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Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies

Review

. 2014 Oct;25(10):1901-1914. doi: 10.1093/annonc/mdu042. Epub 2014 Apr 27. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. Electronic address: d.chan@imperial.ac.uk.
² Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
³ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Jersey, USA.
⁵ Division of Biostatistics, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
⁶ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Washington, USA.
⁷ Department of Oncology, Oslo University Hospital, Oslo; Faculty of Health Sciences, Department of Community Medicine, University of Tromso, Tromso, Norway.
⁸ School of Mathematics and Statistics, University of Newcastle, Newcastle upon Tyne, UK.

PMID: 24769692
PMCID: PMC4176449
DOI: 10.1093/annonc/mdu042

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Review

Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies

D S M Chan et al. Ann Oncol. 2014 Oct.

. 2014 Oct;25(10):1901-1914. doi: 10.1093/annonc/mdu042. Epub 2014 Apr 27. Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. Electronic address: d.chan@imperial.ac.uk.
² Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
³ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Jersey, USA.
⁵ Division of Biostatistics, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
⁶ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Washington, USA.
⁷ Department of Oncology, Oslo University Hospital, Oslo; Faculty of Health Sciences, Department of Community Medicine, University of Tromso, Tromso, Norway.
⁸ School of Mathematics and Statistics, University of Newcastle, Newcastle upon Tyne, UK.

PMID: 24769692
PMCID: PMC4176449
DOI: 10.1093/annonc/mdu042

Item in Clipboard

Abstract

Background: Positive association between obesity and survival after breast cancer was demonstrated in previous meta-analyses of published data, but only the results for the comparison of obese versus non-obese was summarised.

Methods: We systematically searched in MEDLINE and EMBASE for follow-up studies of breast cancer survivors with body mass index (BMI) before and after diagnosis, and total and cause-specific mortality until June 2013, as part of the World Cancer Research Fund Continuous Update Project. Random-effects meta-analyses were conducted to explore the magnitude and the shape of the associations.

Results: Eighty-two studies, including 213 075 breast cancer survivors with 41 477 deaths (23 182 from breast cancer) were identified. For BMI before diagnosis, compared with normal weight women, the summary relative risks (RRs) of total mortality were 1.41 [95% confidence interval (CI) 1.29-1.53] for obese (BMI >30.0), 1.07 (95 CI 1.02-1.12) for overweight (BMI 25.0-<30.0) and 1.10 (95% CI 0.92-1.31) for underweight (BMI <18.5) women. For obese women, the summary RRs were 1.75 (95% CI 1.26-2.41) for pre-menopausal and 1.34 (95% CI 1.18-1.53) for post-menopausal breast cancer. For each 5 kg/m(2) increment of BMI before, <12 months after, and ≥12 months after diagnosis, increased risks of 17%, 11%, and 8% for total mortality, and 18%, 14%, and 29% for breast cancer mortality were observed, respectively.

Conclusions: Obesity is associated with poorer overall and breast cancer survival in pre- and post-menopausal breast cancer, regardless of when BMI is ascertained. Being overweight is also related to a higher risk of mortality. Randomised clinical trials are needed to test interventions for weight loss and maintenance on survival in women with breast cancer.

Keywords: body mass index; meta-analysis; survival after breast cancer; systematic literature review.

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Figures
Figure 1.

Flowchart of search.

Figure 1.

Flowchart of search.

Figure 1.

Flowchart of search.

Figure 2.

Categorical meta-analysis of pre-diagnosis BMI…

Figure 2.

Categorical meta-analysis of pre-diagnosis BMI and total mortality.

Figure 2.

Categorical meta-analysis of pre-diagnosis BMI and total mortality.

Figure 3.

Non-linear dose–response curves of BMI…

Figure 3.

Non-linear dose–response curves of BMI and mortality.

Figure 3.

Non-linear dose–response curves of BMI and mortality.

Figure 4.

Linear dose–response meta-analysis of BMI…

Figure 4.

Linear dose–response meta-analysis of BMI and total mortality.

Figure 4.

Linear dose–response meta-analysis of BMI and total mortality.

Figure 5.

Categorical meta-analysis of pre-diagnosis BMI…

Figure 5.

Categorical meta-analysis of pre-diagnosis BMI and breast cancer mortality.

Figure 5.

Categorical meta-analysis of pre-diagnosis BMI and breast cancer mortality.

Figure 6.

Linear dose–response meta-analysis of BMI…

Figure 6.

Linear dose–response meta-analysis of BMI and breast cancer mortality.

Figure 6.

Linear dose–response meta-analysis of BMI and breast cancer mortality.