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Distinct Effects of Body Mass Index and Waist/Hip Ratio on Risk of Breast Cancer by Joint Estrogen and Progestogen Receptor Status: Results from a Case-Control Study in Northern and Eastern China and Implications for Chemoprevention.
Oncologist 2017; 22(12):1431-1443O

Abstract

BACKGROUND

Obesity is a consideration in the pharmacologic intervention for estrogen receptor (ER) positive (ER+) breast cancer risk. Body mass index (BMI) and waist/hip ratio (WHR) have demonstrated different effects on breast cancer risk in relation to estrogen receptor (ER) status, but the results have been inconsistent. Furthermore, the situation in Chinese women remains unclear.

MATERIALS AND METHODS

We conducted a case-control study including 1,439 breast cancer cases in Northern and Eastern China. Both ER and progesterone receptor (PR) statuses were available for 1,316 cases. Associations between body size-related factors and breast cancer risk defined by receptor status were assessed by multiple polytomous unconditional logistic regression analysis.

RESULTS

Body mass index and WHR were positively associated with overall breast cancer risk. Body mass index was positively associated with both ER+/PR positive (PR+) and ER negative (ER-)/PR negative(PR-) subtype risks, although only significantly for ER+/PR+ subtype. Waist-hip ratio was only positively correlated with ER-/PR- subtype risk, although independent of BMI. Body mass index was positively associated with risk of ER+/PR+ and ER-/PR- subtypes in premenopausal women, whereas WHR was inversely correlated with ER+/PR- and positively with ER-/PR- subtype risks. Among postmenopausal women, WHR >0.85 was associated with increased risk of ER-/PR- subtype.

CONCLUSION

Both general and central obesity contribute to breast cancer risk, with different effects on specific subtypes. General obesity, indicated by BMI, is more strongly associated with ER+/PR+ subtype, especially among premenopausal women, whereas central obesity, indicated by WHR, is more specific for ER-/PR- subtype, independent of menopausal status. These results suggest that different chemoprevention strategies may be appropriate in selected individuals.

IMPLICATIONS FOR PRACTICE

The results of this study suggest that general and central obesity may play different roles in different breast cancer subtypes, supporting the hypothesis that obesity affects breast carcinogenesis via complex molecular interconnections, beyond the impact of estrogens. The results also imply that different chemoprevention strategies may be appropriate for selected individuals, highlighting the need to be particularly aware of women with a high waist/hip ratio but normal body mass index. Given the lack of any proven pharmacologic intervention for estrogen receptor negative breast cancer, stricter weight-control measures may be advised in these individuals.

Authors+Show Affiliations

Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China.Department of Breast Surgery, Shanxi Cancer Hospital, Taiyuan, Shanxi Province, People's Republic of China.Department of Breast Surgery, the First Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China.Breast Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China.Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China.Department of Thyroid and Breast Surgery, the First Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong Province, People's Republic of China.Department of Breast Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.Department of General Surgery, Linyi People's Hospital, Linyi, Shandong Province, People's Republic of China.Breast Disease Center, Peking University People's Hospital, Beijing, People's Republic of China.Department of General Surgery, Beijing Chaoyang Hospital, Beijing, People's Republic of China.Breast Disease Center, Peking University First Hospital, Beijing, People's Republic of China.Breast Center, Qingdao University Affiliated Hospital, Qingdao, Shandong Province, People's Republic of China.Department of Breast and Thyroid Surgery, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Affiliated Hospital of Qingdao Medical College, Qingdao Central Hospital, Qingdao, Shandong Province, People's Republic of China.Department of General Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China.Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital Cancer Institute of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China.Department of Breast and Thyroid Surgery, Zibo Central Hospital, Zibo, Shandong Province, People's Republic of China.Department of Breast Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong Province, People's Republic of China.Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China yzg@medmail.com.cn. Suzhou Institute of Shandong University, Suzhou, Jiangsu Province, People's Republic of China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28912152

Citation

Wang, Fei, et al. "Distinct Effects of Body Mass Index and Waist/Hip Ratio On Risk of Breast Cancer By Joint Estrogen and Progestogen Receptor Status: Results From a Case-Control Study in Northern and Eastern China and Implications for Chemoprevention." The Oncologist, vol. 22, no. 12, 2017, pp. 1431-1443.
Wang F, Liu L, Cui S, et al. Distinct Effects of Body Mass Index and Waist/Hip Ratio on Risk of Breast Cancer by Joint Estrogen and Progestogen Receptor Status: Results from a Case-Control Study in Northern and Eastern China and Implications for Chemoprevention. Oncologist. 2017;22(12):1431-1443.
Wang, F., Liu, L., Cui, S., Tian, F., Fan, Z., Geng, C., ... Yu, Z. (2017). Distinct Effects of Body Mass Index and Waist/Hip Ratio on Risk of Breast Cancer by Joint Estrogen and Progestogen Receptor Status: Results from a Case-Control Study in Northern and Eastern China and Implications for Chemoprevention. The Oncologist, 22(12), pp. 1431-1443. doi:10.1634/theoncologist.2017-0148.
Wang F, et al. Distinct Effects of Body Mass Index and Waist/Hip Ratio On Risk of Breast Cancer By Joint Estrogen and Progestogen Receptor Status: Results From a Case-Control Study in Northern and Eastern China and Implications for Chemoprevention. Oncologist. 2017;22(12):1431-1443. PubMed PMID: 28912152.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distinct Effects of Body Mass Index and Waist/Hip Ratio on Risk of Breast Cancer by Joint Estrogen and Progestogen Receptor Status: Results from a Case-Control Study in Northern and Eastern China and Implications for Chemoprevention. AU - Wang,Fei, AU - Liu,Liyuan, AU - Cui,Shude, AU - Tian,Fuguo, AU - Fan,Zhimin, AU - Geng,Cuizhi, AU - Cao,Xuchen, AU - Yang,Zhenlin, AU - Wang,Xiang, AU - Liang,Hong, AU - Wang,Shu, AU - Jiang,Hongchuan, AU - Duan,Xuening, AU - Wang,Haibo, AU - Li,Guolou, AU - Wang,Qitang, AU - Zhang,Jianguo, AU - Jin,Feng, AU - Tang,Jinhai, AU - Li,Liang, AU - Zhu,Shiguang, AU - Zuo,Wenshu, AU - Ma,Zhongbing, AU - Zhou,Fei, AU - Yu,Lixiang, AU - Xiang,Yujuan, AU - Li,Liang, AU - Shen,Shuohao, AU - Yu,Zhigang, Y1 - 2017/09/14/ PY - 2017/04/01/received PY - 2017/07/30/accepted PY - 2017/9/16/pubmed PY - 2018/7/24/medline PY - 2017/9/16/entrez KW - Body mass index KW - Breast neoplasms KW - Estrogen receptors KW - Progesterone receptors KW - Waist/hip ratio SP - 1431 EP - 1443 JF - The oncologist JO - Oncologist VL - 22 IS - 12 N2 - BACKGROUND: Obesity is a consideration in the pharmacologic intervention for estrogen receptor (ER) positive (ER+) breast cancer risk. Body mass index (BMI) and waist/hip ratio (WHR) have demonstrated different effects on breast cancer risk in relation to estrogen receptor (ER) status, but the results have been inconsistent. Furthermore, the situation in Chinese women remains unclear. MATERIALS AND METHODS: We conducted a case-control study including 1,439 breast cancer cases in Northern and Eastern China. Both ER and progesterone receptor (PR) statuses were available for 1,316 cases. Associations between body size-related factors and breast cancer risk defined by receptor status were assessed by multiple polytomous unconditional logistic regression analysis. RESULTS: Body mass index and WHR were positively associated with overall breast cancer risk. Body mass index was positively associated with both ER+/PR positive (PR+) and ER negative (ER-)/PR negative(PR-) subtype risks, although only significantly for ER+/PR+ subtype. Waist-hip ratio was only positively correlated with ER-/PR- subtype risk, although independent of BMI. Body mass index was positively associated with risk of ER+/PR+ and ER-/PR- subtypes in premenopausal women, whereas WHR was inversely correlated with ER+/PR- and positively with ER-/PR- subtype risks. Among postmenopausal women, WHR >0.85 was associated with increased risk of ER-/PR- subtype. CONCLUSION: Both general and central obesity contribute to breast cancer risk, with different effects on specific subtypes. General obesity, indicated by BMI, is more strongly associated with ER+/PR+ subtype, especially among premenopausal women, whereas central obesity, indicated by WHR, is more specific for ER-/PR- subtype, independent of menopausal status. These results suggest that different chemoprevention strategies may be appropriate in selected individuals. IMPLICATIONS FOR PRACTICE: The results of this study suggest that general and central obesity may play different roles in different breast cancer subtypes, supporting the hypothesis that obesity affects breast carcinogenesis via complex molecular interconnections, beyond the impact of estrogens. The results also imply that different chemoprevention strategies may be appropriate for selected individuals, highlighting the need to be particularly aware of women with a high waist/hip ratio but normal body mass index. Given the lack of any proven pharmacologic intervention for estrogen receptor negative breast cancer, stricter weight-control measures may be advised in these individuals. SN - 1549-490X UR - https://www.unboundmedicine.com/medline/citation/28912152/Distinct_Effects_of_Body_Mass_Index_and_Waist/Hip_Ratio_on_Risk_of_Breast_Cancer_by_Joint_Estrogen_and_Progestogen_Receptor_Status:_Results_from_a_Case_Control_Study_in_Northern_and_Eastern_China_and_Implications_for_Chemoprevention_ L2 - http://theoncologist.alphamedpress.org/cgi/pmidlookup?view=long&pmid=28912152 DB - PRIME DP - Unbound Medicine ER -