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13 July 2006
Obesity impacts on early breast cancer prognosis
Although obesity is not a risk factor for breast cancer
recurrence in node-negative, estrogen receptor (ER)-negative
patients, study findings show that elevated body mass index
(BMI) has a deleterious affect on other outcomes.
The research, published in the journal
Breast Cancer Research and Treatment, found a link between
obesity and likelihood of dying or developing contralateral
disease or a second primary tumor.
"In early stage cancer among younger
patients such as those considered here, factors affecting
cancer survivorship are of particular interest, and so weight
maintenance may come to be recognized as an important facet
of disease management," lead author James Dignam (University
of Chicago, Illinois, USA) and colleagues comment.
The team examined data from three National
Surgical Adjuvant Breast and Bowel Project clinical trials
involving 4077 women with node-negative, ER-negative breast
cancer.
When compared with women with a healthy
weight, defined as a BMI of 24.9 or less, the disease-free
survival hazard ratio (HR) for those with an obese BMI of
30 or more was 1.16.
Obesity was also associated with an increased
risk of both contralateral postmenopausal breast cancer
(HR=2.08) and second primary cancer (HR=1.49).
Of note, participants with a BMI of 35.0
or higher had a HR of 1.86 for death unrelated to recurring
breast cancer or a second primary tumor compared with women
with a healthy BMI.
Further analysis demonstrated that, after
taking into consideration BMI, Black women had poorer disease-free
survival (HR=1.17), contralateral breast cancer (HR=1.37)
and non-breast cancer-related mortality (HR=2.10) than their
White counterparts.
Dignam et al recommend that further research
is performed to examine the impact of weight fluctuation
following breast cancer diagnosis, especially regarding
the impact of weight gain on prognosis.
"With regard to outcome for Black
women, while disparities in these randomized trials are
smaller than those in the population at large, more work
is needed to elucidate their causes and possible interventions,"
they continue.
"These investigations should consider
tumor-specific mechanisms as well as the social, health,
and economic differences that may persist even within the
clinical trial setting."
Breast Cancer Res Treat 2006; 97: 245–254
US acculturation alters Chinese breast
density
Chinese women who adopt Western habits on emigrating to
the USA may inadvertently increase their likelihood of developing
breast cancer, a study of the breast cancer risk factor,
breast density, suggests.
"These analyses are the first to
show breast density differences by level of acculturation
among foreign-born US Chinese women," Marilyn Tseng
(Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA)
and colleagues write in the journal Cancer Epidemiology
Biomarkers and Prevention.
The team made the discovery after recruiting
212 such women participating in breast cancer screening
programs in the Philadelphia area. Breast tissue was classified
as being between "extremely fatty" to "extremely
dense," and the women were questioned regarding their
socioeconomic, cultural, reproductive, and lifestyle background.
Analysis showed that women in the highest
category for acculturation had significantly denser breasts
than those in the lowest category (odds ratio=3.1).
Acculturation was also associated with
fewer live births, older age at time of first live birth,
and increasing dairy product consumption, all of which,
the researchers say, have been previously linked to breast
density.
Examining information from 196 women with
a complete set of data, the researchers found that taking
into consideration number of live births and dairy product
consumption altered the estimation of acculturation by over
10%.
Taking these factors into consideration,
alongside menopausal status and age, participants with the
highest degree of acculturation were still twice as likely
to have dense breasts than those with less acculturation.
"Despite reproductive and lifestyle
differences by level of acculturation, differences in these
factors did not explain the acculturation-breast density
association," Tseng et al summarize.
"Future longitudinal research will
examine whether the association is due to early-life factors,
postmigration lifestyle changes, or perimenopausal exposures,"
they say.
Cancer Epidemiol
Biomark Prev 2006; 15: 1301–1305
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