Association of Body Mass Index and Age With Subsequent Breast Cancer Risk in Premenopausal Women

Schoemaker, Minouk J.; Nichols, Hazel B.; Wright, Lauren B.; Brook, Mark N.; Jones, Michael E.; O’Brien, Katie M.; Adami, Hans‐Olov; Baglietto, Laura; Bernstein, Leslie; Bertrand, Kimberly A.; Boutron‐Ruault, Marie‐Christine; Br̈aaten, Tonje; Chen, Yu; Connor, Avonne E.; Dorronsoro, Miren; Dossus, Laure; Eliassen, A. Heather; Giles, Graham G.; Hankinson, Susan E.; Kaaks, Rudolf; Key, Timothy J.; Kirsh, Victoria A.; Kitahara, Cari M.; Koh, Woon‐Puay; Larsson, Susanna C.; Linet, Martha S.; Ma, Hui; Masala, Giovanna; Merritt, Melissa A.; Milne, Roger L.; Overvad, Kim; Ozasa, Kotaro; Palmer, Julie R.; Peeters, Petra H.M.; Riboli, Elio; Rohan, Thomas E.; Sadakane, Atsuko; Sund, Malin; Tamimi, Rulla M.; Trichopoulou, Antonia; Ursin, Giske; Vatten, Lars J.; Visvanathan, Kala; Weiderpass, Elisabete; Willett, Walter C.; Wolk, Alicja; Yuan, Jian‐Min; Zeleniuch‐Jacquotte, Anne; Sandler, Dale P.; Swerdlow, Anthony

doi:10.1001/jamaoncol.2018.1771

Cited by 216 publications

(120 citation statements)

References 62 publications

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Section: Discussionsupporting

confidence: 92%

“…Our findings confirmed the findings from previous several studies, including a reduction in breast cancer risk among younger women diagnosed with overweight and obesity . We note that parity and overweight and obesity are positively associated and that parity and breast cancer risk are inversely associated . The increased risk of liver cancer could likely be explained by both excessive alcohol consumption , and the prevalence of non‐alcoholic fatty liver disease, an important complication of obesity .…”

Section: Discussionsupporting

confidence: 91%

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Hospital‐diagnosed overweight and obesity related to cancer risk: a 40‐year Danish cohort study

et al. 2020

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Background Obesity is associated with metabolic abnormalities that predispose patients to increased cancer risk. Contemporary data on the long‐term risk of specific cancers are sparse among patients with hospital‐diagnosed overweight and obesity. Objectives To examine the overall cancer incidence and specific site‐related cancer incidences among patients with overweight and obesity, compared to the general Danish population. Methods For this 40‐year (1977–2016), nationwide, Danish cohort study, we reviewed medical databases to identify individuals with hospital‐based overweight and obesity diagnoses. We computed age‐ and gender‐standardized incidence ratios (SIRs) for subsequent cancer compared to the general population. Results We observed 20 706 cancers among 313 321 patients diagnosed with overweight and obesity (median age 43 years; median follow‐up 6.7 years, range 1–40 years) compared to the 18 480 cancers expected; thus, the SIR was 1.12 [95% confidence interval (95% CI): 1.11–1.14]. The SIR associated with overweight and obesity was increased with concomitant comorbidities, like type 2 diabetes (SIR: 1.18; 95% CI: 1.13–1.23) and alcoholism‐related diseases (SIR: 1.62; 95% CI: 1.45–1.82). The SIR was 1.31 (95% CI: 1.28–1.34) for cancers previously identified as obesity‐related, including pancreatic (SIR: 1.38; 95% CI; 1.27–1.49) and postmenopausal breast cancer (SIR: 1.14; 95% CI: 1.09–1.19). Obesity/overweight status also elevated the SIRs for haematological (SIR: 1.24; 95% CI: 1.18–1.29) and neurological cancers (SIR: 1.19; 95% CI: 1.11–1.27]. In contrast, SIRs were 1.01 (95% CI: 0.97–1.05) for immune‐related cancers, 0.88 (95% CI: 0.82–0.95) for malignant melanoma, and 0.88 (95% CI: 0.85–0.92) for hormone‐related cancers, other than postmenopausal breast cancer. Conclusion In this large cohort study, overweight and obesity was associated with increased risk of several common cancers.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Hospital‐diagnosed overweight and obesity related to cancer risk: a 40‐year Danish cohort study

et al. 2020

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“…The Premenopausal Breast Cancer Collaborative group (as described above) observed an inverse association between premenopausal obesity and ER+/PR+ breast cancer (27). In contrast, BMI at ages 25-54 years was not consistently associated with TNBC or ER-breast cancer (27).…”

Section: Obesity and Triple Negative Breast Cancer (Tnbc)mentioning

confidence: 96%

“…A summary of trials testing for the association between obesity and breast cancer (and findings) is presented in Table 1A. For high WHR and basal type TNBC Appalachian study (29) Significant association between obesity and incidence For TNBC Women's CARE study (30) Inverse association BMI at age 18 and premenopausal BC Positive association current BMI and post-menopausal BC For ER-/PR-BC For ER+/PR+ BC Black women's health study (31) Inverse association BMI at age 18 and pre-or post-menopausal BC Inverse association current BMI and premenopausal BC Women's circle of health study (32,33) Inverse association BMI and post-menopausal BC Association with premenopausal BC The Premenopausal Breast Cancer Collaborative group recently published a multicenter analysis used pooled individuallevel data from 758,592 premenopausal women from 19 prospective cohorts to estimate hazard ratios (HRs) of premenopausal breast cancer in association with BMI from ages 18 through 54 years (27). Results of this study provide evidence increased adiposity was associated with a reduced risk of premenopausal breast cancer at a greater magnitude than previously shown and across the entire distribution of BMI.…”

Section: Complex Relationship Between Obesity and Breast Cancer Obesimentioning

confidence: 99%

Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin

Yee¹,

Mortimer²,

Natarajan³

et al. 2020

Front. Endocrinol.

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The potential association between obesity and TNBC has been a subject of intense research study. As outlined below, studies investigating the potential relationship between obesity and TNBC have been inconsistent. This is a summary of some of the key studies that have been recently published.The Carolina Breast Cancer Study is a North Carolina population-based case-controlled study of breast cancer, conducted in three phases (28). The current study phase, Phase 3 (years 2008-2014), includes women resident in 44 North Carolina Counties (28), employing randomized recruitment to oversample African-American/Black women and women under age 50 (28). Waist to hip ratio (WHR) was compared between the highest (≥0.84) and lowest (<0.77) groups vs. the basal-type subset of TNBC. There was an increased risk [odds ratio (OR) = 2.3; 95% CI, 1.4-3.6] for basal-type TNBC in women with higher WHR (43). Premenopausal women (OR = 1.8; 95% CI, 1.0-3.4) and post-menopausal women (OR = 2.7; 95% CI, 1.3-5.4) with the highest WHR had increased risk of developing basal-type TNBC compared to the lowest WHR (43). Basal-type breast cancer was observed to be highest among premenopausal African-American/Black women (43). There was no significant association between increased BMI (defined as BMI ≥ 25 kg/m 2 ) and basal-type TNBC.The Appalachian Study investigated the potential association between obesity (defined as BMI ≥ 30 kg/m 2 ) and TNBC in 620 predominantly non-Hispanic White women in rural Appalachia. This study reported a significant association between obesity and the incidence of TNBC (29).Women's CARE study is a case-controlled study of BMI and breast cancer risk in non-Hispanic White women and African-American/Black women. The Women's CARE study reported (1) an inverse association between a woman's BMI at age 18 and premenopausal ER-/PR-breast cancer and (2) a positive association between current BMI and post-menopausal ER+/PR+ breast cancer (30).

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“…Overall 17% of ER+/PR+ BC was attributable to weight gain of >5 kg since age 18. In a multicenter analysis of pooled cohort studies, premenopausal BC risk was inversely associated with BMI at ages 18-24 years (HR per 5 kg/m 2 difference 0.77 95% CI 0.73-0.80) (34). Associations were strongest for ER+/PR+ subtype of BC but the HR did not vary by other BC risk factors nor for BMI later in adulthood.…”

Section: Figure 3 |mentioning

confidence: 97%

Breast Cancer and Nutrition: A Paradigm for Prevention in 3D Across the Life Course

Forman

2020

Front. Oncol.

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Breast cancer, the most common cancer in women worldwide, has recognized reproductive and anthropometric risk factors including age at menarche and adult height. Yet the age when a woman attains her adult height or experiences menarche for example is simply the timing of the major life event at the end of a long trail of exposures that began in utero. The objective of this article is to investigate through a review of the literature the role of nutrition in breast cancer prevention through three dimensions (D). Each D offers a different lens. The First D identifies windows/ages of exposures or conditions that convey vulnerability or protection from breast cancer. The Second D addresses the intensity and duration of the exposure; and the (Third D) examines the pace, i.e., how rapid or slow the young woman experiences her growth and development. Birthweight illustrative of the First D reveals a strong signal across the life course on BC risk, but the risk group varies from low to high birthweight. Stressful life events like being a pubertal aged girl living in a household with an unemployed father during the Great Depression or high levels of environmental contaminants exposure are representative of the Second D. Height velocity at specific ages and weight loss in postmenopausal years are illustrative of anthropometric trajectories that reveal an adaptive biosystem that provides a contextual state to interact with the other two Ds. This article presents a new paradigm of nutrition and breast cancer prevention through the lens of three very different dimensions. It is the premise of this article that all three dimensions are essential tasks to tease apart the life course and identify windows for preventive strategies.Breast cancer is the most common cancer in women across the world (1). A family history of breast cancer (BC), high breast density, reproductive risk factors including early age at menarche, late age at menopause, older age at first birth, and nulliparity, as well as being tall, moderate to high alcohol consumption, being physically inactive and menopausal status specific-body mass index are a constellation of recognized risk factors influencing BC risk (2, 3). Yet the age when a woman attains her adult height or experiences menarche for example is simply the timing of the major life event at the end of a long trail of exposures that began in utero. The tempo of height velocity and the peak height velocity that end in a woman's adult height, and the age of first birth and pace of occurrence (i.e., time interval between first and last births) are essential components to understanding the cumulative risk from adult height and parity on BC risk (4). Indeed profiling a woman's linear growth trajectory from birth across her life course may likely be key to identifying and understanding strategies for BC prevention.

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Association of Body Mass Index and Age With Subsequent Breast Cancer Risk in Premenopausal Women

Cited by 216 publications

References 62 publications

Hospital‐diagnosed overweight and obesity related to cancer risk: a 40‐year Danish cohort study

Hospital‐diagnosed overweight and obesity related to cancer risk: a 40‐year Danish cohort study

Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin

Breast Cancer and Nutrition: A Paradigm for Prevention in 3D Across the Life Course

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