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Weight Gain Prior to Diagnosis and Survival from Breast Cancer

¹ Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina; ² Global Epidemiology, Safety, and Risk Management, Pfizer, Inc.; ³ Department of Community and Preventive Medicine, Mt. Sinai School of Medicine; ⁴ Department of Epidemiology, Mailman School of Public Health, Columbia University; ⁵ Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; and ⁶ Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington

Requests for reprints: Rebecca J. Cleveland, Department of Epidemiology, University of North Carolina, CB 7435 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435. Phone: 919-966-7410; Fax: 919-966-2089. E-mail: becki{at}unc.edu

Background: To examine the effects of prediagnostic obesity and weight gain throughout the life course on survival after a breast cancer diagnosis, we conducted a follow-up study among a population-based sample of women diagnosed with first, primary invasive, and in situ breast cancer between 1996 and 1997 (n = 1,508).

Methods: In-person interviews were conducted shortly after diagnosis to obtain information on height and weight at each decade of life from age 20 years until 1 year before diagnosis. Patients were followed to determine all-cause (n = 196) and breast cancer–specific (n = 127) mortality through December 31, 2002.

Results: In multivariate Cox proportional hazards models, obese women had increased mortality due to breast cancer compared with ideal weight women among those who were premenopausal at diagnosis [hazard ratio (HR), 2.85; 95% confidence interval (95% CI), 1.30-6.23] and postmenopausal at diagnosis (HR, 1.91; 95% CI, 1.06-3.46). Among women diagnosed with premenopausal breast cancer, those who gained >16 kg between age 20 years and 1 year before diagnosis, compared with those whose weight remained stable (±3 kg), had more than a 2-fold elevation in all-cause (HR, 2.45; 95% CI, 0.96-6.27) and breast cancer–specific mortality (HR, 2.09; 95% CI, 0.80-5.48). Women diagnosed with postmenopausal breast cancer who gained more than 12.7 kg after age of 50 years up to the year before diagnosis had a 2- to 3-fold increased risk of death due to all-causes (HR, 2.69; 95% CI, 1.63-4.43) and breast cancer (HR, 2.95; 95% CI, 1.36-6.43).

Conclusions: These results indicate that high levels of prediagnostic weight and substantial weight gain throughout life can decrease survival in premenopausal and postmenopausal breast cancer patients. (Cancer Epidemiol Biomarkers Prev 2007;16(9):1803–11)