Environment and Breast Cancer: Science Review

Evidence From Humans
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Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma
Daling, J. R., Malone, K. E., Doody, D. R., Johnson, L. G., Gralow, J. R., Porter, P. L. Cancer. 2001. 92:4, 720-9.
Topic area
Body size
Study design
Prospective cohort (population based follow-up study for mortality)
Study Participants
Number of Cases
317 deaths
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Number in Cohort
Cohort: 1177 (invasive only)
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In:age 45 years or younger; diagnosed with invasive ductal breast carcinoma between 1983 and 1992; resided in King, Pierce and Snohomish Counties in western Washington State Ex: women with in situ disease; women whose tumors were medullary or lobular; women whose BMI was missing
Comment about participation selection
Strengths: histologic slides were collected from 80% of the cohort; medical records were reviewed by trained personnel; analyzed premenopausal women only; analyzed breast cancer mortality after 5 and 10 years by BMI in women under 45 years of age; analyzed tumor markers and pathology in relation to BMI in women under 45 years; one of the few studies to analyze tumor characteristics in relation to BMI in women under 45 years; analyzed breast cancer mortality in 5 and 10 years according to type of therapy by BMI; only assesses ductal tumors; population based study Limitations: anthropometric data self-reported; only tested 70.7% of the tumors in the cohort; results only apply to ductal carcinomas and non all breast carcinomas; possibility that women who were eligible for the study and were not interviewed had a higher rate of mortality than those interviewed
Exposure Investigated
How exposure was measured
Questionnaire, in person Anthropometric measurement, researcher-administered
Exposure assessment comment
Anthropometric data self-reported
Statistical Analysis
Breast cancer outcome investigated
Breast cancer recurrence or progression
Mortality from breast cancer
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: age, diagnosis year and stage
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Description of major analysis
Follow-up: between 1983 and 1992 (years of diagnosis) to 6/00 Effect modifiers: adjuvant therapy, radiation, chemotherapy, hormone therapy, doxorubicin treatment
Strength of associations reported
Women with breast cancer in the highest quartile of BMI (>25.847 vs 15.8-20.639) are more likely to die of their disease within 5 years after diagnosis, HR=2.5(1.6-3.9) and within 10 years HR=2.1(1.5-2.9)
Women with breast cancer in the highest quartile of BMI (>25.847 vs 15.8-20.639) are more likely to have tumors with a high mitotic cell count OR=2.0(1.2-3.1), high S-phase fraction by flow cytometric assay OR=1.9(1.2-3.1) and have large tumors (2 to <5 cm OR=2.2(1.5-3.1); or > 5 cm OR=2.7(1.5-4.8)
Results Comments
Women with breast cancer in the highest quartile of BMI (>25.847 vs 15.8-20.639) had a greater risk of mortality within 5 and 10 years after adjuvant therapy, radiation, chemotherapy, and hormone therapy.
Author address
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA. jdaling@fhcrc.org