Body weight and incidence of breast cancer defined by estrogen and progesterone receptor status—A meta‐analysis

Abstract

Epidemiological evidence indicates that the association between body weight and breast cancer risk may differ across menopausal status as well as the estrogen receptor (ER) and progesterone receptor (PR) tumor status. To date, no meta-analysis has been conducted to assess the association between body weight and ER/PR defined breast cancer risk, taking into account menopausal status and study design. We searched MEDLINE for relevant studies published from January 1, 1970 through December 31, 2007. Summarized risk estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. The summarized results of 9 cohorts and 22 case-control studies comparing the highest versus the reference categories of relative body weight showed that the risk for ER1PR1 tumors was 20% lower (95% CI ¼ 230% to 28%) among premenopausal (2,643 cases) and 82% higher (95% CI ¼ 55-114%) among postmenopausal (5,469 cases) women. The dose-response meta-analysis of ER1PR1 tumors showed that each 5-unit increase in body mass index (BMI, kg/m 2 ) was associated with a 33% increased risk among postmenopausal women (95% CI ¼ 20-48%) and 10% decreased risk among premenopausal women (95% CI ¼ 218% to 21%). No associations were observed for ER2PR2 or ER1PR2 tumors. For discordant tumors ER1PR2 (pre) and ER2PR1 (pre/post) the number of cases were too small (<200) to interpret results. The relation between body weight and breast cancer risk is critically dependent on the tumor's ER/PR status and the woman's menopausal status. Body weight control is the effective strategy for preventing ER1PR1 tumors after menopause. ' 2008 Wiley-Liss, Inc.Key words: breast cancer; body weight; body mass index; estrogen receptor; progesterone receptor; risk Obesity could affect breast cancer risk through affecting circulating endogenous estrogen levels. Therefore, it have been postulated that the association between body weight and breast cancer risk may be heterogeneous according to the tumor's estrogen receptor (ER) and progesterone receptor (PR) status. Cumulative epidemiological evidence 1-3 also suggests that the impact of body weight on breast cancer risk differs across women's menopausal status; studies indicate a weak inverse association between body weight and breast cancer risk among premenopausal women 4 and a positive association among postmenopausal women (reversal association discussion 5 ). 6Many epidemiological studies have evaluated body weight in relation to ER and PR defined breast cancer incidence. 10,20,21,26,30,32,37 One qualitative literature review 39 and one quantitative review 40 reported the relation of ER and/or PR defined breast cancer risk with postmenopausal obesity. However, no study has quantitatively summarized the results with a meta-analytical approach for the relationship between body weight and the risk of breast cancer defined by ER/PR status. We therefore summarized all available evidence to clarify the association between body weight and the incidence of breast cancer defined by ER/PR status of the tumo...

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