Obesity and Risk of Recurrence in Patients with Breast Cancer Treated with Aromatase Inhibitors
(2023) In JAMA Network Open 6(10). p.2337780-2337780- Abstract
Importance: Clinical studies confirm that obesity is a risk factor for recurrence in postmenopausal women with hormone receptor-positive (HR+) breast cancer. Evidence suggests that women with obesity do not obtain similar protection from aromatase inhibitors as women with healthy weight. Objective: To examine the associations of body mass index (BMI) with recurrence. Design, Setting, and Participants: The cohort study was conducted using data from the Danish Breast Cancer Group and enrolled postmenopausal women diagnosed with stage I to III HR+ breast cancer from 1998 through 2016. Data analysis was conducted from November 2022 to April 2023. Exposures: BMI was classified as (1) healthy weight (18.5-24.9), (2) overweight (25.0-29.9),... (More)
Importance: Clinical studies confirm that obesity is a risk factor for recurrence in postmenopausal women with hormone receptor-positive (HR+) breast cancer. Evidence suggests that women with obesity do not obtain similar protection from aromatase inhibitors as women with healthy weight. Objective: To examine the associations of body mass index (BMI) with recurrence. Design, Setting, and Participants: The cohort study was conducted using data from the Danish Breast Cancer Group and enrolled postmenopausal women diagnosed with stage I to III HR+ breast cancer from 1998 through 2016. Data analysis was conducted from November 2022 to April 2023. Exposures: BMI was classified as (1) healthy weight (18.5-24.9), (2) overweight (25.0-29.9), (3) obesity (30.0-34.9), and (4) severe obesity (≥35.0) using the World Health Organization guidelines. Healthy weight was considered the reference group in statistical analyses. Main Outcomes and Measures: Follow-up began 6 months after breast cancer surgery and continued until the first event of recurrence, contralateral breast cancer, new primary malignant neoplasm, death, emigration, end of clinical follow-up at 10 years, or September 25, 2018. Cox regression was used to estimate crude and adjusted hazard ratios with 95% CIs, adjusting for patient, tumor, and treatment characteristics. Results: A total of 13230 patients (median [IQR] age at diagnosis, 64.4 [58.6-70.2] years) with information on BMI were enrolled. There were 1587 recurrences with a median (IQR) potential estimated follow-up of 6.2 (3.6-8.5) years. Multivariable analyses revealed increased recurrence hazards associated with obesity (adjusted hazard ratio, 1.18 [95% CI, 1.01-1.37]) and severe obesity (adjusted hazard ratio, 1.32 [95% CI, 1.08-1.62]) vs patients with healthy weight. Patients with overweight had a greater risk, but the results were not statistically significant (adjusted hazard ratio, 1.10 [95% CI, 0.97-1.24]). Conclusions and Relevance: In this study, obesity was associated with an increased risk of breast cancer recurrence among postmenopausal patients with HR+ early-stage breast cancer treated with aromatase inhibitors. Physicians should be aware of the significance of obesity on breast cancer outcomes to secure optimal treatment benefit in all patients..
(Less)
- author
- Harborg, Sixten ; Cronin-Fenton, Deirdre ; Jensen, Maj Britt Raaby ; Ahern, Thomas P. ; Ewertz, Marianne and Borgquist, Signe LU
- organization
- publishing date
- 2023-10
- type
- Contribution to journal
- publication status
- published
- subject
- in
- JAMA Network Open
- volume
- 6
- issue
- 10
- pages
- 2337780 - 2337780
- publisher
- American Medical Association
- external identifiers
-
- pmid:37831449
- scopus:85174751678
- ISSN
- 2574-3805
- DOI
- 10.1001/jamanetworkopen.2023.37780
- language
- English
- LU publication?
- yes
- id
- 8e331e3a-ccc1-4b87-b197-5be918a540b7
- date added to LUP
- 2023-12-15 10:27:55
- date last changed
- 2024-04-14 02:18:44
@article{8e331e3a-ccc1-4b87-b197-5be918a540b7,
abstract = {{<p>Importance: Clinical studies confirm that obesity is a risk factor for recurrence in postmenopausal women with hormone receptor-positive (HR+) breast cancer. Evidence suggests that women with obesity do not obtain similar protection from aromatase inhibitors as women with healthy weight. Objective: To examine the associations of body mass index (BMI) with recurrence. Design, Setting, and Participants: The cohort study was conducted using data from the Danish Breast Cancer Group and enrolled postmenopausal women diagnosed with stage I to III HR+ breast cancer from 1998 through 2016. Data analysis was conducted from November 2022 to April 2023. Exposures: BMI was classified as (1) healthy weight (18.5-24.9), (2) overweight (25.0-29.9), (3) obesity (30.0-34.9), and (4) severe obesity (≥35.0) using the World Health Organization guidelines. Healthy weight was considered the reference group in statistical analyses. Main Outcomes and Measures: Follow-up began 6 months after breast cancer surgery and continued until the first event of recurrence, contralateral breast cancer, new primary malignant neoplasm, death, emigration, end of clinical follow-up at 10 years, or September 25, 2018. Cox regression was used to estimate crude and adjusted hazard ratios with 95% CIs, adjusting for patient, tumor, and treatment characteristics. Results: A total of 13230 patients (median [IQR] age at diagnosis, 64.4 [58.6-70.2] years) with information on BMI were enrolled. There were 1587 recurrences with a median (IQR) potential estimated follow-up of 6.2 (3.6-8.5) years. Multivariable analyses revealed increased recurrence hazards associated with obesity (adjusted hazard ratio, 1.18 [95% CI, 1.01-1.37]) and severe obesity (adjusted hazard ratio, 1.32 [95% CI, 1.08-1.62]) vs patients with healthy weight. Patients with overweight had a greater risk, but the results were not statistically significant (adjusted hazard ratio, 1.10 [95% CI, 0.97-1.24]). Conclusions and Relevance: In this study, obesity was associated with an increased risk of breast cancer recurrence among postmenopausal patients with HR+ early-stage breast cancer treated with aromatase inhibitors. Physicians should be aware of the significance of obesity on breast cancer outcomes to secure optimal treatment benefit in all patients..</p>}},
author = {{Harborg, Sixten and Cronin-Fenton, Deirdre and Jensen, Maj Britt Raaby and Ahern, Thomas P. and Ewertz, Marianne and Borgquist, Signe}},
issn = {{2574-3805}},
language = {{eng}},
number = {{10}},
pages = {{2337780--2337780}},
publisher = {{American Medical Association}},
series = {{JAMA Network Open}},
title = {{Obesity and Risk of Recurrence in Patients with Breast Cancer Treated with Aromatase Inhibitors}},
url = {{http://dx.doi.org/10.1001/jamanetworkopen.2023.37780}},
doi = {{10.1001/jamanetworkopen.2023.37780}},
volume = {{6}},
year = {{2023}},
}