Obesity and Survival Among Black Women and White Women 35 to 64 Years of Age at Diagnosis With Invasive Breast Cancer

Abstract

A B S T R A C T PurposeTo evaluate the effect of obesity on survival among black women and white women with invasive breast cancer and to determine whether obesity explains the poorer survival of black women relative to white women. Patients and MethodsWe observed 4,538 (1,604 black, 2,934 white) women who were 35 to 64 years of age when diagnosed with incident invasive breast cancer between 1994 and 1998. Multivariate Cox regression models were used to examine the effect of body mass index (BMI, in kilograms per square meter) 5 years before diagnosis on risk of death from any cause and from breast cancer. ResultsDuring a median of 8.6 years of follow-up, 1,053 women died (519 black, 534 white), 828 as a result of breast cancer (412 black, 416 white). Black women were more likely to die than white women (multivariate-adjusted relative risk [RR], 1.33; 95% CI, 1.16 to 1.53). Compared with women with BMI of 20 to 24.9 kg/m 2 , those who were obese (BMI Ն 30 kg/m 2 ) had a greater risk of all-cause mortality (RR, 1.23; 95% CI, 1.04 to 1.47) and breast cancer-specific mortality (RR, 1.20; 95% CI, 0.99 to 1.46). These associations were observed among white women (all-cause RR, 1.54; 95% CI, 1.21 to 1.96; breast cancer RR, 1.46; 95% CI, 1.11 to 1.92), but not among black women (all-cause RR, 1.03; 95% CI, 0.81 to 1.29; breast cancer RR, 1.02; 95% CI, 0.79 to 1.33). ConclusionObesity may play an important role in mortality among white but not black patients with breast cancer. It is unlikely that differences in obesity distributions between black women and white women account for the poorer survival of black women.

Race and Hormone Receptor–Positive Breast Cancer Outcomes in a Randomized Chemotherapy Trial

“…In a model that included race, obesity, and their interaction, there was a statistically significant interaction between black race and obesity, such that black race was associated with inferior outcomes only in nonobese patients. A similar finding was recently reported in a cohort of black woman diagnosed with breast cancer who were enrolled in the Women's Contraceptive and Reproductive (CARE) Study (24). The results of our study and the CARE study suggest that black race confers additional risk of breast cancer recurrence and death but not in patients who are already at high risk because of obesity.…”

“…Because black patients had a statistically significantly higher median BMI and were more likely to be obese (defined as BMI ≥30 kg/m 2 ) compared with nonblack patients, obesity was also included in the model. Obesity is known to be associated with more comorbidities and is also associated with higher breast cancer rates and worse outcomes for those who develop breast cancer (24). Our multivariable analyses suggest that race and obesity have independent adverse effects on survival: In multivariable models that evaluated the influence of race (excluding obesity as a variable) or obesity (excluding race as a variable) in patients with hormone receptorpositive and HER2-negative or unknown disease, each model demonstrated that obesity and black race were independently associated with inferior outcomes, including disease-free survival, breast cancer-specific survival, and overall survival.…”

Predictors of substance abuse treatment participation among homeless adults

“…These include the prevalence of ER, PR negative status (Dignam, 2000;Joslyn, 2002), TNBC (Bauer et al, 2007;Lund et al, 2009), and the p53 gene (Dookeran et al, 2010). In addition, being of a young age at diagnosis (Palmer, Wise, & Horton, 2003;Shavers et al, 2003), having an increased BMI (Lu et al, 2011;Sarkissyan, Wu, & Vadgama, 2011), and increased risk of greater parity (Palmer et al, 2011;Palmer et al, 2003) are all contributing factors. Collectively these risk factors may increase the burden of chronic stress.…”

Obesity and Risk of Breast Cancer Mortality in Hispanic and Non-Hispanic White Women: The New Mexico Women's Health Study

“…2,5 Several recent prospective studies have examined the relationship between obesity and breast cancer-specific mortality and reported relative risks ranging from 1.45 to 1.57. 5,11,12 The purpose of the present analyses was to determine if obesity (BMI > 30 kg/m 2 ) is associated with breast cancer-specific, all-cause, and non-breast cancer mortality, and if these associations differ by Hispanic versus nonHispanic white (NHW) ethnicity based on data for participants in the New Mexico Women's Health Study (NMWHS).…”