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General and Abdominal Obesity and Survival among Young Women with Breast Cancer

Departments of ¹ Epidemiology and ² Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ³ Department of Epidemiology, Rollins School of Public Health and ⁴ Winship Cancer Institute, Emory University; ⁵ Surveillance and Epidemiology Branch, Division of Global Migration and Quarantine, National Center for Infectious Diseases and ⁶ Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; ⁷ Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; and ⁸ Office of Disease Prevention, Office of Dietary Supplements; ⁹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland

Requests for reprints: Page E. Abrahamson, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4-B402, Seattle, WA 98109-1024. Phone: 206-667-5491; Fax: 206-667-7850. E-mail: pabraham{at}fhcrc.org

Among postmenopausal women, obesity is linked to increased risk of breast cancer and poorer subsequent survival. For premenopausal women, obesity may reduce incidence, but less is known about its effect on prognosis, particularly for abdominal obesity. This study investigated whether general or abdominal obesity at diagnosis influenced survival in a cohort of young women with breast cancer. A population-based follow-up study was conducted among 1,254 women ages 20 to 54 who were diagnosed with invasive breast cancer between 1990 and 1992 in Atlanta or New Jersey. Women were interviewed within several months of diagnosis and asked about their weight and height at age 20 and in the year before diagnosis. Study personnel did anthropometric measures at the interview. With 8 to 10 years of follow-up, all-cause mortality status was determined using the National Death Index (n = 290 deaths). Increased mortality was observed for women who were obese [body mass index (BMI), 30] at the time of interview compared with women of ideal weight [BMI, 18.5-24.9; stage- and income-adjusted hazard ratio (HR), 1.48; 95% confidence interval (95% CI), 1.09-2.01]. A similar result was seen for the highest versus lowest quartile of waist-to-hip ratio (HR, 1.52; 95% CI, 1.05-2.19). Strong associations with mortality were found for women who were obese at age 20 (HR, 2.49; 95% CI, 1.15-5.37) or who were overweight/obese (BMI, 25) at both age 20 and the time of interview (HR, 2.22; 95% CI, 1.45-3.40). This study provides evidence that breast cancer survival is reduced among younger women with general or abdominal obesity. (Cancer Epidemiol Biomarkers Prev 2006;15(10):1871–7)

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