Environment and Breast Cancer: Science Review

Evidence From Humans
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Inflammatory breast cancer survival: the role of obesity and menopausal status at diagnosis
Chang, S., Alderfer, J. R., Asmar, L., Buzdar, A. U. Breast Cancer Research & Treatment. 2000. 64:2, 157-63.
Topic area
Body size
Study design
Prospective cohort
Study Participants
Number of Cases
101 deaths from inflammatory breast cancer (IBC) (40 normal/lean) (25 overweight) (36 obese)
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Post menopausal
Number in Cohort
Cohort: 177 (83 pre) (94 post)
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: IBC patients seen from 1974-1993 at The University of Texas MD Anderson Cancer Center; diagnosis confirmed by biopsy; no evidence of distant metastasis at diagnosis Ex: height or weight were not recorded within 31 days of protocol enrollment; unknown menopausal status at diagnosis
Comment about participation selection
Strengths: diagnosis was confirmed by biopsy; participants engaged in an annual vital status follow-up; mean follow of 8.33 years; anthropometric data were obtained from medical records and were not self-reported; noted the number of nodes involved; first investigation to evaluate the influence of body size and menopausal status at diagnosis on survival from IBC; homogenous case group due to a consistent set of diagnostic criteria obtained at enrollment; prospective study Limitations: limited number of IBC patients available for analysis; lack of information on clinical prognostic indicators that might have revealed the biological processes of IBC progression
Breast cancer outcome investigated
Breast cancer recurrence or progression (survival)
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Adequately controlled, Confounders: nodal involvement and chemotherapy protocols,
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Strength of associations reported
Analysis included an examination of: effect modifiers: menopausal status, follow-up: 8.8 years median, and Inflammatory breast cancer (IBC).
Obese IBC patients had a non-significantly worse chance of survival compared to non-obese women, BMI > 30 vs < 25, HR=1.34(0.88-2.05)
Obese pre-menopausal IBC patients had a non-significantly better chance of survival compared to non-obese women, BMI > 30 vs < 25, HR=0.63(0.34-1.15)
Obese post-menopausal IBC patients had a significantly worse chance of survival compared to non-obese women, BMI > 30 vs < 25, HR=1.86(1.02-3.40)
Author address
Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston 77030-4095, USA. schang@mdanderson.org