Environment and Breast Cancer: Science Review

Evidence From Humans
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Body mass and stage of breast cancer at diagnosis
Cui, Y., Whiteman, M. K., Flaws, J. A., Langenberg, P., Tkaczuk, K. H., Bush, T. L. International Journal of Cancer. 2002. 98:2, 279-83.
Topic area
Body size
Study design
Other: case series study (medical records)
Study Participants
Number of Cases
966 (60% white) (40% black)
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Post menopausal
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: newly diagnosed breast cancer patients from 2 Baltimore metropolitan area hospitals; diagnosed between 1991-1997; age 20-85 at diagnosis; white or black women Ex: women with a previous malignancy; women outside the age of 20-85; women whose charts were unavailable
Comment about participation selection
Strengths: anthropometric data were measured by trained staff; 10% of the medical records were reviewed by a second investigator to ensure reliability of data abstraction; analyzed stage of breast cancer diagnosis by BMI; analyzed tumor characteristics by BMI; analyzed stage of diagnosis by BMI, modified by age; main findings were consistent with previous studies; large sample size; reliable anthropometric data; reliable information on date of diagnosis and tumor stage Limitations: premorbid and early adulthood body weight were not routinely recorded and thus were not used as variables in the study; potential risk factors such as menstrual history, reproductive history, hormone use and lifestyle factors were unavailable for analysis; detection methods were unavailable for a high proportion of study subjects
Breast cancer outcome investigated
Breast cancer recurrence or progression
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
Non-hispanic White Americans African Americans
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, ethnicity, income, education, and marital status
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 the effect modifiers: age and race.
Association between increased BMI and later stage of breast cancer diagnosis (stage > II), BMI >30 vs <25 OR=1.53(1.05-2.23) trend p=0.03
Association between increased BMI and tumor size (tumor > 2 cm), BMI >27.3 vs <27.3, OR=1.57(1.12-2.17)
Association between increased BMI and stage of diagnosis in women under 50 years of age, BMI >27.3 vs <27.3, OR=2.34(1.34-4.08)
Results Comments
No significant association between stage of diagnosis and BMI stratified by ethnicity.
Author address
Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA. ycui@umaryland.edu