Pre-diagnostic changes in body mass index and mortality among breast cancer patients
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Pre-diagnostic changes in body mass index and mortality among breast cancer patients. / Larsen, Signe Benzon; Torstensson, Maia; Kenborg, Line; Christensen, Jane; Kroman, Niels; Dalton, Susanne Oksbjerg; Tjønneland, Anne; Johansen, Christoffer; Bidstrup, Pernille Envold.
In: Breast Cancer Research and Treatment, Vol. 170, No. 3, 2018, p. 605-612.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Pre-diagnostic changes in body mass index and mortality among breast cancer patients
AU - Larsen, Signe Benzon
AU - Torstensson, Maia
AU - Kenborg, Line
AU - Christensen, Jane
AU - Kroman, Niels
AU - Dalton, Susanne Oksbjerg
AU - Tjønneland, Anne
AU - Johansen, Christoffer
AU - Bidstrup, Pernille Envold
PY - 2018
Y1 - 2018
N2 - PURPOSE: We investigated whether changes in body mass index (BMI) before a breast cancer diagnosis affected mortality and whether trajectories more accurately predict overall mortality compared to a single measure of BMI.METHODS: Our prospective cohort comprised 2012 women with breast cancer who reported their weight in each decade from 20 to 50-64 years of age. We used trajectory analysis to identify groups with similar development patterns in BMI and Cox proportional hazards models to examine the association between trajectory groups and mortality, and interactions with oestrogen receptor status and smoking. We used c-index statistics to compare the trajectory model with the single measure model of BMI.RESULTS: We identified three distinct trajectory groups, with a mean BMI at age 20 of 19, 22 and 24 increasing to 23 (normal-to-normal), 29 (normal-to-overweight) and 37 (normal-to-obese) at 50-64 years of age, respectively. Women in the normal-to-obese trajectory group experienced significantly higher overall mortality than those in the normal-to-normal trajectory group (HR 1.76, 95% CI 1.21‒2.56). The association declined to a non-significant level after adjustments for clinical prognostic factors. Although not significant, the same tendency was seen for breast cancer-specific mortality. The association was strongest in women with oestrogen receptor-negative tumours. Weight changes over time were not significantly different from a single BMI measure before diagnosis to predict survival.CONCLUSION: Weight gain affects overall mortality after breast cancer but clinical prognostic factors largely eliminate the association. Using trajectories of weight changes did not improve the predictive value compared to a single measure of BMI.
AB - PURPOSE: We investigated whether changes in body mass index (BMI) before a breast cancer diagnosis affected mortality and whether trajectories more accurately predict overall mortality compared to a single measure of BMI.METHODS: Our prospective cohort comprised 2012 women with breast cancer who reported their weight in each decade from 20 to 50-64 years of age. We used trajectory analysis to identify groups with similar development patterns in BMI and Cox proportional hazards models to examine the association between trajectory groups and mortality, and interactions with oestrogen receptor status and smoking. We used c-index statistics to compare the trajectory model with the single measure model of BMI.RESULTS: We identified three distinct trajectory groups, with a mean BMI at age 20 of 19, 22 and 24 increasing to 23 (normal-to-normal), 29 (normal-to-overweight) and 37 (normal-to-obese) at 50-64 years of age, respectively. Women in the normal-to-obese trajectory group experienced significantly higher overall mortality than those in the normal-to-normal trajectory group (HR 1.76, 95% CI 1.21‒2.56). The association declined to a non-significant level after adjustments for clinical prognostic factors. Although not significant, the same tendency was seen for breast cancer-specific mortality. The association was strongest in women with oestrogen receptor-negative tumours. Weight changes over time were not significantly different from a single BMI measure before diagnosis to predict survival.CONCLUSION: Weight gain affects overall mortality after breast cancer but clinical prognostic factors largely eliminate the association. Using trajectories of weight changes did not improve the predictive value compared to a single measure of BMI.
KW - Adult
KW - Aged
KW - Body Mass Index
KW - Body Weight
KW - Breast Neoplasms/diagnosis
KW - Denmark/epidemiology
KW - Disease Management
KW - Female
KW - Humans
KW - Middle Aged
KW - Mortality
KW - Prognosis
KW - Proportional Hazards Models
KW - Public Health Surveillance
KW - Registries
KW - Risk Factors
KW - Young Adult
U2 - 10.1007/s10549-018-4771-5
DO - 10.1007/s10549-018-4771-5
M3 - Journal article
C2 - 29637418
VL - 170
SP - 605
EP - 612
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
SN - 0167-6806
IS - 3
ER -
ID: 214464590