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Senior Citizen Health & Medicine
Obesity Means More Aggressive Breast Cancer; Body
Mass Index May Predict It
Women with locally advanced, inflammatory breast
cancers also have poor outcomes if overweight
 March 14, 2008 - Women with breast cancer have more
aggressive disease and lower survival rates if they are overweight or
obese, according to findings published in the March 15 issue of Clinical
Cancer Research. The researchers suggest Body Mass Index (BMI), the
measure of a person's fat based on their height and weight, may be an
effective prognostic tool for specific types of breast cancer.
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Health & Medicine |
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The research from The University of Texas M. D.
Anderson Cancer Center reports that women with locally advanced breast
cancer (LABC) and inflammatory breast cancer (IBC) with high BMIs had
worse prognosis than women with the disease whose BMIs were in the
healthy range.
The more obese a patient is, the more aggressive
the disease, said Massimo Cristofanilli, MD, associate professor of
medicine in the Department of Breast Medical Oncology at The University
of Texas M.D. Anderson Cancer Center. We are learning that the fat
tissue may increase inflammation that leads to more aggressive disease.
One's BMI is scored based on height and weight. A
score less than 18.5 indicates that a person is underweight and a score
of 18.5 -24.9 indicates that one is in a normal or healthy range.
A person is overweight if their score is 25-29.9
and any score above 30 classifies that a person as obese.
According to Cristofanilli, the study's senior
author, LABC, or cancer that has spread to nearby tissue or lymph nodes,
accounts for approximately five percent of newly diagnosed breast cancer
cases each year in the United States.
In underserved communities, LABC accounts for 50
percent of new cases. IBC is extremely aggressive, yet rare -
representing just 1- 2 percent of all breast cancers diagnosed in this
country.
Before now, there were few epidemiological or
retrospective studies suggesting a correlation between weight gain,
obesity and risk of developing breast cancer; even fewer had address the
prognostic value of obesity, said Cristofanilli, associate professor in
M. D. Anderson's department of Breast Medical Oncology.
"This is the first study to highlight the value of
BMI at the time of diagnosis as a prognostic indicator in women with
aggressive disease and at a high risk of recurrence and at the time of
diagnosis in locally advanced disease, including it's most aggressive
form, inflammatory breast cancer," said Cristofanilli.
"We embarked on this research because the vast
majority of our newly-diagnosed inflammatory breast cancer patients were
overweight or obese, and IBC is associated with a poor prognosis. The
idea was to understand the etiological link between the most aggressive
forms of breast cancers and, ultimately, with prognosis."
For the retrospective study, researchers reviewed
606 patients - 495 (82 percent) with LABC and 111 (18 percent) with
non-metastatic IBC. All were enrolled in clinical protocols at M. D.
Anderson between 1974 and 2000.
The median follow up was six years for all
patients; for women still alive, the median follow-up was 9.9 years.
In calculating BMI, 208 (34 percent) of the
patients were normal or underweight, 194 (32 percent) were overweight
and 204 (34 percent) were obese. Cristofanilli noted that obesity was
more frequent in women with IBC, 45 percent vs. 31 percent in non-IBC
cases.
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For the entire group, the median overall survival
was 8.6 years and recurrence-free survival was 5.8 years. Both
statistics were significantly worse for overweight and obese patients
compared to those who were of normal weight or underweight.
Specifically regarding overall survival, for
overweight LABC patients, five-year survival was 58.3 percent and
10-year survival was 44.1 percent; 58.6 percent of obese LABC patients
lived five years and 42.4 percent lived 10 years.
In contrast, 69.3 percent of women with LABC who
were normal or underweight lived five years and 57.3 percent lived 10
years.
In women with IBC who were overweight, five-year
survival was 45.3 percent and 10-year survival was 29.1 percent; 49.3
percent of obese IBC patients lived five years and 43.7 percent lived 10
years. In comparison, 55.1 percent of women with IBC who were normal or
underweight lived five years and 50.9 percent lived 10 years.
For the design of the study, it's important to note
that all patients received similar anthracycline-based treatments and
that doses were not adjusted based on a patient's weight, said
Cristofanilli.
"Of course, it's important to explore interventions
to prevent overall obesity. These outcomes may have a major impact not
only on the incidence of future breast cancer patients, but on their
long-term outcome," Cristofanilli said.
"From a research standpoint, we really need to
further look at the relationship between obesity and some endocrine
factors that may explain why inflammatory breast cancer patients are
more frequently obese, for example. Our next step is to go back to the
lab and start looking into those specific factors related to obesity in
breast cancer - insulin, estrogen levels and leptin are areas of
immediate interest."
Cristofanilli acknowledged that dietary
intervention might be difficult for women undergoing chemotherapy;
however, some change of lifestyle habits for overweight and obese
patients after diagnosis are vital.
Cristofanilli noted that before BMI is completely
accepted as a prognostic tool for breast cancer, prospective trials and
endocrinology studies must be conducted. However, to oncologists
currently treating overweight and obese LABC and IBC patients,
Cristofanilli recommends they be more aggressive in follow-up, including
considering more frequent physical exams and imaging studies.
Editors Notes:
In addition to Cristofanilli, M. D. Anderson
authors on the study include: Kristine Broglio; Rabiul Islam, and
Gabriel Hortobagyi, M.D. Shaheenah Dawood, M.R.C.P. of Dubai Hospital,
is the study's first author. The study was funded, in part, by the Susan
G. Komen Foundation, the Nellie B. Connally Fund for Breast Cancer
Research and the Inflammatory Breast Cancer Research Group.
M. D. Anderson says it is home to the first clinic
and research program in the world dedicated to a greater understanding
of IBC.
About M. D. Anderson
The University of Texas M. D. Anderson Cancer
Center in Houston ranks as one of the world's most respected center
focused on patient care, research, education and prevention. M. D.
Anderson is one of only 39 Comprehensive Cancer Centers designated by
the National Cancer Institute. For five of the past eight years, M. D.
Anderson has ranked first in cancer care in "America's Best Hospitals,"
a survey published annually in U.S. News and World Report.
The study was funded by the Susan G. Komen
Foundation, the Nellie B. Connally Fund for Breast Cancer Research and
the Inflammatory Breast Cancer Research Group.
The mission of the American Association for Cancer
Research is to prevent and cure cancer. Founded in 1907, AACR is the
world's oldest and largest professional organization dedicated to
advancing cancer research.
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