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Home > Understanding Breast Cancer > Breast Cancer Research > Table 58: Body weight and breast cancer survival

  


Table 58: Body weight and breast cancer survival

This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.

Introduction: Introduction: Body weight is linked to breast cancer risk (see Table 1). For breast cancer survivors, being overweight increases the risk of:

  • Breast cancer recurrence  
  • Breast cancer-specific mortality (death from breast cancer)
  • Overall mortality (death from any cause, not necessarily breast cancer)

This means that heavier breast cancer survivors are more likely to have their breast cancer return and more likely to die from breast cancer or other causes compared to thinner survivors.

Learn more about body weight, weight gain and breast cancer survival.   

Learn about the strengths and weaknesses of different types of studies.

Study selection criteria: Prospective cohort studies with at least 3,000 participants, pooled analyses and meta-analyses.

Table notes: In the studies below, researchers used a measure called the body mass index (BMI) to estimate a woman’s body fat. BMI takes into account both a person’s height and weight. Calculate your BMI.

Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.

Studies that include women with stage IV breast cancer often do not report data on recurrence because many women with stage IV cancer have already had a relapse.

Unless noted, studies measured body weight at the time of breast cancer diagnosis.  

Study 

Study Population
(number of participants)
 

Follow-up (years) 

Levels of Body Mass Index (BMI) Compared 

Breast Cancer-Specific Mortality RR (95% CI) 

Overall Mortality
RR (95% CI)
 

Prospective cohort studies 

Ewertz et al. [1]

18,967
women with
stage I-III breast cancer  

11

25-29 vs.
Less than 25 

 1.26
(1.09-1.46)

 

 

   

30 or more vs.
Less than 25

 1.38
(1.11-1.71)

 

Majed et al. [2]

14,709
women with
stage I-III breast cancer

8

30 or more vs.
Less than 30

1.35
(1.19-1.54)

1.43 
(1.28-1.60)

Jiralerspong et al. [3]

 6,342
women with
stage I-III breast cancer

5

 30 or more vs.
Less than 25

1.23
(1.00-1.52)

1.24
(1.04-1.48)

Nurses' Health Study [4]

5,204
women with
stage I-III breast cancer

9

More than 30 vs.
21-22

1.09
(0.80-1.48)

1.20
(0.95-1.52)*

Shanghai Breast Cancer Survival Study [5]

5,042
women with
stage I-IV breast cancer

4

30 or more vs.
18.5-24.9

 

1.55
(1.10-2.17)

Eastern Cooperative Oncology Group [6]

4,770
women with
stage I-III breast cancer 

8-14

30 or more vs.
Less than 25

 

1.23
(1.08-1.40)

BIG 1-98 [7]

4,760
women with
stage I-II breast cancer

9

 30 or more vs.
Less than 25

1.01
(0.84-1.23)

1.19
(0.99-1.44)

Collaborative Women's Longevity Study [8]

3,993
women with
stage I-III breast cancer

6

30 or more vs.
18.5-24.9†

2.28
(1.43-3.64)

1.27
(0.99-1.64)

Whiteman et al. [9]

3,924
women with
stage I-IV breast cancer

15

30 or more vs.
23 or less

1.34
(1.09-1.65)

 

Women’s Healthy Eating and Living Study [10]

3,088
women with
stage I-IIIa breast cancer

7

30 or more vs.
18.5-24.9†

 

1.28
(0.97-1.70)

Pooled and meta-analyses 

Protani et al. [11]

43 studies

 

30 or more vs.
Less than 25‡ 

1.33
(1.19-1.50)

1.33
(1.21-1.47)

Niraula et al. [12]

21 studies

 

30 or more vs.
25 or less‡ 

1.43
(1.21-1.69)

1.25
(1.16-1.35) 

Chan et al. [13]

12 studies

 

30 or more vs.
18.5-24.9‡

1.25
(1.10-1.42)

1.23
(1.12-1.33)

Pajares et al. [14] 

5,683
women with
stage I-III breast cancer 

8

 35 or more vs.
18.5-24.9

1.32
(1.01-1.72)

1.47
(1.16-1.85)

Ladoire et al. [15]

4,996
women with
stage I-III breast cancer 

6

30 or more vs.
Less than 30 

 

1.27
(0.98-1.63)





 

Disease-Free Survival or
Risk of Breast Cancer Recurrence
RR (95% CI)
 

Ewertz et al. [1]

18,967
women with
stage I-III breast cancer  

7

 25-29 vs.
Less than 25

1.42
(1.17-1.73)§ 

 

   

30 or more vs.
Less than 25

 1.46
(1.11-1.92)§ 

Jiralerspong et al. [3]

 6,342
women with
stage I-III breast cancer

5

25-29.9 vs.
Less than 25 

1.18
(1.02-1.36) 

     

30 or more vs.
Less than 25

 1.13
(0.98-1.31)

Nurses' Health Study [4]

5,204
women with
stage I-III breast cancer

9

More than 30 vs.
21-22

 1.00 
(0.76-1.31)

Shanghai Breast Cancer Survival Study [5]

5,042
women with
stage I-IV breast cancer

4

30 or more vs.
18.5-24.9

1.44
(1.02-2.03)

Eastern Cooperative Oncology Group [6]

 4,770
women with
stage I-III breast cancer

8-14

30 or more vs.
Less than 25

1.17
(1.04-1.31)

BIG 1-98 [7]

4,760
women with
stage I-II breast cancer

9

30 or more vs.
Less than 30

1.09
(0.94-1.27)

Crozier et al. [16]

3,017
women with
stage I-III breast cancer

5

30 or more vs.
Less than 25

1.28
(1.05-1.55)

Pooled analyses 

Pajares et al. [14]

5,683
women with
stage I-III breast cancer 

8

 35 or more vs.
18.5-24.9

1.14
(0.91-1.42)

Ladoire et al. [15]

4,996
women with
stage I-III breast cancer

6

 30 or more vs.
Less than 30

1.13
(0.93-1.37)

NS = Results are not statistically significant.

Sig = Results are statistically significant.  

* Among never smokers, women with higher BMI (and those who gained weight after diagnosis) were at increased risk of overall mortality, breast cancer-specific mortality and breast cancer recurrence. 

† Body weight measured after treatment completed.

‡ Most common comparison of BMI measures used in studies. 

§ Risk of metastasis at 5 to 10 years. Risk of breast cancer recurrence at 5 to 10 years was not increased. 

References   

  1. Ewertz M, Jensen MB, Gunnarsdóttir KA, et al. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol. 29(1):25-31, 2011.
  2. Majed B, Moreau T, Senouci K, Salmon RJ, Fourquet A, Asselain B. Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat. 111(2):329-42, 2008.
  3. Jiralerspong S, Kim ES, Dong W, Feng L, Hortobagyi GN, Giordano SH. Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients. Ann Oncol. 24(10):2506-14, 2013.
  4. Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol. 23(7):1370-8, 2005.
  5. Chen X, Lu W, Zheng W, et al. Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat. 122(3):823-33, 2010.
  6. Sparano JA, Wang M, Zhao F, et al. Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer. 118(23):5937-46, 2012.
  7. Ewertz M, Gray KP, Regan MM, et al. Obesity and risk of recurrence or death after adjuvant endocrine therapy with letrozole or tamoxifen in the breast international group 1-98 trial. J Clin Oncol. 30(32):3967-75, 2012.
  8. Nichols HB, Trentham-Dietz A, Egan KM, et al. Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev. 18(5):1403-9, 2009.
  9. Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA. Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev. 14(8):2009-14, 2005.
  10. Flatt SW, Thomson CA, Gold EB, et al. Low to moderate alcohol intake is not associated with increased mortality after breast cancer. Cancer Epidemiol Biomarkers Prev. 19(3):681-8, 2010.
  11. Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 123(3):627-35, 2010.
  12. Niraula S, Ocana A, Ennis M, Goodwin PJ. Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat. 134(2):769-81, 2012.
  13. Chan DS, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014 Apr 27. [Epub ahead of print].
  14. Pajares B, Pollán M, Martín M, et al. Obesity and survival in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathological subtypes: a pooled analysis. Breast Cancer Res. 2013 Nov 6;15(6):R105. [Epub ahead of print].
  15. Ladoire S1, Dalban C2, Roché H3, et al. Effect of obesity on disease-free and overall survival in node-positive breast cancer patients in a large French population: a pooled analysis of two randomised trials. Eur J Cancer. 50(3):506-16, 2014.
  16. Crozier JA1, Moreno-Aspitia A, Ballman KV, Dueck AC, Pockaj BA, Perez EA. Effect of body mass index on tumor characteristics and disease-free survival in patients from the HER2-positive adjuvant trastuzumab trial N9831. Cancer. 119(13):2447-54, 2013. 

Updated 06/26/14