Sci Sports Exerc. 2014;46:1744–51. START is the first aerobic or resistance exercise intervention to publish results on BC survival endpoints, which showed promising results of improved survival compared with patients who received usual care during adjuvant treatment.PubMedCrossRef Courneya KS, Segal RJ, McKenzie DC, et al. Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Med Sci Sports Exerc. 2014;46:1744–51. START is the first aerobic or resistance exercise intervention to publish results on BC survival endpoints, which showed promising results of improved survival compared with patients who received usual care during adjuvant treatment.PubMedCrossRef
90.•
go back to reference Reeves MM, Terranova CO, Eakin EG, et al. Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev. 2014;15:749–68. In this systematic review, BC survivors in 8 out of the 14 intervention trials attained significant weight loss and health benefits with no adverse effects, which provided supporting evidence of the feasibility and beneficial effects of weight loss through diet and/or exercise.PubMedCrossRef Reeves MM, Terranova CO, Eakin EG, et al. Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev. 2014;15:749–68. In this systematic review, BC survivors in 8 out of the 14 intervention trials attained significant weight loss and health benefits with no adverse effects, which provided supporting evidence of the feasibility and beneficial effects of weight loss through diet and/or exercise.PubMedCrossRef
91.•
go back to reference Goodwin PJ, Segal RJ, Vallis M, et al. Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol. 2014;32:2231–9. The LISA trial is the latest weight loss intervention trial to publish results and showed that significant weight loss could be achieved in BC survivors through simple lifestyle modification strategies that were delivered through telephone counselling.PubMedCrossRef Goodwin PJ, Segal RJ, Vallis M, et al. Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol. 2014;32:2231–9. The LISA trial is the latest weight loss intervention trial to publish results and showed that significant weight loss could be achieved in BC survivors through simple lifestyle modification strategies that were delivered through telephone counselling.PubMedCrossRef
92.
go back to reference Travier N, Fonseca-Nunes A, Javierre C, et al. Effect of a diet and physical activity intervention on body weight and nutritional patterns in overweight and obese breast cancer survivors. Med Oncol. 2014;31:783.PubMedCrossRef Travier N, Fonseca-Nunes A, Javierre C, et al. Effect of a diet and physical activity intervention on body weight and nutritional patterns in overweight and obese breast cancer survivors. Med Oncol. 2014;31:783.PubMedCrossRef
93.
go back to reference Caan BJ, Kwan ML, Shu XO, et al. Weight change and survival after breast cancer in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev. 2012;21:1260–71.PubMedCentralPubMedCrossRef Caan BJ, Kwan ML, Shu XO, et al. Weight change and survival after breast cancer in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev. 2012;21:1260–71.PubMedCentralPubMedCrossRef
94.
go back to reference Rack B, Andergassen U, Neugebauer J, et al. The German SUCCESS C Study—the first European lifestyle study on breast cancer. Breast Care (Basel). 2010;5:395–400.CrossRef Rack B, Andergassen U, Neugebauer J, et al. The German SUCCESS C Study—the first European lifestyle study on breast cancer. Breast Care (Basel). 2010;5:395–400.CrossRef
95.
go back to reference Villarini A, Pasanisi P, Traina A, et al. Lifestyle and breast cancer recurrences: the DIANA-5 trial. Tumori. 2012;98:1–18.PubMed Villarini A, Pasanisi P, Traina A, et al. Lifestyle and breast cancer recurrences: the DIANA-5 trial. Tumori. 2012;98:1–18.PubMed
96.
go back to reference Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30–67.PubMedCrossRef Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30–67.PubMedCrossRef
97.
go back to reference Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–26.PubMedCrossRef Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–26.PubMedCrossRef
Metadata
Title
Obesity and Breast Cancer: Not Only a Risk Factor of the Disease
Authors
Doris S. M. Chan, M.Sc.
Teresa Norat, Ph.D.
Publication date
01-05-2015
Publisher
Springer US
Published in
Current Treatment Options in Oncology / Issue 5/2015
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI
https://doi.org/10.1007/s11864-015-0341-9

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