Obesity and survival among a cohort of breast cancer patients is partially mediated by tumor characteristics

Cindy K. Blair, Charles L. Wiggins, Andrea M. Nibbe, Curt B. Storlie, Eric R. Prossnitz, Melanie Royce, Lesley C. Lomo, Deirdre A. Hill

Research output: Contribution to journalArticle

Abstract

Obesity exerts adverse effects on breast cancer survival, but the means have not been fully elucidated. We evaluated obesity as a contributor to breast cancer survival according to tumor molecular subtypes in a population-based case–cohort study using data from the Surveillance Epidemiology and End Results (SEER) program. We determined whether obese women were more likely to be diagnosed with poor prognosis tumor characteristics and quantified the contribution of obesity to survival. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated via Cox multivariate models. The effect of obesity on survival was evaluated among 859 incident breast cancers (subcohort; 15% random sample; median survival 7.8 years) and 697 deaths from breast cancer (cases; 100% sample). Obese women had a 1.7- and 1.8-fold increased risk of stage III/IV disease and grade 3/4 tumors, respectively. Obese women with Luminal A- and Luminal B-like breast cancer were 1.8 (95% CI 1.3–2.5) and 2.2 (95% CI 0.9–5.0) times more likely to die from their cancer compared to normal weight women. In mediation analyses, the proportion of excess mortality attributable to tumor characteristics was 36.1% overall and 41% and 38% for Luminal A- and Luminal B-like disease, respectively. Obesity was not associated with breast cancer-specific mortality among women who had Her2-overexpressing or triple-negative tumors. Obesity may influence hormone-positive breast cancer-specific mortality in part through fostering poor prognosis tumors. When tumor biology is considered as part of the causal pathway, the public health impact of obesity on breast cancer survival may be greater than previously estimated.

Original languageEnglish (US)
Article number33
Journalnpj Breast Cancer
Volume5
Issue number1
DOIs
StatePublished - Dec 1 2019

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Obesity
Breast Neoplasms
Survival
Neoplasms
Confidence Intervals
Mortality
SEER Program
Foster Home Care
Proportional Hazards Models
Public Health
Hormones
Weights and Measures
Population

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Pharmacology (medical)

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Obesity and survival among a cohort of breast cancer patients is partially mediated by tumor characteristics. / Blair, Cindy K.; Wiggins, Charles L.; Nibbe, Andrea M.; Storlie, Curt B.; Prossnitz, Eric R.; Royce, Melanie; Lomo, Lesley C.; Hill, Deirdre A.

In: npj Breast Cancer, Vol. 5, No. 1, 33, 01.12.2019.

Research output: Contribution to journalArticle

Blair, Cindy K. ; Wiggins, Charles L. ; Nibbe, Andrea M. ; Storlie, Curt B. ; Prossnitz, Eric R. ; Royce, Melanie ; Lomo, Lesley C. ; Hill, Deirdre A. / Obesity and survival among a cohort of breast cancer patients is partially mediated by tumor characteristics. In: npj Breast Cancer. 2019 ; Vol. 5, No. 1.
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abstract = "Obesity exerts adverse effects on breast cancer survival, but the means have not been fully elucidated. We evaluated obesity as a contributor to breast cancer survival according to tumor molecular subtypes in a population-based case–cohort study using data from the Surveillance Epidemiology and End Results (SEER) program. We determined whether obese women were more likely to be diagnosed with poor prognosis tumor characteristics and quantified the contribution of obesity to survival. Hazard ratios (HRs) and 95{\%} confidence intervals (CI) were calculated via Cox multivariate models. The effect of obesity on survival was evaluated among 859 incident breast cancers (subcohort; 15{\%} random sample; median survival 7.8 years) and 697 deaths from breast cancer (cases; 100{\%} sample). Obese women had a 1.7- and 1.8-fold increased risk of stage III/IV disease and grade 3/4 tumors, respectively. Obese women with Luminal A- and Luminal B-like breast cancer were 1.8 (95{\%} CI 1.3–2.5) and 2.2 (95{\%} CI 0.9–5.0) times more likely to die from their cancer compared to normal weight women. In mediation analyses, the proportion of excess mortality attributable to tumor characteristics was 36.1{\%} overall and 41{\%} and 38{\%} for Luminal A- and Luminal B-like disease, respectively. Obesity was not associated with breast cancer-specific mortality among women who had Her2-overexpressing or triple-negative tumors. Obesity may influence hormone-positive breast cancer-specific mortality in part through fostering poor prognosis tumors. When tumor biology is considered as part of the causal pathway, the public health impact of obesity on breast cancer survival may be greater than previously estimated.",
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