Biological Characteristics of Breast Cancer in Obesity

Abe, Rikiya; Kumagai, Naoto; Kimura, Michio; Hirosaki, Akio; Nakamura, Takashi

doi:10.1620/tjem.120.351

Cited by 68 publications

(30 citation statements)

References 9 publications

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“…Furthermore, it is possible that overweight people may delay or avoid altogether seeking the medical attention they need, 9,30 and this avoidance behavior may be a major contributing factor in elevating the mortality rate of overweight individuals. 31 In conclusion, the results revealed considerable support for the hypothesis that physicians hold different beliefs about and propose that they would provide different levels of care (eg amount of time spent) to obese, overweight and average-weight individuals. In particular, physicians' attitudes and behaviors were significantly influenced by a patient's weight status such that the heavier individuals were, the more negatively they were perceived and treated.…”

Section: Limitations and Implicationsmentioning

confidence: 60%

Weighing the care: physicians' reactions to the size of a patient

2001

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OBJECTIVE:To examine how the weight of a patient affects both the attitudes that physicians hold as well as the treatments that they intend to prescribe. DESIGN: In a six-cell randomized design, physicians evaluated a medical chart of a male or female patient, depicted as either average weight, overweight or obese, who presented with a migraine headache. SUBJECTS: A total of 122 physicians affiliated with one of three hospitals located in the Texas Medical Center of Houston completed the experiment. MEASUREMENTS: Using a standard medical procedure form, physicians indicated how long they would spend with the patient and which of 41 medical tests and procedures they would conduct. They also indicated their affective and behavioral reactions to the patient. RESULTS: The weight of a patient significantly affected how physicians viewed and treated them. Although physicians prescribed more tests for heavier patients, F(2, 107) ¼ 3.65, P < 0.03, they simultaneously indicated that they would spend less time with them, F(2, 107) ¼ 8.38, P < 0.001, and viewed them significantly more negatively on 12 of the 13 indices. CONCLUSION: This study reveals that physicians continue to play an influential role in lowering the quality of healthcare that overweight and obese patients receive. As the girth of America continues to increase, continued research and improvements in the quality of such healthcare deserve attention.

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Section: Limitations and Implicationsmentioning

confidence: 60%

Weighing the care: physicians' reactions to the size of a patient

2001

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“…There was no significant relationship between body weight and the ER status of the primary tumour and this held true when the first time of measurement was considered, i.e., either on presentation, or first relapse, or at the start of endocrine treatment (Table IV) Several studies have reported an association between high body weight and axillary lymph node involvement (Abe et al, 1976;Eberlein et al, 1985;Greenberg et al, 1985;De Waard et al, 1977). In some of these there was also an association between high body weight and reduced disease free and overall survival (Abe et al, 1976;Eberlein et al, 1985;Greenberg et al, 1985).…”

Section: Resultsmentioning

confidence: 96%

“…In some of these there was also an association between high body weight and reduced disease free and overall survival (Abe et al, 1976;Eberlein et al, 1985;Greenberg et al, 1985). Patients above the median weight are more likely to be obese and to have large breasts where small tumours are more difficult to detect than in small breasts and it is well described that the larger the tumour the more likely axillary nodes are to be involved.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, these factors are generally associated with a worse prognosis (Papatestas et al, 1986;Abe et al, 1976;Eberlein et al, 1985;Greenberg et al, 1985;Tartter et al, 1981;Newman et al, 1986;Boyd et al, 1981), although one small study did not confirm this effect (Sohrabi et al, 1980). Similarly in mice, obesity and a fat enriched diet increase the incidence and speed of onset of mammary tumours (Waxler et al, 1979).…”

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confidence: 99%

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The relationship of body weight to response to endocrine therapy, steroid hormone receptors and survival of patients with advanced cancer of the breast

Williams

Howell²,

Jones³

1988

Br J Cancer

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Summary High body weight is associated with increased production of oestrogens which may influence the clinical behaviour of breast cancer. We have examined the influence of body weight on the response to endocrine therapy, steroid hormone receptor content and survival in 227 women who either presented with or developed advanced cancer of the breast. One hundred and thirty-three (59%) patients presented with operable disease and 94 (41%) with locally advanced tumours. Two hundred (88%) were treated by tamoxifen and 27 (12%) by ovarian ablation.High body weight was correlated with advanced tumour stage (P=0.002) and progesterone receptor (PR) positivity (P=0.01), but not with the presence of oestrogen receptor (ER P=0.21). The association between high body weight and PR positivity was particularly noticeable among ER positive tumours. There was no significant relationship between the nature of the response to therapy and weight (P=0.57). There was no significant difference in survival from the start of endocrine therapy (P=0.95), nor the time to progression of disease (P=0.29) between patients above and below the median weight of 64kg. Among the patients with operable disease, there was no difference in overall survival (P=0.42), relapse free survival (P=0.69), and survival from the start of endocrine therapy (P=0.85) according to body weight.Most epidemiological evidence suggests that high body weight and obesity are correlated with the incidence of breast cancer, particularly in postmenopausal women (Dewaard, 1982). Furthermore, these factors are generally associated with a worse prognosis (Papatestas et al., 1986;Abe et al., 1976;Eberlein et al., 1985;Greenberg et al., 1985;Tartter et al., 1981;Newman et al., 1986;Boyd et al., 1981), although one small study did not confirm this effect (Sohrabi et al., 1980). Similarly in mice, obesity and a fat enriched diet increase the incidence and speed of onset of mammary tumours (Waxler et al., 1979).In postmenopausal women the major source of oestrogens is the conversion of androstenedione, derived from the adrenal gland, to oestrone in body fat by the aromatase system (Cloncope, 1971;MacDonald et al., 1969). The strong correlation between the production of oestrone, the degree of this conversion and indices of obesity (e.g., weight, percentage of ideal weight and weight:height ratio) suggests that the excess production of steroid hormones within body fat which promotes the growth of mammary epithelial cells, may be the mechanism whereby there is an association between body weight and tumour incidence (Rizkallah et al., 1975; McDonald et al., 1978; Kirschner et al., 1982). This is supported by the report of lower levels of sex hormone binding globulin in the obese which may lead to higher levels of free oestrogens (Kirschner et al., 1982).Our working hypothesis for this study was that the greater endogenous production of growth promoting steroids in women of above average weight might override the effects of endocrine treatment and lead to a lower response rate and red...

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“…At 3 years disease-free survival was 78% in the nonobese compared with 86% in the obese. [32]. A study of 393 postmenopausal patients at Guy's Hospital (London, UK) showed a direct relationship between LVI and BMI [33].…”

Section: Aromatasementioning

confidence: 99%

Perioperative Progesterone for Obese Women with Breast Cancer May Improve Survival

Fentiman

2016

Womens Health (Lond Engl)

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Biological Characteristics of Breast Cancer in Obesity

Cited by 68 publications

References 9 publications

Weighing the care: physicians' reactions to the size of a patient

Weighing the care: physicians' reactions to the size of a patient

The relationship of body weight to response to endocrine therapy, steroid hormone receptors and survival of patients with advanced cancer of the breast

Perioperative Progesterone for Obese Women with Breast Cancer May Improve Survival

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