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Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer.
Breast Cancer Res Treat. 2006 Jun; 97(3):245-54.BC

Abstract

BACKGROUND

Several factors may contribute to poorer prognosis for obese breast cancer patients, including unfavorable disease features, the influence of fat on estrogen availability, co-morbidity, and socio-demographic factors. Both obesity and estrogen receptor negative (ER-) tumors are more prevalent in black women than in whites in North America. We evaluated obesity and race in relation to outcomes in women with ER-breast cancer.

METHODS

Among 4,077 women from National Surgical Adjuvant Breast and Bowel Project clinical trials for node-negative, ER-breast cancer, we evaluated disease-free survival (DFS) and its constituents (tumor recurrence, contralateral breast cancer (CBC), second primary cancers, deaths prior to these events) and mortality in relation to body mass index (BMI) and race, using statistical modeling to account for other prognostic factors.

RESULTS

Compared to those of normal weight (BMI< or =24.9), DFS hazard was greater for obese (BMI > or = 30) women [hazard ratio (HR)=1.16, 95% confidence interval (CI)=1.01-1.33]. Obesity did not increase recurrence hazard, but did influence CBC (HR=2.08, 95% CI=1.22-3.55 in postmenopausal women) and second cancers (HR=1.49, 95% CI=1.06-2.10). Mortality increased with obesity; when partitioned by likely cause, those with BMI > or = 35.0 had greater risk of non-breast cancer mortality (HR=1.86, 95% CI=1.21-2.84). Relative to whites and adjusted for BMI, black women had greater hazard for DFS (HR=1.17, 95% CI=1.00-1.38), CBC (HR=1.37, 95% CI=0.94-1.99), and non-breast cancer deaths (HR=2.10, 95% CI=1.45-3.03); risk for deaths likely due to breast cancer was closer to that in whites (HR=1.18; 95% CI=0.93-1.50).

CONCLUSIONS

For women with node-negative, ER-breast cancer from clinical trials, obesity did not increase recurrence risk, but was associated with greater risk for second cancers, CBC, and mortality, particularly non-breast cancer deaths. Less favorable prognosis for black women persists in clinical trials, and is in part attributable to non-breast cancer outcomes.

Authors+Show Affiliations

Department of Health Studies, The University of Chicago, Chicago, IL 60637, USA. jdignam@health.bsd.uchicago.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

16331345

Citation

Dignam, James J., et al. "Effects of Obesity and Race On Prognosis in Lymph Node-negative, Estrogen Receptor-negative Breast Cancer." Breast Cancer Research and Treatment, vol. 97, no. 3, 2006, pp. 245-54.
Dignam JJ, Wieand K, Johnson KA, et al. Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Res Treat. 2006;97(3):245-54.
Dignam, J. J., Wieand, K., Johnson, K. A., Raich, P., Anderson, S. J., Somkin, C., & Wickerham, D. L. (2006). Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Research and Treatment, 97(3), 245-54.
Dignam JJ, et al. Effects of Obesity and Race On Prognosis in Lymph Node-negative, Estrogen Receptor-negative Breast Cancer. Breast Cancer Res Treat. 2006;97(3):245-54. PubMed PMID: 16331345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. AU - Dignam,James J, AU - Wieand,Kelly, AU - Johnson,Karen A, AU - Raich,Peter, AU - Anderson,Stewart J, AU - Somkin,Carol, AU - Wickerham,D Lawrence, Y1 - 2005/12/06/ PY - 2005/11/07/received PY - 2005/11/08/accepted PY - 2005/12/7/pubmed PY - 2006/11/15/medline PY - 2005/12/7/entrez SP - 245 EP - 54 JF - Breast cancer research and treatment JO - Breast Cancer Res Treat VL - 97 IS - 3 N2 - BACKGROUND: Several factors may contribute to poorer prognosis for obese breast cancer patients, including unfavorable disease features, the influence of fat on estrogen availability, co-morbidity, and socio-demographic factors. Both obesity and estrogen receptor negative (ER-) tumors are more prevalent in black women than in whites in North America. We evaluated obesity and race in relation to outcomes in women with ER-breast cancer. METHODS: Among 4,077 women from National Surgical Adjuvant Breast and Bowel Project clinical trials for node-negative, ER-breast cancer, we evaluated disease-free survival (DFS) and its constituents (tumor recurrence, contralateral breast cancer (CBC), second primary cancers, deaths prior to these events) and mortality in relation to body mass index (BMI) and race, using statistical modeling to account for other prognostic factors. RESULTS: Compared to those of normal weight (BMI< or =24.9), DFS hazard was greater for obese (BMI > or = 30) women [hazard ratio (HR)=1.16, 95% confidence interval (CI)=1.01-1.33]. Obesity did not increase recurrence hazard, but did influence CBC (HR=2.08, 95% CI=1.22-3.55 in postmenopausal women) and second cancers (HR=1.49, 95% CI=1.06-2.10). Mortality increased with obesity; when partitioned by likely cause, those with BMI > or = 35.0 had greater risk of non-breast cancer mortality (HR=1.86, 95% CI=1.21-2.84). Relative to whites and adjusted for BMI, black women had greater hazard for DFS (HR=1.17, 95% CI=1.00-1.38), CBC (HR=1.37, 95% CI=0.94-1.99), and non-breast cancer deaths (HR=2.10, 95% CI=1.45-3.03); risk for deaths likely due to breast cancer was closer to that in whites (HR=1.18; 95% CI=0.93-1.50). CONCLUSIONS: For women with node-negative, ER-breast cancer from clinical trials, obesity did not increase recurrence risk, but was associated with greater risk for second cancers, CBC, and mortality, particularly non-breast cancer deaths. Less favorable prognosis for black women persists in clinical trials, and is in part attributable to non-breast cancer outcomes. SN - 0167-6806 UR - https://www.unboundmedicine.com/medline/citation/16331345/Effects_of_obesity_and_race_on_prognosis_in_lymph_node_negative_estrogen_receptor_negative_breast_cancer_ L2 - https://doi.org/10.1007/s10549-005-9118-3 DB - PRIME DP - Unbound Medicine ER -