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Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women

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Abstract

Objective: Epidemiologic evidence suggests a positive association between body mass, adult height, and postmenopausal breast cancer. However, most studies have not been large enough to examine the association across a very wide range of body mass or height, and few studies have assessed the relationship between body mass or height and postmenopausal breast cancer mortality. Methods: The relation between body mass index (BMI) and height and postmenopausal breast cancer mortality was examined in the American Cancer Society's Cancer Prevention Study II (CPS-II), a large prospective mortality study of US adults enrolled in 1982. After 14 years of follow-up, 2852 breast cancer deaths were observed among 424,168 postmenopausal women who were cancer-free at interview. Cox proportional hazards modeling was used to estimate relative risks and to control for potential confounding. Results: Breast cancer mortality rates increased continually and substantially with increasing BMI (rate ratio (RR) = 3.08, 95% confidence interval (CI) = 2.09–4.51 for BMI ≥ 40.0 compared to BMI 18.5–20.49). If causal, the multivariate-adjusted RR estimates in this study correspond to approximately 30–50% of breast cancer deaths among postmenopausal women in the US population being attributable to overweight. Breast cancer mortality also increased with increasing height up to 66 inches with RR = 1.64, (95% CI = 1.23–2.18) in women 66 inches tall compared to those < 60 inches. Conclusions: Postmenopausal obesity is an important and potentially avoidable predictor of fatal breast cancer in this study. These results underscore the importance of maintaining moderate weight throughout adult life.

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References

  1. American Cancer Society (2000) Cancer Facts & Figures 2000. Atlanta, GA: ACS.

    Google Scholar 

  2. American Cancer Society (2000) Breast Cancer Facts & Figures 1999-2000. Atlanta, GA: ACS.

    Google Scholar 

  3. Hunter DJ, Willett WC (1993) Body size and the risk of breast cancer. Epidemiol Rev 15: 116-132.

    Google Scholar 

  4. Ballard-Barbash R (1994) Anthropometry and breast cancer. Cancer 74: 1090-1100.

    Google Scholar 

  5. Ballard-Barbash R, Swanson CA (1996) Body weight: estimation of risk for breast and endometrial cancers. [Review]. Am J Clin Nutr 63: 437S-441S.

    Google Scholar 

  6. La Vecchia C, Decarli A, Parazzini F, et al. (1987) General epidemiology of breast cancer in Northern Italy. Int J Epidemiol 16: 347-355.

    Google Scholar 

  7. Schatzkin A, Palmer J, Rosenberg L, et al. (1987) Risk factors for breast cancer in black women. J Natl Cancer Inst 78: 213-217.

    Google Scholar 

  8. Ewertz M (1988) Influence of non-contraceptive exogenous and endogenous sex hormones on breast cancer risk in Denmark. Int J Cancer 42: 832-839.

    Google Scholar 

  9. Swanson C, Brinton L, Taylor P, et al. (1989) Body size and breast cancer risk assessed in women participating in the Breast Cancer Detection Demonstration Project. Am J Epidemiol 130: 1133-1141.

    Google Scholar 

  10. Chu S, Lee N, Wingo P, et al. (1991) The relationship between body mass index and breast cancer among women enrolled in the Cancer and Steroid Hormone Study. J Clin Epidemiol 44: 1197-1206.

    Google Scholar 

  11. Franceschi S, Favero A, La Vecchia C, et al. (1996) Body size indices and breast cancer risk before and after menopause. Int J Cancer 67: 181-186.

    Google Scholar 

  12. La Vecchia C, Negri E, Franceschi S, et al. (1997) Body mass index and post-menopausal breast cancer: an age-specific analysis. Br J Cancer 75: 441-444.

    Google Scholar 

  13. Trentham-Dietz A, Newcomb PA (1997) Body size and risk of breast cancer. Am J Epidemiol 145: 1011-1019.

    Google Scholar 

  14. Tornberg SA, Holm LE, Carstensen JM (1988) Breast cancer risk in relation to serum cholesterol, serum beta-lipoprotein, height, weight, and blood pressure. Acta Oncol 27: 31-37.

    Google Scholar 

  15. Swanson D, Jones D, Schatzkin A, Brinton L, Zeigler R (1988) Breast cancer risk assessed by anthropometry in the NHANES I Epidemiologic Follow-up Study. Cancer Res 48: 5363-5367.

    Google Scholar 

  16. London S, Colditz G, Stampfer M (1989) Prospective study of relative weight, height and risk of breast cancer. JAMA 262: 2853-2858.

    Google Scholar 

  17. Tretli S (1989) Height and weight in relation to breast cancer morbidity and mortality: a prospective study of 570,000 women in Norway. Int J Cancer 44: 23-30.

    Google Scholar 

  18. Folsom AR, Kaye SA, Prineas RJ, et al. (1990) Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol 131: 794-803.

    Google Scholar 

  19. Vatten L, Kvinnsland S (1990) Body mass index and risk of breast cancer: a prospective study of 23,826 Norwegian women. Int J Cancer 45: 440-444.

    Google Scholar 

  20. Sellers TA, Kushi LH, Potter J, et al. (1992) Effect of family history, body-fat distribution, and reproductive factors on the risk of postmenopausal breast cancer. N Engl J Med 326: 1323-1329.

    Google Scholar 

  21. De Stavola B, Wang DY, Allen DS, et al. (1993) The association of height, weight, menstrual and reproductive events with breast cancer: results from two prospective studies on the island of Guernsey (United Kingdom). Cancer Causes Control 4: 331-340.

    Google Scholar 

  22. Barnes-Josiah D, Potter JD, Sellers TA, Himes JH (1995) Early body size and subsequent weight gain as predictors of breast cancer incidence (Iowa, US). Cancer Causes Control 6: 112-118.

    Google Scholar 

  23. Freni SC, Eberhardt MS, Turturro A, Hine RJ (1996) Anthropometric measures and metabolic rate in association with risk of breast cancer (United States). Cancer Causes Control 7: 358-365.

    Google Scholar 

  24. Huang Z, Hankinson S, Colditz G (1997) Dual effects of weight and weight gain on breast cancer risk. Am J Epidemiol 278: 1407-1411.

    Google Scholar 

  25. van den Brandt PA, Dirx MJM, Ronckers CM, van den Hoogen P, Goldbohm A (1997) Height, weight, weight change, and postmenopausal breast cancer risk: the Netherlands Cohort Study. Cancer Causes Control 8: 39-47.

    Google Scholar 

  26. Galanis DJ, Kolonel LN, Lee J, Le Marchand L (1998) Anthropometric predictors of breast cancer incidence and survival in a multi-ethnic cohort of female residents of Hawaii, United States. Cancer Causes Control 9: 217-224.

    Google Scholar 

  27. Donegan W, Hartz A, Rimm A (1978) The association of body weight with recurrent cancer of the breast. Cancer 41: 1590-1594.

    Google Scholar 

  28. Boyd N, Campbell J, Germanson T, et al. (1981) Body weight and prognosis in breast cancer. J Natl Canc Inst 67: 785-789.

    Google Scholar 

  29. Tartter P, Papatestas A, Ionnovich J, et al. (1981) Cholesterol and obesity as prognostic factors in breast cancer. Cancer 47: 2222-2227.

    Google Scholar 

  30. Greenberg ER, Vessey MP, McPherson K, Doll R, Yeates D (1985) Body size and survival in premenopausal breast cancer. Br J Cancer 51: 691-697.

    Google Scholar 

  31. Herbert J, Augustine A, Barone J, et al. (1988) Weight, height and body mass index in the prognosis of breast cancer: early results of a prospective study. Int J Cancer 42: 315-318.

    Google Scholar 

  32. Lees A, Jenkins H, May C, et al. (1989) Risk factors and 10-year breast cancer survival in northern Alberta. Breast Cancer Res Treat 13: 143-151.

    Google Scholar 

  33. Kyogoku S, Hirohata T, Takeshita S, et al. (1990) Survival of breast-cancer patients and body size indicators. Int J Cancer 46: 824-831.

    Google Scholar 

  34. Tretli S, Haldorsen T, Ottestad L (1990) The effect of pre-morbid height and weight on the survival of breast cancer patients. Br J Cancer 62: 299-303. BMI, height, and breast cancer 331

    Google Scholar 

  35. Newman S, Lees A, Jenkins H (1997) The effect of body mass index and oestrogen receptor level on survival of breast cancer patients. Int J Epidemiol 26: 484-490.

    Google Scholar 

  36. Gray G, Pike M, Henderson B (1979) Breast-cancer incidence and mortality rates in different countries in relation to known risk factors and dietary practices. Br J Cancer 39: 1-7.

    Google Scholar 

  37. Lew E, Garfinkel L (1979) Variations in mortality by weight among 750,000 men and women. J Chron Dis 32: 563-576.

    Google Scholar 

  38. Cannon G, Ed. (1997) Food, Nutrition and the Prevention of Cancer: a global perspective. Washington, DC: American Institute for Cancer Research.

    Google Scholar 

  39. Hislop T, Coldman A, Elwood J (1986) Childhood and recent eating patterns and risk of breast cancer. Cancer Detect Prev 9: 47-58.

    Google Scholar 

  40. Hsieh C, Trichopolous D, Katsouyanni K, Yuasa S (1990) Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: associations and interactions in an international case-control study. Int J Cancer 46: 796-800.

    Google Scholar 

  41. de Waard F, Baanders-van Halewijn E (1974) A prospective study in general practice on breast cancer risk in postmenopausal women. Int J Cancer 14: 153-160.

    Google Scholar 

  42. Vatten LJ, Kvinnsland S (1990) Body height and risk of breast cancer. A prospective study of 23,831 Norwegian women. Br J Cancer 61: 881-885.

    Google Scholar 

  43. Berkey C, Frazier A, Gardner J, Colditz G (1999) Adolescence and breast carcinoma risk. Cancer 85: 2400-2409.

    Google Scholar 

  44. Garfinkel L (1985) Selection, follow-up, and analysis in the American Cancer Society prospective studies. Monogr Natl Cancer Inst 67: 49-52.

    Google Scholar 

  45. Stellman S, Garfinkel L (1986) Smoking habits and tar levels in a new American Cancer Society prospective study of 1.2million men and women. J Natl Cancer Inst 76: 1057-1063.

    Google Scholar 

  46. Calle E, Terrell D (1993) Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants. Am J Epidemiol 137: 235-241.

    Google Scholar 

  47. World Health Organization (1977) International Classification of Diseases. Manual of the international statistical classification of diseases, injuries, and causes of death. Geneva: World Health Organization.

    Google Scholar 

  48. WHO Expert Committee on Physical Status (1995) Physical Status: the Use and Interpretation of Anthropometry. Geneva: World Health Organization.

    Google Scholar 

  49. Flanders W (1984) Approximate variance formulas for standardized rate ratios. J Chronic Dis 37: 449-453.

    Google Scholar 

  50. Rothman K (1986) Modern Epidemiology. Boston, MA: Little, Brown.

    Google Scholar 

  51. Cox D (1972) Regression models and life tables (with discussion). J R Stat Soc (B) 34: 187-220.

    Google Scholar 

  52. SAS Institute Inc. (1996) SAS/STAT Software: Changes and Enhancements through Release 6.11. Cary, NC: SAS Institute Inc.

    Google Scholar 

  53. Kleinbaum D, Kupper L, Morgenstern H (1982) Epidemiologic Research: principles and quantitative methods. New York: Van Nostrand Reinhold.

    Google Scholar 

  54. Rothman KJ, Greenland S (1998) Modern Epidemiology. Philadelphia, Lippincott-Raven.

    Google Scholar 

  55. Cox D, Oakes D (1984) Analysis of Survival Data. London: Chapman & Hall.

    Google Scholar 

  56. Greenland S (1998) Applications of stratified analysis methods. In: Rothman K, Greenland S, eds. Modern Epidemiology. Philadelphia: Lippincott-Raven, pp. 281-300.

    Google Scholar 

  57. Flegal K, Carroll M, Kuczmarski R, Johnson C (1998) Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes 22: 39-47.

    Google Scholar 

  58. Madigan M, Troisi R, Potischman N, et al. (1998) Serum hormone levels in relation to reproductive and lifestyle factors in postmenopasual women (United States). Cancer Causes Control 9: 199-207.

    Google Scholar 

  59. Newcomb P, Klein R, Bek K, et al. (1995) Association of dietary and life-style factors with sex hormones in postmenopausal women. Epidemiology 6: 318-321.

    Google Scholar 

  60. Hall I, Newman B, Millikan R, Moorman P (2000) Body size and breast cancer risk in black women and white women, the Carolina breast cancer study. Am J Epidemiol 151: 754-764.

    Google Scholar 

  61. de Waard F, Trichopolous D (1988) A unifying concept of the aetiology of breast cancer. Int J Cancer 41: 666-669.

    Google Scholar 

  62. Wee C, McCarthy E, Davis R, Phillips R (2000) Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med 132: 697-704.

    Google Scholar 

  63. Reeves M, Newcomb P, Remington P, Marcus P, MacKenzie W (1996) Body mass and breast cancer, relationship between method of detection and stage of disease. Cancer 77: 301-307.

    Google Scholar 

  64. Hunt K, Sickles E (2000) Effect of obesity on screening mammography: outcomes analysis of 88,346 consecutive examinations. Am J Roentgenol 174: 1251-1255.

    Google Scholar 

  65. Potter J, Slattery M, Bostick R, Gapstur S (1993) Colon cancer: a review of the epidemiology. Epidemiol Rev 15: 499-545.

    Google Scholar 

  66. Giovannucci E, Rimm E, Stampfer M, Colditz G, Willett W(1997) Height, body weight, and risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 6: 557-563.

    Google Scholar 

  67. Helle S, Lonning P (1996) Insulin-like growth factors in breast cancer. Acta Oncol 35 (Suppl. 5): 19-22.

    Google Scholar 

  68. Bates P, Fisher R, Ward A, et al. (1995) Mammary cancer in transgenic mice expressing insulin-like growth factor II (IGF II). Br J Cancer 72: 1189-1193.

    Google Scholar 

  69. Papa V, Gliozzo B, Clark G, et al. (1993) Insulin-like growth factor-I receptors are overexpressed and predict a low risk in human breast cancer. Cancer Res 53: 3736-3740.

    Google Scholar 

  70. Ballard-Barbash R, Schatzkin A, Taylor P, Kahle L (1990) Association of change in body mass with breast cancer. Cancer Res 50: 2152-2155.

    Google Scholar 

  71. Brinton LA, Swanson CA (1992) Height and weight at various ages and risk of breast cancer. Ann Epidemiol 2: 597-609.

    Google Scholar 

  72. Radimer K, Siskind V, Bain C, Schofield F (1993) Relation between anthropometric indicators and risk of breast cancer among Australian women. Am J Epidemiol 8: 77-89.

    Google Scholar 

  73. Keys A, Fidanza F, Karvonen M, Kimura N, Taylor H (1972) Indices of relative weight and obesity. J Chron Dis 2: 329-343.

    Google Scholar 

  74. Borkan G, Hults D, Gerzof S, Robbins A, Silbert C (1983) Age changes in body composition revealed by computed tomography. J Gerontol 38: 673-677.

    Google Scholar 

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Authors and Affiliations

  1. Department of Epidemiology and Surveillance Research, American Cancer Society, 1599 Clifton Road, NE, Atlanta, GA, 30329, USA

    Jennifer M. Petrelli, Eugenia E. Calle, Carmen Rodriguez & Michael J. Thun

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  1. Jennifer M. Petrelli
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Petrelli, J.M., Calle, E.E., Rodriguez, C. et al. Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 13, 325–332 (2002). https://doi.org/10.1023/A:1015288615472

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