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Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies.

Abstract

BACKGROUND

Positive association between obesity and survival after breast cancer was demonstrated in previous meta-analyses of published data, but only the results for the comparison of obese versus non-obese was summarised.

METHODS

We systematically searched in MEDLINE and EMBASE for follow-up studies of breast cancer survivors with body mass index (BMI) before and after diagnosis, and total and cause-specific mortality until June 2013, as part of the World Cancer Research Fund Continuous Update Project. Random-effects meta-analyses were conducted to explore the magnitude and the shape of the associations.

RESULTS

Eighty-two studies, including 213 075 breast cancer survivors with 41 477 deaths (23 182 from breast cancer) were identified. For BMI before diagnosis, compared with normal weight women, the summary relative risks (RRs) of total mortality were 1.41 [95% confidence interval (CI) 1.29-1.53] for obese (BMI >30.0), 1.07 (95 CI 1.02-1.12) for overweight (BMI 25.0-<30.0) and 1.10 (95% CI 0.92-1.31) for underweight (BMI <18.5) women. For obese women, the summary RRs were 1.75 (95% CI 1.26-2.41) for pre-menopausal and 1.34 (95% CI 1.18-1.53) for post-menopausal breast cancer. For each 5 kg/m(2) increment of BMI before, <12 months after, and ≥12 months after diagnosis, increased risks of 17%, 11%, and 8% for total mortality, and 18%, 14%, and 29% for breast cancer mortality were observed, respectively.

CONCLUSIONS

Obesity is associated with poorer overall and breast cancer survival in pre- and post-menopausal breast cancer, regardless of when BMI is ascertained. Being overweight is also related to a higher risk of mortality. Randomised clinical trials are needed to test interventions for weight loss and maintenance on survival in women with breast cancer.

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  • Authors+Show Affiliations

    ,

    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK d.chan@imperial.ac.uk.

    ,

    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

    ,

    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

    ,

    Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Jersey, USA.

    ,

    Division of Biostatistics, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK.

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    Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Washington, USA.

    ,

    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

    ,

    Department of Oncology, Oslo University Hospital, Oslo Faculty of Health Sciences, Department of Community Medicine, University of Tromso, Tromso, Norway.

    ,

    School of Mathematics and Statistics, University of Newcastle, Newcastle upon Tyne, UK.

    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

    Source

    MeSH

    Body Mass Index
    Breast Neoplasms
    Female
    Follow-Up Studies
    Humans
    MEDLINE
    Obesity
    Prognosis
    Randomized Controlled Trials as Topic
    Risk Factors
    Survivors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    24769692

    Citation

    Chan, D S M., et al. "Body Mass Index and Survival in Women With Breast Cancer-systematic Literature Review and Meta-analysis of 82 Follow-up Studies." Annals of Oncology : Official Journal of the European Society for Medical Oncology, vol. 25, no. 10, 2014, pp. 1901-14.
    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(10):1901-14.
    Chan, D. S., Vieira, A. R., Aune, D., Bandera, E. V., Greenwood, D. C., McTiernan, A., ... Norat, T. (2014). Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Annals of Oncology : Official Journal of the European Society for Medical Oncology, 25(10), pp. 1901-14. doi:10.1093/annonc/mdu042.
    Chan DS, 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(10):1901-14. PubMed PMID: 24769692.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. AU - Chan,D S M, AU - Vieira,A R, AU - Aune,D, AU - Bandera,E V, AU - Greenwood,D C, AU - McTiernan,A, AU - Navarro Rosenblatt,D, AU - Thune,I, AU - Vieira,R, AU - Norat,T, Y1 - 2014/04/27/ PY - 2014/4/29/entrez PY - 2014/4/29/pubmed PY - 2015/6/13/medline KW - body mass index KW - meta-analysis KW - survival after breast cancer KW - systematic literature review SP - 1901 EP - 14 JF - Annals of oncology : official journal of the European Society for Medical Oncology JO - Ann. Oncol. VL - 25 IS - 10 N2 - BACKGROUND: Positive association between obesity and survival after breast cancer was demonstrated in previous meta-analyses of published data, but only the results for the comparison of obese versus non-obese was summarised. METHODS: We systematically searched in MEDLINE and EMBASE for follow-up studies of breast cancer survivors with body mass index (BMI) before and after diagnosis, and total and cause-specific mortality until June 2013, as part of the World Cancer Research Fund Continuous Update Project. Random-effects meta-analyses were conducted to explore the magnitude and the shape of the associations. RESULTS: Eighty-two studies, including 213 075 breast cancer survivors with 41 477 deaths (23 182 from breast cancer) were identified. For BMI before diagnosis, compared with normal weight women, the summary relative risks (RRs) of total mortality were 1.41 [95% confidence interval (CI) 1.29-1.53] for obese (BMI >30.0), 1.07 (95 CI 1.02-1.12) for overweight (BMI 25.0-<30.0) and 1.10 (95% CI 0.92-1.31) for underweight (BMI <18.5) women. For obese women, the summary RRs were 1.75 (95% CI 1.26-2.41) for pre-menopausal and 1.34 (95% CI 1.18-1.53) for post-menopausal breast cancer. For each 5 kg/m(2) increment of BMI before, <12 months after, and ≥12 months after diagnosis, increased risks of 17%, 11%, and 8% for total mortality, and 18%, 14%, and 29% for breast cancer mortality were observed, respectively. CONCLUSIONS: Obesity is associated with poorer overall and breast cancer survival in pre- and post-menopausal breast cancer, regardless of when BMI is ascertained. Being overweight is also related to a higher risk of mortality. Randomised clinical trials are needed to test interventions for weight loss and maintenance on survival in women with breast cancer. SN - 1569-8041 UR - https://www.unboundmedicine.com/medline/citation/24769692/full_citation L2 - https://academic.oup.com/annonc/article-lookup/doi/10.1093/annonc/mdu042 DB - PRIME DP - Unbound Medicine ER -