Obesity, mammography use and accuracy, and advanced breast cancer risk

Karla Kerlikowske, Rod Walker, Diana L Miglioretti, Arati Desai, Rachel Ballard-Barbash, Diana S M Buist

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: Being overweight or obese is associated with increased breast cancer risk and disease severity among postmenopausal women, but whether extent of mammography use and accuracy modify this association and further contribute to increases in disease severity at diagnosis among overweight and obese women is unclear. Methods: We prospectively collected data during 1996-2005 on 287 115 postmenopausal women not using hormone therapy (HT) who underwent 614 562 mammography examinations; 4446 women were diagnosed with breast cancer within 12 months of a mammography examination. We calculated rates per 1000 mammography examinations of large (>15 mm), advanced-stage (IIb, III, or IV), high-grade (3 or 4), estrogen receptor (ER)-positive and -negative, and screen-detected and non-screen-detected breast cancer across body mass index (BMI, kg/m 2) groups defined as normal (18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), and obese class II/III (≥35.0), adjusting for age, race/ethnicity, and mammography registry and use. All statistical tests were two-sided. Results: Adjusted rates per 1000 mammography examinations of overall breast cancer increased across BMI groups (6.6 normal, 7.4 overweight, 7.9 obese I, 8.5 obese II/III; Ptrend < .001), as did rates of advanced disease, including large invasive (2.3 normal, 2.6 overweight, 2.9 obese I, 3.2 obese II/III; Ptrend < .001), advanced-stage (0.8 normal, 0.9 overweight, 1.3 obese I, 1.5 obese II/III; Ptrend < .001), and high nuclear grade (1.5 normal, 1.7 overweight, 1.7 obese I, 1.9 obese II/III; Ptrend = .10) tumors. Rates of ER-positive tumors increased across BMI groups (Ptrend < .001); rates of ER-negative tumors did not. Rates of screen-detected cancers were higher among overweight and obese women than normal and underweight women, but rates of non-screen-detected (false-negative) cancers were similar. Rates of advanced breast cancer increased across BMI groups regardless of extent of mammography use. Conclusions: Patterns of mammography use and mammography accuracy are not the primary reasons for higher rates of advanced breast cancer among overweight and obese postmenopausal women not using HT; thus, biologic differences in breast tumor development and/or progression may be important.

Original languageEnglish (US)
Pages (from-to)1724-1733
Number of pages10
JournalJournal of the National Cancer Institute
Volume100
Issue number23
DOIs
StatePublished - Dec 2008
Externally publishedYes

Fingerprint

Mammography
Obesity
Breast Neoplasms
Estrogen Receptors
Neoplasms
Hormones
Breast Diseases
Biological Therapy
Thinness
Registries
Body Mass Index

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Kerlikowske, K., Walker, R., Miglioretti, D. L., Desai, A., Ballard-Barbash, R., & Buist, D. S. M. (2008). Obesity, mammography use and accuracy, and advanced breast cancer risk. Journal of the National Cancer Institute, 100(23), 1724-1733. https://doi.org/10.1093/jnci/djn388

Obesity, mammography use and accuracy, and advanced breast cancer risk. / Kerlikowske, Karla; Walker, Rod; Miglioretti, Diana L; Desai, Arati; Ballard-Barbash, Rachel; Buist, Diana S M.

In: Journal of the National Cancer Institute, Vol. 100, No. 23, 12.2008, p. 1724-1733.

Research output: Contribution to journalArticle

Kerlikowske, K, Walker, R, Miglioretti, DL, Desai, A, Ballard-Barbash, R & Buist, DSM 2008, 'Obesity, mammography use and accuracy, and advanced breast cancer risk', Journal of the National Cancer Institute, vol. 100, no. 23, pp. 1724-1733. https://doi.org/10.1093/jnci/djn388
Kerlikowske, Karla ; Walker, Rod ; Miglioretti, Diana L ; Desai, Arati ; Ballard-Barbash, Rachel ; Buist, Diana S M. / Obesity, mammography use and accuracy, and advanced breast cancer risk. In: Journal of the National Cancer Institute. 2008 ; Vol. 100, No. 23. pp. 1724-1733.
@article{2143ce5ae8d44042a3393c709653767d,
title = "Obesity, mammography use and accuracy, and advanced breast cancer risk",
abstract = "Background: Being overweight or obese is associated with increased breast cancer risk and disease severity among postmenopausal women, but whether extent of mammography use and accuracy modify this association and further contribute to increases in disease severity at diagnosis among overweight and obese women is unclear. Methods: We prospectively collected data during 1996-2005 on 287 115 postmenopausal women not using hormone therapy (HT) who underwent 614 562 mammography examinations; 4446 women were diagnosed with breast cancer within 12 months of a mammography examination. We calculated rates per 1000 mammography examinations of large (>15 mm), advanced-stage (IIb, III, or IV), high-grade (3 or 4), estrogen receptor (ER)-positive and -negative, and screen-detected and non-screen-detected breast cancer across body mass index (BMI, kg/m 2) groups defined as normal (18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), and obese class II/III (≥35.0), adjusting for age, race/ethnicity, and mammography registry and use. All statistical tests were two-sided. Results: Adjusted rates per 1000 mammography examinations of overall breast cancer increased across BMI groups (6.6 normal, 7.4 overweight, 7.9 obese I, 8.5 obese II/III; Ptrend < .001), as did rates of advanced disease, including large invasive (2.3 normal, 2.6 overweight, 2.9 obese I, 3.2 obese II/III; Ptrend < .001), advanced-stage (0.8 normal, 0.9 overweight, 1.3 obese I, 1.5 obese II/III; Ptrend < .001), and high nuclear grade (1.5 normal, 1.7 overweight, 1.7 obese I, 1.9 obese II/III; Ptrend = .10) tumors. Rates of ER-positive tumors increased across BMI groups (Ptrend < .001); rates of ER-negative tumors did not. Rates of screen-detected cancers were higher among overweight and obese women than normal and underweight women, but rates of non-screen-detected (false-negative) cancers were similar. Rates of advanced breast cancer increased across BMI groups regardless of extent of mammography use. Conclusions: Patterns of mammography use and mammography accuracy are not the primary reasons for higher rates of advanced breast cancer among overweight and obese postmenopausal women not using HT; thus, biologic differences in breast tumor development and/or progression may be important.",
author = "Karla Kerlikowske and Rod Walker and Miglioretti, {Diana L} and Arati Desai and Rachel Ballard-Barbash and Buist, {Diana S M}",
year = "2008",
month = "12",
doi = "10.1093/jnci/djn388",
language = "English (US)",
volume = "100",
pages = "1724--1733",
journal = "Journal of the National Cancer Institute",
issn = "0027-8874",
publisher = "Oxford University Press",
number = "23",

}

TY - JOUR

T1 - Obesity, mammography use and accuracy, and advanced breast cancer risk

AU - Kerlikowske, Karla

AU - Walker, Rod

AU - Miglioretti, Diana L

AU - Desai, Arati

AU - Ballard-Barbash, Rachel

AU - Buist, Diana S M

PY - 2008/12

Y1 - 2008/12

N2 - Background: Being overweight or obese is associated with increased breast cancer risk and disease severity among postmenopausal women, but whether extent of mammography use and accuracy modify this association and further contribute to increases in disease severity at diagnosis among overweight and obese women is unclear. Methods: We prospectively collected data during 1996-2005 on 287 115 postmenopausal women not using hormone therapy (HT) who underwent 614 562 mammography examinations; 4446 women were diagnosed with breast cancer within 12 months of a mammography examination. We calculated rates per 1000 mammography examinations of large (>15 mm), advanced-stage (IIb, III, or IV), high-grade (3 or 4), estrogen receptor (ER)-positive and -negative, and screen-detected and non-screen-detected breast cancer across body mass index (BMI, kg/m 2) groups defined as normal (18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), and obese class II/III (≥35.0), adjusting for age, race/ethnicity, and mammography registry and use. All statistical tests were two-sided. Results: Adjusted rates per 1000 mammography examinations of overall breast cancer increased across BMI groups (6.6 normal, 7.4 overweight, 7.9 obese I, 8.5 obese II/III; Ptrend < .001), as did rates of advanced disease, including large invasive (2.3 normal, 2.6 overweight, 2.9 obese I, 3.2 obese II/III; Ptrend < .001), advanced-stage (0.8 normal, 0.9 overweight, 1.3 obese I, 1.5 obese II/III; Ptrend < .001), and high nuclear grade (1.5 normal, 1.7 overweight, 1.7 obese I, 1.9 obese II/III; Ptrend = .10) tumors. Rates of ER-positive tumors increased across BMI groups (Ptrend < .001); rates of ER-negative tumors did not. Rates of screen-detected cancers were higher among overweight and obese women than normal and underweight women, but rates of non-screen-detected (false-negative) cancers were similar. Rates of advanced breast cancer increased across BMI groups regardless of extent of mammography use. Conclusions: Patterns of mammography use and mammography accuracy are not the primary reasons for higher rates of advanced breast cancer among overweight and obese postmenopausal women not using HT; thus, biologic differences in breast tumor development and/or progression may be important.

AB - Background: Being overweight or obese is associated with increased breast cancer risk and disease severity among postmenopausal women, but whether extent of mammography use and accuracy modify this association and further contribute to increases in disease severity at diagnosis among overweight and obese women is unclear. Methods: We prospectively collected data during 1996-2005 on 287 115 postmenopausal women not using hormone therapy (HT) who underwent 614 562 mammography examinations; 4446 women were diagnosed with breast cancer within 12 months of a mammography examination. We calculated rates per 1000 mammography examinations of large (>15 mm), advanced-stage (IIb, III, or IV), high-grade (3 or 4), estrogen receptor (ER)-positive and -negative, and screen-detected and non-screen-detected breast cancer across body mass index (BMI, kg/m 2) groups defined as normal (18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), and obese class II/III (≥35.0), adjusting for age, race/ethnicity, and mammography registry and use. All statistical tests were two-sided. Results: Adjusted rates per 1000 mammography examinations of overall breast cancer increased across BMI groups (6.6 normal, 7.4 overweight, 7.9 obese I, 8.5 obese II/III; Ptrend < .001), as did rates of advanced disease, including large invasive (2.3 normal, 2.6 overweight, 2.9 obese I, 3.2 obese II/III; Ptrend < .001), advanced-stage (0.8 normal, 0.9 overweight, 1.3 obese I, 1.5 obese II/III; Ptrend < .001), and high nuclear grade (1.5 normal, 1.7 overweight, 1.7 obese I, 1.9 obese II/III; Ptrend = .10) tumors. Rates of ER-positive tumors increased across BMI groups (Ptrend < .001); rates of ER-negative tumors did not. Rates of screen-detected cancers were higher among overweight and obese women than normal and underweight women, but rates of non-screen-detected (false-negative) cancers were similar. Rates of advanced breast cancer increased across BMI groups regardless of extent of mammography use. Conclusions: Patterns of mammography use and mammography accuracy are not the primary reasons for higher rates of advanced breast cancer among overweight and obese postmenopausal women not using HT; thus, biologic differences in breast tumor development and/or progression may be important.

UR - http://www.scopus.com/inward/record.url?scp=57349182181&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=57349182181&partnerID=8YFLogxK

U2 - 10.1093/jnci/djn388

DO - 10.1093/jnci/djn388

M3 - Article

VL - 100

SP - 1724

EP - 1733

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

SN - 0027-8874

IS - 23

ER -