Body weight and vascular invasion in post-menopausal women with breast cancer

Abstract

Summary To examine the relationship between body weight and vascular invasion (VI) around tumours in post-menopausal women with operable breast cancer, a retrospective study was conducted of 393 patients treated in a breast unit between 1987 and 1991. Weight was measured at the time of diagnosis. Vascular invasion was recorded as being present or absent. Vascular invasion was seen in slightly more of the 50 perimenopausal patients than in the 343 post-menopausal women (44% vs 36%). In the tumour specimens from post-menopausal patients weighing <50 kg, VI was observed in 11% compared with 45% of those weighing more than 80 kg (P = 0.02). Furthermore, the 5-year survival of those with VI was 74% compared with 91% for those without (P < 0.0001). Menopausal status and body weight may influence survival in patients with breast cancer, possibly as a result of the presence of unopposed circulating oestrogens at the time of surgery. Oestrogens may alter cohesiveness of breast cancer cells and modulate secretion of proteases, thereby influencing invasive potential.Excision of tumours in such an environment may have a deleterious impact on survival.Keywords: breast cancer; prognosis; weight; post-menopausal women; vascular invasionThe prognosis of women with operable breast cancer depends upon tumour type, axillary nodal involvement and also menopausal status (Adami et al, 1986;Caleffi et al, 1989). Premenopausal cases have the lowest hazard rates for relapse and death. Rates are intermediate in post-menopausal women and the highest rates are found in perimenopausal women, that is those within 5 years of last menstrual period (Langlands et al, 1989). The observed differences may be due to the different hormonal environment to which tumours are exposed in these three groups of women.Survival has been shown to be inversely related to body weight in the majority of studies (Boyd et al, 1981; Tartter et al, 1981;Newman et al, 1986;Tretli et al, 1990; Senie et al, 199 la;Vatten et al, 1991), but such a relationship is less obvious in premenopausal women (Greenberg et al, 1985). Although there is a relation between body weight and other prognostic factors, such as tumour size and axillary lymph node involvement, the effect of obesity remains an independent factor in multivariate analysis (Tarttar et al, 1981;Vatten et al, 1991). The mechanism through which menopausal status and body weight influence survival is uncertain, although it is known that most circulating oestrogens in postmenopausal women are derived from peripheral aromatization of adrenal androgens in subcutaneous fat. Thus, more obese women have higher plasma levels of oestrogens (Grodin et al, 1973).Additionally, the impact of obesity on survival is more pronounced among those women with oestrogen receptor-positive breast cancers (Verreault et al, 1989).The risk of relapse and death also depends upon the metastatic potential of the tumour as manifested by the presence of malignant Correspondence to: IS Fentiman cells in lymphatic channels and blood vessels (vascu...

Obesity and Angiolymphatic Invasion in Primary Breast Cancer

“…29,30 In contrast to other studies demonstrating higher rates of triple-negative breast cancer, 19–21 the heavy patients in our sample were less likely to have triple-negative tumors. Obese women in our sample, as in others, 32 are more likely to have diabetes.…”

“…In logistic regression, angiolymphatic invasion was independently associated with nodal status, histologic grade, weight, and height. 29 The investigators did not, however, control for other factors associated with tumor biology, such as estrogen receptor status or diabetes. Information on the presence or absence of angiolymphatic invasion is largely missing from studies of breast cancer prognosis in obese women.…”

Perioperative Endocrine Status and Prognosis in Early Breast Cancer

“…The effect of unopposed estrogen in breast cancer was shown in another study from Guy's (28). Postmenopausal fatter women tend to have higher levels of circulating estrogen because of aromatization of adrenal androgens in the adipose tissue.…”

“…Further reduction in the cohesion of malignant cells during the ‘‘unfavorable’’ time of the menstrual cycle and increased exfoliation has also been reported (3,42). In an environment of unopposed estrogen, such as in obese postmenopausal women, vascular invasion was more frequently observed and was associated with a worse survival (28). The histologic finding of vascular invasion may be a ‘‘snapshot’’ of tumor cells invading systemic or lymphatic circulation as a result of the pressure exerted on the cancer during surgery.…”

Perioperative Progesterone for Obese Women with Breast Cancer May Improve Survival

“…[32]. A study of 393 postmenopausal patients at Guy's Hospital (London, UK) showed a direct relationship between LVI and BMI [33]. In the specimens from those <50 kg, LVI was observed in 11% compared with 45% from women >80 kg (p = 0.02).…”