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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: Body weight is related to breast cancer risk (see Table 1). For this reason, studies are looking at whether body weight is linked to survival after treatment among women with stage I-III (non-metastatic) breast cancer.

Body weight and survival

Heavier breast cancer survivors tend to have lower overall survival compared to leaner survivors. This means they are more likely to die from any cause, not necessarily related to their cancer (called overall mortality). And, growing evidence shows heavier survivors are also more likely to die from their breast cancer (called breast cancer-specific mortality).

Body weight and recurrence

At this time, there is not enough evidence to support a link between body weight and breast cancer recurrence.

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

Study selection criteria: Prospective cohort studies with at least 1,000 participants 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  

11.4

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)

Nurses' Health Study [3]

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 [4]

5,042
women with
stage I-IV breast cancer

3.8

30 or more vs.
18.5-24.9

 

1.55
(1.10-2.17)

Eastern Cooperative Oncology Group [5]

4,770
women with
stage I-III breast cancer 

7.9-14.4

30 or more vs.
Less than 25

 

1.23
(1.08-1.40)

Collaborative Women's Longevity Study [6]

3,993
women with
stage I-III breast cancer

6.4

30 or more vs.
18.5-24.9†

2.28
(1.43-3.64)

1.27
(0.99-1.64)

Whiteman et al. [7]

3,924
women with
stage I-IV breast cancer

14.6

30 or more vs.
23 or less

1.34
(1.09-1.65)

 

Women’s Healthy Eating and Living Study [8]

3,088
women with
stage I-IIIa breast cancer

7.3

25-29.9 vs.
18.5-24.9†

 

0.98
(0.74-1.30)

     

30 or more vs.
18.5-24.9†

 

1.28
(0.97-1.70)

Caan et al. [9]

1,689
women with
stage I-III breast cancer

7

30 or more vs.
Less than 25†

1.2
(0.7-2.1)

1.3
(0.8-1.9)

Pierce et al. [10]

1,490
women with
stage I-III breast cancer

8.7

30 or more vs.
20-25†

1.42
(0.87-2.31)

 

Shanghai Breast Cancer Study [11]

1,455
women with
stage I-IV breast cancer

5.1

25 or more vs.
Less than 23

 

1.3
(1.0-1.8)

Dal Maso et al. [12]

1,453
women with
stage I-IV breast cancer

12.6

30 or more vs.
Less than 25

1.38
(1.02-1.86)

1.29
(0.99-1.68)*

Abrahamson et al. [13]

1,254
women with
stage I-IV breast cancer

8-10

30 or more vs.
18.5 to less than 25

 

1.28
(1.09-2.01)

Newman et al. [14]

1,169
women with
stage I-III breast cancer

3.6

More than 29 vs.
Less than 23

2.47 
(1.17-5.22)

 

Meta-analyses 

Protani et al. [15]

43 studies

 

30 or more vs.
Less than 25‡ 

1.33
(1.19-1.50)

1.33
(1.21-1.47)





 

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

Ewertz et al. [1]

18,967
women with
stage I-III breast cancer  

7.1

 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)§ 

Nurses' Health Study [3]

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 [4]

5,042
women with
stage I-IV breast cancer

3.8

30 or more vs.
18.5-24.9

1.44
(1.02-2.03)

Eastern Cooperative Oncology Group [5]

 4,770
women with
stage I-III breast cancer

7.9-14.4

30 or more vs.
Less than 25

1.17
(1.04-1.31)

Imkampe et al. [16]

2,298
women with
stage I-III breast cancer

7.1

30 or more vs.
Less than 30

1.43
(1.12-1.83)

Caan et al. [9]

1,689
women with
stage I-III breast cancer

7

30 or more vs.
Less than 25

1.0
(0.7-1.4)

Shanghai Breast Cancer Study [11]

1,455
women with
stage I-IV breast cancer

5.1

25 or more vs.
Less than 23

 5-year disease-free survival:
77% vs. 82%Sig 

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 statistically significant. 

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. 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.

4. 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.

5. Sparano JA, Wang M, Zhao F, et al. Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer. Aug 27, 2012. [Epub ahead of print].

6. 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.

7. 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.

8. 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.

9. Caan BJ, Kwan ML, Hartzell G, et al. Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control. 19(10):1319-28, 2008.

10. Pierce JP, Stefanick ML, Flatt SW, et al. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol. 25(17):2345-51, 2007.

11. Tao MH, Shu XO, Ruan ZX, Gao YT, Zheng W. Association of overweight with breast cancer survival. Am J Epidemiol. 163(2):101-7, 2006.

12. Dal Maso L, Zucchetto A, Talamini R, et al., for the Prospective Analysis of Case-control studies on Environmental factors and health (PACE) study group. Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer. 123 :2188-2194, 2008.

13. Abrahamson PE, Gammon MD, Lund MJ, et al. General and abdominal obesity and survival among young women with breast cancer. Cancer Epidemiol Biomarkers Prev. 15(10):1871-7, 2006.

14. Newman SC, Lees AW, Jenkins HJ. The effect of body mass index and oestrogen receptor level on survival of breast cancer patients. Int J Epidemiol. 26(3):484-90, 1997.

15. 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.

16. Imkampe AK, Bates T. Impact of a raised body mass index on breast cancer survival in relation to age and disease extent at diagnosis. Breast J. 16(2):156-61, 2010.

Updated 01/25/13