Obesity and mortality after breast cancer by Race/Ethnicity: The california breast cancer survivorship consortium

Marilyn L. Kwan, Esther M. John, Bette J. Caan, Valerie S. Lee, Leslie Bernstein, Iona Cheng, Scarlett Lin Gomez, Brian E. Henderson, Theresa H Keegan, Allison W. Kurian, Yani Lu, Kristine R. Monroe, Janise M. Roh, Salma Shariff-Marco, Richard Sposto, Cheryl Vigen, Anna H. Wu

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

We investigated body size and survival by race/ethnicity in 11,351 breast cancer patients diagnosed from 1993 to 2007 with follow-up through 2009 by using data from questionnaires and the California Cancer Registry. We calculated hazard ratios and 95% confidence intervals from multivariable Cox proportional hazard model-estimated associations of body size (body mass index (BMI) (weight (kg)/height (m)2) and waist-hip ratio (WHR)) with breast cancer-specific and all-cause mortality. Among 2,744 ascertained deaths, 1,445 were related to breast cancer. Being underweight (BMI <18.5) was associated with increased risk of breast cancer mortality compared with being normal weight in non-Latina whites (hazard ratio (HR) = 1.91, 95% confidence interval (CI): 1.14, 3.20), whereas morbid obesity (BMI ≥40) was suggestive of increased risk (HR = 1.43, 95% CI: 0.84, 2.43). In Latinas, only the morbidly obese were at high risk of death (HR = 2.26, 95% CI: 1.23, 4.15). No BMI-mortality associations were apparent in African Americans and Asian Americans. High WHR (quartile 4 vs. quartile 1) was associated with breast cancer mortality in Asian Americans (HR = 2.21, 95% CI: 1.21, 4.03; P for trend = 0.01), whereas no associations were found in African Americans, Latinas, or non-Latina whites. For all-cause mortality, even stronger BMI and WHR associations were observed. The impact of obesity and body fat distribution on breast cancer patients' risk of death may vary across racial/ethnic groups.

Original languageEnglish (US)
Pages (from-to)95-111
Number of pages17
JournalAmerican Journal of Epidemiology
Volume179
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • adiposity
  • body mass index
  • breast cancer
  • mortality
  • obesity
  • race/ethnicity
  • survival
  • waist-hip ratio

ASJC Scopus subject areas

  • Epidemiology

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  • Cite this

    Kwan, M. L., John, E. M., Caan, B. J., Lee, V. S., Bernstein, L., Cheng, I., Gomez, S. L., Henderson, B. E., Keegan, T. H., Kurian, A. W., Lu, Y., Monroe, K. R., Roh, J. M., Shariff-Marco, S., Sposto, R., Vigen, C., & Wu, A. H. (2014). Obesity and mortality after breast cancer by Race/Ethnicity: The california breast cancer survivorship consortium. American Journal of Epidemiology, 179(1), 95-111. https://doi.org/10.1093/aje/kwt233