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Lee Y, Kang E, Shin HC, Lee H, Yoon K, Kang B, Kim EK. The Effect of Body Mass Index on Initial Breast Cancer Stage Among Korean Women. Clin Breast Cancer 2021; 21:e631-e637. [PMID: 34024752 DOI: 10.1016/j.clbc.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between obesity and breast cancer stage is not well-known in the Korean population. This study aimed to identify the effect of body mass index (BMI) on initial breast cancer stage. PATIENTS AND METHODS Among patients who underwent surgery for breast cancer (stages 0-III) from June 2003 to December 2018, we analyzed 4510 patients for whom there were BMI data. RESULTS The average BMI of our patients was 23.5 (14.2-44.9). In total, 4.6% and 24.2% of the patients had a BMI of ≥30 and 25-29.9, respectively. In the patients with obesity, the proportion of T2 to T4 was 41.4%, which was higher than that in patients with a BMI of 25 to 29 (28.4%; P = .001) or a BMI of <25 (23.3%; P < .001). There was no difference in positive rates of estrogen receptor and progesterone receptor with BMI, but obese patients were less likely to be human epidermal growth factor receptor 2 positive. Patients with higher stages were more likely to have a higher BMI. The effect of BMI on stage was stronger in patients <50 years (odds ratio, 2.439; 95% CI, 1.783-3.335). Although there was no statistical significance, tumors >2 cm were less likely to be palpable in obese patients than in patients of normal weight (nonpalpable in 33.8% and 27.0%, respectively). CONCLUSION Our study suggests that obesity is associated with a more advanced breast cancer stage, which represents a poor prognosis, and large tumors tend to be less palpable in women with obesity.
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Affiliation(s)
- Yongwoong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Haemin Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyunghwak Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byeongju Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Relationship of breast volume, obesity and central obesity with different prognostic factors of breast cancer. Sci Rep 2021; 11:1872. [PMID: 33479372 PMCID: PMC7820412 DOI: 10.1038/s41598-021-81436-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/30/2020] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to investigate whether the BC tumor biology in women with larger breast volume, in obese women and especially in women with central adiposity at the moment of diagnosis of BC is more aggressive than in those women without these characteristics. 347 pre- and postmenopausal women with a recent diagnosis of BC were analyzed. In all patients, anthropometric measurements at the time of diagnosis was collected. In 103 of them, the breast volume was measured by the Archimedes method. The Breast volume, BMI, WHR and the menopausal status were related to different well-known pathological prognostic factors for BC. At the time of diagnosis, 35.4% were obese (BMI > 30 kg/m2), 60.2% had a WHR ≥ 0.85, 68.8% were postmenopausal and 44.7% had a breast volume considered "large" (> 600 cc). Between patients with a large breast volume, only a higher prevalence of ER (+) tumors was found (95.3% vs. 77.2%; p = 0.04) compared to those with small breast volumes. The obese BC patients showed significantly higher rates of large tumors (45.5% vs. 40.6%; p = 0.04), axillary invasion (53.6% vs. 38.8%; p = 0.04), undifferentiated tumors (38.2% vs. 23.2%) and unfavorable NPI (p = 0.04) than non-obese women. Those with WHR ≥ 0.85 presented higher postsurgical tumor stages (61.7% vs. 57.8%; p = 0.03), higher axillary invasion (39.9% vs. 36.0%; p = 0.004), more undifferentiated tumors (30.0% vs. 22.3%; p = 0.009), higher lymphovascular infiltration (6.5% vs. 1.6%; p = 0.02), and a higher NPI (3.6 ± 1.8 vs. 3.2 ± 1.8; p = 0.04). No statistically significant differences were found according to menopausal status. We conclude that obesity, but especially central obesity can be associated with a more aggressive tumour phenotype. No relation between breast volume and tumoral prognostic factors was found, except for a higher proportion of ER (+) tumor in women with higher breast volume.
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Miles RC, Lehman CD, Mercaldo SF, Tamimi RM, Dontchos BN, Narayan AK. Obesity and breast cancer screening: Cross-sectional survey results from the behavioral risk factor surveillance system. Cancer 2019; 125:4158-4163. [PMID: 31393609 DOI: 10.1002/cncr.32430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Postmenopausal obese women demonstrate an elevated breast cancer risk and experience increased breast cancer morbidity and mortality compared with women with a normal body mass index (BMI). However, to the authors' knowledge, prior studies have yielded inconclusive results regarding the effects of obesity on mammography screening adherence. Using national cross-sectional survey data, the objective of the current study was to assess the current association between increasing BMI and use of mammography screening. METHODS Cross-sectional survey data from the 2016 Behavioral Risk Factor Surveillance System, a state-based national telephone survey of noninstitutionalized adults in the United States, was used to identify the association between mammography screening use and increasing incremental BMI categories, including normal (18.5-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), obese class I (30-34.9 kg/m2 ), obese class II (35-39.9 kg/m2 ), and obese class III (>40 kg/m2 ), with adjustments for potential confounders. A multivariable logistic regression model was used to evaluate the effect of each BMI category on self-reported mammography use, using unadjusted and adjusted odds ratios. Effect modification by race/ethnicity was determined by testing interaction terms using Wald tests. RESULTS Of 116,343 survey respondents, 33.5% (38,984 respondents) had a normal BMI, 32.6% (37,969 respondents) were overweight, 19.3% (22,416 respondents) were classified as obese class I, 8.4% (9791 respondents) were classified as obese class II, and 6.2% (7183 respondents) were classified as obese class III. There was no statistically significant difference (P < .05) observed with regard to mammography use between women with a normal BMI and obese women from each obese class (classes I-III) when compared individually. There also was no evidence of effect modification by race (P = .53). CONCLUSIONS In contrast to prior reports, the results of the current study demonstrated no association between obesity and adherence to screening mammography. These findings may relate to the increasing social acceptance of obesity among women from all racial/ethnic groups and the removal of weight-related facility-level barriers over time.
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Affiliation(s)
- Randy C Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah F Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rulla M Tamimi
- Channing Institute, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brian N Dontchos
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Sebastiani F, Cortesi L, Sant M, Lucarini V, Cirilli C, De Matteis E, Marchi I, Negri R, Gallo E, Federico M. Increased Incidence of Breast Cancer in Postmenopausal Women with High Body Mass Index at the Modena Screening Program. J Breast Cancer 2016; 19:283-291. [PMID: 27721878 PMCID: PMC5053313 DOI: 10.4048/jbc.2016.19.3.283] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/18/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose We conducted a study to evaluate the relationship between body mass index (BMI) and the risk of breast cancer (BC) and outcome in a population of 14,684 women aged 55 to 69 years eligible to participate in the Mammography Screening Program (MSP) in the Province of Modena, Italy. Methods The study population was drawn from women who underwent mammography screening between 2004 and 2006 in the Province of Modena. Women were subdivided into obese, overweight, and normal-weight categories according to BMI and followed until July 31, 2010, to evaluate the BC incidence. The clinicopathological characteristics of BC were also evaluated in different groups of patients classified according to BMI. After BC diagnosis, patients were followed for a median period of 65 (range, 2–104) months. Second events (recurrences and second tumors) were recorded, and the 5-year event-free survival (EFS) was calculated. Results After a period of 73 months, 366 cases of BC were diagnosed. Compared with normal-weight women, obese women had a significantly higher incidence of BC (relative risk [RR], 1.32; p=0.040) (RR=1), larger tumors (27% of tumors were larger than T2 size), and more nodal involvement (38.5% of tumors were node-positive). Furthermore, a significantly higher rate of total events was seen in obese women compared with overweight and normal-weight patients, respectively (17.9% vs. 11.4% vs. 10.8%, p=0.032). The 5-year EFS was 89.0%, 89.0%, and 80.0% for normal-weight, overweight, and obese patients, respectively. Conclusion We observed a significantly higher risk of BC in obese women among those eligible to participate in the MSP in the Province of Modena. Finally, obese women had more second events and poorer EFS compared to nono bese women.
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Affiliation(s)
- Federica Sebastiani
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Cortesi
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Milena Sant
- Department of Preventive and Predictive Medicine, National Tumor Institute, Milan, Italy
| | - Valeria Lucarini
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Cirilli
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta De Matteis
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Marchi
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Rossella Negri
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ennio Gallo
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Federico
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
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Leung J, Martin J, McLaughlin D. Rural-urban disparities in stage of breast cancer at diagnosis in Australian women. Aust J Rural Health 2016; 24:326-332. [PMID: 26798970 DOI: 10.1111/ajr.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine urban-rural differences and individual risk factors for a late stage of breast cancer at diagnosis in Australian women. DESIGN Individual-level longitudinal data were linked with cancer registry data from New South Wales (New South Wales Cancer Registry linked by the Centre for Health Record Linkage (CHeReL)), Queensland (Queensland Cancer Registry) and Victoria (The Cancer Council Victoria). SETTING Participants were drawn from the Australian Longitudinal Study on Women's Health 1946-1951 cohort (n = 13 715). PARTICIPANTS The sample included 195 women identified from the linked cancer registry data with a breast cancer diagnosis. INTERVENTIONS Rural or urban residence was measured using Accessibility/Remoteness Index of Australia Plus (ARIA+). Individual characteristics and socio-demographic variables examined included survey year, menopausal status, country of birth, education and marital status. MAIN OUTCOME MEASURES A late stage of breast cancer at diagnosis was defined based on the TNM Classification of Malignant Tumours. RESULTS A late stage of breast cancer diagnosis was observed in 36% of women residing in urban areas and 40% of women residing in rural areas. After adjusting for individual characteristics, we found that obesity was the strongest risk factor for a late stage of breast cancer at diagnosis. CONCLUSIONS Given that women are becoming increasingly obese, and that the rate of obesity is higher in the Australian rural population, this paper provides further evidence for targeting interventions for obesity, particularly in rural Australia, as a public health priority.
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Affiliation(s)
- Janni Leung
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia. .,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.
| | - Jennifer Martin
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deirdre McLaughlin
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Abrahamsson L, Czene K, Hall P, Humphreys K. Breast cancer tumour growth modelling for studying the association of body size with tumour growth rate and symptomatic detection using case-control data. Breast Cancer Res 2015; 17:116. [PMID: 26293658 PMCID: PMC4546241 DOI: 10.1186/s13058-015-0614-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/10/2015] [Indexed: 01/23/2023] Open
Abstract
Introduction A large body size is associated with larger breast cancer tumours at diagnosis. Standard regression models for tumour size at diagnosis are not sufficient for unravelling the mechanisms behind the association. Methods Using Swedish case-control data, we identified 1352 postmenopausal women with incident invasive breast cancer diagnosed between 1993 and 1995. We used a novel continuous tumour growth model, which models tumour sizes at diagnosis through three submodels: for tumour growth, time to symptomatic detection, and screening sensitivity. Tumour size at other time points is thought of as a latent variable. Results We quantified the relationship between body size with tumour growth and time to symptomatic detection. High body mass index and large breast size are, respectively, significantly associated with fast tumour growth rate and delayed time to symptomatic detection (combined P value = 5.0 × 10−5 and individual P values = 0.089 and 0.022). We also quantified the role of mammographic density in screening sensitivity. Conclusions The times at which tumours will be symptomatically detected may vary substantially between women with different breast sizes. The proposed tumour growth model represents a novel and useful approach for quantifying the effects of breast cancer risk factors on tumour growth and detection.
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Affiliation(s)
- Linda Abrahamsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, SE-171 77, Sweden.
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, SE-171 77, Sweden.
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, SE-171 77, Sweden.
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, SE-171 77, Sweden.
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Larsen SB, Kroman N, Ibfelt EH, Christensen J, Tjønneland A, Dalton SO. Influence of metabolic indicators, smoking, alcohol and socioeconomic position on mortality after breast cancer. Acta Oncol 2015; 54:780-8. [PMID: 25761087 DOI: 10.3109/0284186x.2014.998774] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Factors differently distributed among social groups like obesity, metabolic syndrome, diabetes, smoking, and alcohol intake predict survival after breast cancer diagnosis and therefore might mediate part of the observed social inequality in survival. MATERIAL AND METHODS We conducted a cohort study among 1250 postmenopausal breast cancer patients identified among 29 875 women in the Danish Diet, Cancer and Health Study. Participants completed questionnaires and anthropometric measurements were made at enrollment. Information on survival, socioeconomic position, and comorbidity was obtained by linkage to national Danish registries. Clinical information was obtained from the nationwide Danish Breast Cancer Database. Selected information was obtained from hospital records at time of diagnosis. All analyses were based on Cox proportional hazard models, using death from all causes as outcome. RESULTS Median follow-up was 9.6 years [interquartile range (IQR), 2.2-17.0 years]. The hazard ratio (HR) for death from all causes increased with lower education (p for trend, 0.01). Adjustment for disease-related prognostic factors, comorbidity and metabolic indicators measured as BMI, waist circumference and diabetes, and smoking and alcohol affected but did not explain the social gradient. CONCLUSION The findings indicate that these factors explain some but not all the social inequality in survival after breast cancer and that improvement of lifestyle to some extent would improve survival among women with low socioeconomic position.
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Dookeran KA, Silva A, Warnecke RB, Rauscher GH. Race/ethnicity and disparities in mastectomy practice in the Breast Cancer Care in Chicago study. Ann Surg Oncol 2014; 22:66-74. [PMID: 25135847 DOI: 10.1245/s10434-014-3945-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine racial/ethnic disparities in mastectomy practice and explore mediating factors to explain the disparity. METHODS Participants included 989 females aged 30-79 years, from a population-based study of newly diagnosed (primary in situ/invasive) breast cancer patients, in Chicago, Illinois, from 2005 to 2008, who completed an interview. Medical records were also abstracted for tumor, diagnostic, and treatment information. Multivariable logistic regression models with model-based standardization were used to estimate risk differences. Differences in rescaled coefficients were used to estimate the proportion of the disparity that could be mediated by patient and tumor characteristics. RESULTS Mastectomy prevalence overall was 40 %. Factors significantly associated with increased rates of mastectomy (p < 0.05) included the following: non-Hispanic (nH) black and Hispanic race/ethnicity; younger age at diagnosis; lower socioeconomic status (SES); lack of recency of and adherence to screening mammography; and higher tumor pathologic stage and grade. In adjusted models (age, body mass index, comorbidity), compared to nH white patients, mastectomy was increased by 10 % points in both nH black (95 % confidence interval [CI] 0.03, 0.18; p = 0.007) and Hispanic (95 % CI 0.01, 0.19; p = 0.028) patients. After accounting for the proportion of disparity mediated by tumor stage, the disparity was reduced by about a third in nH black (risk difference = 0.07, 95 % CI -0.01, 0.14) and half in Hispanic patients (risk difference = 0.04, 95 % CI -0.05, 0.13). Additional control for mediation by SES and other tumor-related factors almost completely eliminated the nH black:nH white disparity. CONCLUSIONS The best approach to reducing the racial/ethnic disparity in mastectomy rates would be to intervene on factors that could affect stage at diagnosis.
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Affiliation(s)
- Keith A Dookeran
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA,
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Williams PT. Breast cancer mortality vs. exercise and breast size in runners and walkers. PLoS One 2013; 8:e80616. [PMID: 24349006 PMCID: PMC3857169 DOI: 10.1371/journal.pone.0080616] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/13/2013] [Indexed: 02/06/2023] Open
Abstract
Purpose Identify predictors of breast cancer mortality in women who exercised below (<7.5 metabolic equivalent hours/week, MET-hours/wk), at (7.5 to 12.5 MET-hours/wk), or above (≥12.5 MET-hours/wk) recommended levels. Methods Cox proportional hazard analyses of baseline pre-diagnosis MET-hours/wk vs. breast cancer mortality adjusted for follow-up age, race, baseline menopause, and estrogen and oral contraceptive use in 79,124 women (32,872 walkers, 46,252 runners) from the National Walkers' and Runners' Health Studies. Results One-hundred eleven women (57 walkers, 54 runners) died from breast cancer during the 11-year follow-up. The decline in mortality in women who exercised ≥7.5 MET-hours/wk was not different for walking and running (P = 0.34), so running and walking energy expenditures were combined. The risk for breast cancer mortality was 41.5% lower for ≥7.5 vs. <7.5 MET-hours/wk (HR: 0.585, 95%CI: 0.382 to 0.924, P = 0.02), which persisted when adjusted for BMI (HR: 0.584, 95%CI: 0.368 to 0.956, P = 0.03). Other than age and menopause, baseline bra cup size was the strongest predictor of breast cancer mortality, i.e., 57.9% risk increase per cup size when adjusted for MET-hours/wk and the other covariates (HR: 1.579, 95%CI: 1.268 to 1.966, P<0.0001), and 70.4% greater when further adjusted for BMI (HR: 1.704, 95%CI: 1.344 to 2.156, P = 10−5). Breast cancer mortality was 4.0-fold greater (HR: 3.980, 95%CI: 1.894 to 9.412, P = 0.0001) for C-cup, and 4.7-fold greater (HR: 4.668, 95%CI: 1.963 to 11.980, P = 0.0004) for ≥D-cup vs. A-cup when adjusted for BMI and other covariates. Adjustment for cup size and BMI did not eliminate the association between breast cancer mortality and ≥7.5 MET-hour/wk walked or run (HR: 0.615, 95%CI: 0.389 to 1.004, P = 0.05). Conclusion Breast cancer mortality decreased in association with both meeting the exercise recommendations and smaller breast volume.
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Affiliation(s)
- Paul T. Williams
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California, United States of America
- * E-mail:
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Panagopoulou P, Gogas H, Dessypris N, Maniadakis N, Fountzilas G, Petridou ET. Survival from breast cancer in relation to access to tertiary healthcare, body mass index, tumor characteristics and treatment: a Hellenic Cooperative Oncology Group (HeCOG) study. Eur J Epidemiol 2012; 27:857-66. [PMID: 23086284 DOI: 10.1007/s10654-012-9737-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 09/26/2012] [Indexed: 12/24/2022]
Abstract
Apart from tumour, treatment and patient characteristics at diagnosis, access to healthcare delivery may as well play a significant role in breast cancer prognosis. This study aimed to assess the additional impact exerted on survival by travel burden-a surrogate indicator of limited access to healthcare- expressed as geographical distance and/or time needed to reach the tertiary healthcare center from the patient's residence. Between 1997 and 2005, 2,789 women participated in therapeutic clinical trials conducted by the Hellenic Cooperative Oncology Group. The effect of geographical distance and travel time between patient's residence and treating hospital on survival was estimated using Cox proportional hazards regression adjusting for age, menopausal status, tumour size/grade, positive nodes (number), hormonal receptor status, HER2 overexpression, surgery type/treatment protocol as well as for body mass index>30 kg/m2. More aggressive tumour features, older treatment protocols and modifiable patient characteristics, such as obesity (HR: 1.27) adversely impacted on breast cancer survival. In addition, less studied indicators of access to healthcare, such as geographic distance>350 km and travel time>4 h were independently and significantly associated with worse outcomes (HR=1.43 and 1.34 respectively). In conclusion, to address inequalities in breast cancer survival, improvements in access to healthcare services related to increased travel burden especially for patients of lower socioeconomic status should be considered, more than ever at times of financial crisis and independently of already known modifiable patient characteristics.
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Affiliation(s)
- Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Mikras Asias 75, 115 27, Athens, Greece
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Given breast cancer, does breast size matter? Data from a prospective breast cancer cohort. Cancer Causes Control 2012; 23:1307-16. [DOI: 10.1007/s10552-012-0008-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
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Singh AK, Pandey A, Tewari M, Pratyush DD, Singh HK, Pandey HP, Shukla HS. Obesity augmented breast cancer risk: a potential risk factor for Indian women. J Surg Oncol 2011; 103:217-22. [PMID: 21246565 DOI: 10.1002/jso.21768] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 09/07/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obesity is caused by disturbances of energy balance, which is homeostasized by the physiological processes. The study aims to determine the possible impact of rising prevalence of obesity and its effect in the development of breast carcinoma (BC) in Indian population. METHODS This study is carried out on patients (N = 358) who were diagnosed with BC and breast diseases (BD) by calculating their BMI admitted during the period of 2005 to 2009. NIH criteria were used to categorize the patients. Pathological factors of BC patient were then compared among groups. RESULT These results were indicative of significant positive association between BC risks with peri/post menopausal status, residence, diet nature, and tobacco uses. Metastases were identified more commonly with increasing weight. It was found to be independently associated with obesity I (OR = 3.103, 95% CI = 1.633-5.895) and obesity II (OR = 6.803, 95% CI = 2.415-19.162). Disease stage and cancer related mortality were significantly associated with increased BMI. CONCLUSION The higher prevalence of severe obesity among Indian population was associated with BC. The only alteration apart from early diagnosis is opting for a more natural lifestyle that will affect energy equilibrium and prove to be a viable option for prevention in carcinoma of breast for better survival.
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Affiliation(s)
- Alok K Singh
- Department of Biochemistry, Faculty of Science, Banaras Hindu University, Varanasi, India
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Effects of dietary fat on spontaneous metastasis of Lewis lung carcinoma in mice. Clin Exp Metastasis 2010; 27:581-90. [PMID: 20697780 DOI: 10.1007/s10585-010-9347-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 07/24/2010] [Indexed: 01/22/2023]
Abstract
The present study assessed the effects of dietary fat on spontaneous metastasis of Lewis lung carcinoma in mice. Three-week old male C57BL/6 mice were fed the AIN-93G diet or a 45% fat diet (% kcal.) for 7 weeks before they were subcutaneously injected with 2.5 × 10⁵ viable carcinoma cells. The primary tumor was resected 2 weeks later, and mice were maintained on their respective diets for an additional 2 weeks. The high-fat diet significantly increased body weight and abdominal adipose weight compared to the AIN-93G diet. Feeding mice the 45% fat diet resulted in a two-fold increase in the number of lung metastases (P < 0.05), a 35% increase in tumor cross-sectional area, and a 50% increase in tumor volume compared to mice fed the AIN-93G diet. There were no differences in plasma concentrations of TIMP-1, IL-1β, VEGF and MCP-1 in non-tumor-bearing mice fed the AIN-93G diet or the high-fat diet, but significant increases in these cytokines in tumor-bearing mice fed the AIN-93G diet compared to the non-tumor-bearing mice fed the same diet (P < 0.05 for each comparison). Further significant increases in these cytokines in tumor-bearing mice fed the 45% fat diet compared to the same tumor-bearing mice fed the AIN-93G diet (P < 0.05 for each comparison). The high-fat diet significantly increased plasma leptin and significantly decreased plasma adiponectin compared to the AIN-93G diet in both non-tumor-bearing and tumor-bearing mice. Results of the present study demonstrated that the high-fat diet enhanced spontaneous metastasis of Lewis lung carcinoma in mice and that this aggressiveness was accompanied with significant increases in plasma concentrations of angiogenic cytokines, suggesting that dietary fat affects metastasis by promoting angiogenic processes.
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Metabolic syndrome, central obesity and insulin resistance are associated with adverse pathological features in postmenopausal breast cancer. Clin Oncol (R Coll Radiol) 2010; 22:281-8. [PMID: 20189371 DOI: 10.1016/j.clon.2010.02.001] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 12/10/2009] [Accepted: 02/01/2010] [Indexed: 11/22/2022]
Abstract
AIMS Obesity is associated with both an increased risk of postmenopausal breast cancer and increased mortality rates. The mechanism is unclear, and central (visceral) obesity, insulin resistance, altered sex steroids and altered adipokines are mooted as possible factors. These features may cluster in the so-called metabolic syndrome. The relevance of metabolic syndrome to the biology of breast cancer is unknown, and this was the focus of the present study. MATERIALS AND METHODS All postmenopausal women with newly diagnosed breast cancer (n=105) were recruited. A detailed clinical history was carried out, as well as a body composition analysis, metabolic screen and measurement of adipokines and inflammatory markers. RESULTS The median age was 68 years (40-94 years) and the mean body mass index was 28.3+/-5.2 kg/m2, with 87% of patients centrally obese. Metabolic syndrome was diagnosed in 39% of patients, and was significantly associated with central obesity (P<0.005) and increased inflammation, with C-reactive protein levels doubling in metabolic syndrome patients compared with non-metabolic syndrome patients (10.3 vs 5.8 mg/l; P=0.084). Patients with a later pathological stage (II-IV) were significantly more likely to be obese (P=0.007), centrally obese (P=0.009), hyperglycaemic (P=0.047) and hyperinsulinaemic (P=0.026); 51% had metabolic syndrome compared with 12% for early stage disease. Patients with node-positive disease were significantly more likely to be hyperinsulaemic (P=0.030) and have metabolic syndrome (P=0.028) than patients with node-negative disease. DISCUSSION The data suggest that metabolic syndrome and central obesity are common in postmenopausal breast cancer patients, and that metabolic syndrome may be associated with a more aggressive tumour biology.
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Abstract
Abstract Strong epidemiological data exists implicating anthropometric risk factors in breast cancer aetiology. In premenopausal women the risk of breast cancer increases with increased height, yet decreases with increasing weight and BMI. Although the evidence is not strong, a counter-intuitive positive relationship between central adiposity and premenopausal breast cancer risk is emerging. In post-menopausal women an increased risk in breast cancer has been found for all anthropometric measures: height, weight, BMI, measures of central adiposity (waist:hip ratio and waist circumference) and weight gain, with breast size being a possible additional risk factor. Weight loss as a strategy for reducing breast cancer risk seems to offer a viable prophylaxis in obese post-menopausal women, although data are limited. The evidence for anthropometric measures in relation to breast cancer risk is consistently stronger for post-menopausal women compared with premenopausal women and seems to be dependent on age. A number of possible biological mechanisms have been offered to explain the link between breast cancer risk and anthropometric measures. It has been hypothesised that obesity, especially central fat deposits, linked to insulin resistance, increases circulating hormones such as oestrogens, androgens, insulin, insulin-like growth factor-1 (IGF-1), and decreased levels of hormone-binding proteins such as steroid hormone-binding globulin and IGF-1 binding protein-1. Thus there are resulting increased concentrations of bioavailable sex hormones, which have been linked to increased breast cancer risk. As obesity is an important modifiable risk factor, which has been linked to increased post-menopausal breast cancer, public health recommendations to maintain ideal weight throughout life are warranted.
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Affiliation(s)
- Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, School of Food Biosciences, The University of Reading, PO Box 226, Whiteknights, Reading RG6 6AP, UK.
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Impact of obesity on diagnosis and treatment of breast cancer. Breast Cancer Res Treat 2009; 120:185-93. [PMID: 19597985 DOI: 10.1007/s10549-009-0459-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
In this population-based study, we evaluated the impact of obesity on presentation, diagnosis and treatment of breast cancer. Among all women diagnosed with invasive breast cancer in the canton Geneva (Switzerland) between 2003 and 2005, we identified those with information on body mass index (BMI) and categorized them into normal/underweight (BMI <25 kg/m(2)), overweight (BMI > or =-<30 kg/m(2)) and obese (BMI > or =30 kg/m(2)) women. Using multivariate logistic regression, we compared tumour, diagnosis and treatment characteristics between groups. Obese women presented significantly more often with stage III-IV disease (adjusted odds ratio [OR(adj)]: 1.8, 95% CI: 1.0-3.3). Tumours > or =1 cm and pN2-N3 lymph nodes were significantly more often impalpable in obese than in normal/underweight patients (OR(adj) 2.4, [1.1-5.3] and OR(adj) 5.1, [1.0-25.4], respectively). Obese women were less likely to have undergone ultrasound (OR(adj) 0.5, [0.3-0.9]) and MRI (OR(adj) 0.3, [0.1-0.6]) and were at increased risk of prolonged hospital stay (OR(adj) 4.7, [2.0-10.9]). This study finds important diagnostic and therapeutic differences between obese and lean women, which may impair survival of obese women with breast cancer. Specific strategies are needed to optimize the care of obese women with or at risk of breast cancer.
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Olsson Å, Garne JP, Tengrup I, Zackrisson S, Manjer J. Overweight in relation to tumour size and axillary lymph node involvement in postmenopausal breast cancer patients—Differences between women invited to vs. not invited to mammography in a randomized screening trial. Cancer Epidemiol 2009; 33:9-15. [PMID: 19679041 DOI: 10.1016/j.canep.2009.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 01/22/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
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Kricker A, Newman B, Gertig DM, Goumas C, Armes J, Armstrong BK. Why do large breast cancers still present in a population offered screening? Int J Cancer 2008; 123:2907-14. [DOI: 10.1002/ijc.23829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kerlikowske K, Walker R, Miglioretti DL, Desai A, Ballard-Barbash R, Buist DSM. Obesity, mammography use and accuracy, and advanced breast cancer risk. J Natl Cancer Inst 2008; 100:1724-33. [PMID: 19033562 DOI: 10.1093/jnci/djn388] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Being overweight or obese is associated with increased breast cancer risk and disease severity among postmenopausal women, but whether extent of mammography use and accuracy modify this association and further contribute to increases in disease severity at diagnosis among overweight and obese women is unclear. METHODS We prospectively collected data during 1996-2005 on 287,115 postmenopausal women not using hormone therapy (HT) who underwent 614,562 mammography examinations; 4,446 women were diagnosed with breast cancer within 12 months of a mammography examination. We calculated rates per 1,000 mammography examinations of large (>15 mm), advanced-stage (IIb, III, or IV), high-grade (3 or 4), estrogen receptor (ER)-positive and -negative, and screen-detected and non-screen-detected breast cancer across body mass index (BMI, kg/m(2)) groups defined as normal (18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), and obese class II/III (> or =35.0), adjusting for age, race/ethnicity, and mammography registry and use. All statistical tests were two-sided. RESULTS Adjusted rates per 1000 mammography examinations of overall breast cancer increased across BMI groups (6.6 normal, 7.4 overweight, 7.9 obese I, 8.5 obese II/III; P(trend) < .001), as did rates of advanced disease, including large invasive (2.3 normal, 2.6 overweight, 2.9 obese I, 3.2 obese II/III; P(trend) < .001), advanced-stage (0.8 normal, 0.9 overweight, 1.3 obese I, 1.5 obese II/III; P(trend) < .001), and high nuclear grade (1.5 normal, 1.7 overweight, 1.7 obese I, 1.9 obese II/III; P(trend) = .10) tumors. Rates of ER-positive tumors increased across BMI groups (P(trend) < .001); rates of ER-negative tumors did not. Rates of screen-detected cancers were higher among overweight and obese women than normal and underweight women, but rates of non-screen-detected (false-negative) cancers were similar. Rates of advanced breast cancer increased across BMI groups regardless of extent of mammography use. CONCLUSIONS Patterns of mammography use and mammography accuracy are not the primary reasons for higher rates of advanced breast cancer among overweight and obese postmenopausal women not using HT; thus, biologic differences in breast tumor development and/or progression may be important.
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Affiliation(s)
- Karla Kerlikowske
- Department of Epidemiology and Biostatistics, General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA 94121, USA.
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Jernström H, Henningson M, Johansson U, Olsson H. Coffee intake and CYP1A2*1F genotype predict breast volume in young women: implications for breast cancer. Br J Cancer 2008; 99:1534-8. [PMID: 18813311 PMCID: PMC2579678 DOI: 10.1038/sj.bjc.6604687] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
As breast volume may be associated with heart cancer risk, we studied the relationship between breast volume, CYP1A2*1F and coffee intake. Among healthy premenopausal non-hormone users, 3+ cups per day was associated with lower volume only in C-allele carriers (Pinteraction=0.02), which is consistent with reports that coffee protects only C-allele carriers against breast cancer.
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Affiliation(s)
- H Jernström
- Department of Oncology, Clinical Sciences, Lund University, Barngatan 2B, SE-221 85 Lund, Sweden.
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Risica PM, Weinstock MA, Rakowski W, Kirtania U, Martin RA, Smith KJ. Body satisfaction effect on thorough skin self-examination. Am J Prev Med 2008; 35:68-72. [PMID: 18541179 PMCID: PMC4249722 DOI: 10.1016/j.amepre.2008.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 12/21/2007] [Accepted: 03/11/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Melanoma and obesity have both increased in recent years. Given the propensity of body dissatisfaction among the obese, the objectives of this paper were to determine how body satisfaction might influence skin examination and to examine differences in this relationship by gender among the participants of Check-It-Out, a study to increase thorough skin self-examination (TSSE). METHODS Through primary care offices, 2126 participants were recruited from April 2000 to November 2001 for the baseline cross-sectional telephone data from the Check-It-Out study. TSSE was defined as the self-reported examination of all seven key areas of the body. Body satisfaction was reported based on the degree of disagreement or agreement with the statement I like the way my body looks. Analyses were conducted in 2005 and 2006. RESULTS Among participants, 18% reported performing TSSE, 34% were normal or underweight, 36% were overweight, and 30% were obese. Overall, 23% strongly agreed, 45% somewhat agreed, 19% somewhat disagreed, and 12% strongly disagreed with the statement I like the way my body looks. Body satisfaction was less common among women than men. The odds of conducting TSSE were 1.6 for the total sample (1.9 for women and 1.2 for men) for those with strong agreement that they like the way their body looks. In multivariate analysis, body satisfaction was associated with TSSE performance for women and both genders together, along with the availability of a partner (both genders together and men), the availability of a wall mirror, the advice of a physician, and the use of glasses or contacts(women only). CONCLUSIONS Body satisfaction is an important factor in TSSE performance, especially among women, and should be considered along with other risk factors.
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Affiliation(s)
- Patricia Markham Risica
- Institute for Community Health Promotion, Brown University, Department of Community Health, Providence, Rhode Island 02912, USA.
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Sellahewa C, Nightingale P, Carmichael AR. Women with large breasts are at an increased risk of advanced breast cancer. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2008; 5:16. [PMID: 18590562 PMCID: PMC2474642 DOI: 10.1186/1477-7800-5-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 06/30/2008] [Indexed: 12/03/2022]
Abstract
Background The risk of nodal metastasis is higher in women with bigger breast. It is not clear if this increase is due to the size of the breast (largely related to obesity) or is the result of larger tumour size at presentation (due to delayed diagnosis). It is hypothesised that women with large breasts are more likely to have node positive disease mainly attributable to their breast size. Patients and methods One hundred and twenty consecutive patients who underwent mastectomy during the year 2004 and 2005 for primary breast cancers in a large Teaching Hospital were included in the study. Patient's variable and tumour variable were collected and analysed by SPSS® computer programme. Results It was found that big breasted women (those patients with mastectomy weight greater than 800 g) had a significantly greater tumour size than those with smaller breasts (p = 0.019, Mann-Whitney test) but there was no significant difference in grade (Kendall's tau-b = 0.055, p = 0.57) or lymph node positivity (Kendall's tau-b = 0.011, p = 0.93) between the two groups. Although, the tumour size was significantly greater in those with lymph node metastases (p < 0.001) but mastectomy weight was not found to be significantly greater in those with lymph node metastases (p = 0.11). For patients with similar tumour sizes mastectomy weight was not significantly greater in those patients with lymph node metastases (p = 0.28). Conclusion It is concluded that increased incidence of lymph node positivity at presentation big-breasted women is because of larger size of the primary tumour and not due to the size of the breast alone.
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Progesterone receptor expression is a marker for early stage breast cancer: implications for progesterone receptor as a therapeutic tool and target. Cancer Lett 2007; 258:253-61. [PMID: 17950525 DOI: 10.1016/j.canlet.2007.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 09/07/2007] [Accepted: 09/11/2007] [Indexed: 11/20/2022]
Abstract
We determined the association of estrogen receptor (ER) and progesterone receptor (PR) expression in invasive breast cancer with stage at diagnosis. Univariate analyses indicated that although ER and PR expression were inversely associated with grade (P<0.0001), only PR expression (P<0.01) was inversely associated with stage. Multivariate analyses, adjusted for covariates, including HER-2/neu expression, indicated that PR (odds ratio (OR), 0.88; confidence interval (CI), 0.77-0.99; P=0.03) and not ER expression (OR, 1.04; CI, 0.94-1.16; P=0.45) was inversely associated with stage. PR and not ER expression is a marker for early stage breast cancer.
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Availability and utility of body mass index for population-based cancer surveillance. Cancer Causes Control 2007; 19:51-7. [PMID: 17943455 DOI: 10.1007/s10552-007-9069-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 09/19/2007] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the availability of body height and weight data in the hospital medical record of cancer patients and discuss the utility of the findings to population-based cancer research and the surveillance of overweight and obesity in the United States. METHODS Medical records were reviewed for up to three measures of height and weight for a random sample of 1,739 patients diagnosed (2001-2003) with one of the 12 types of cancer and reported to the population-based Greater Bay Area Cancer Registry of Northern California. RESULTS About 84% of cancer patients had at least one value of height, 91% had at least one value of weight, and 83% had both values recorded in the medical record such that body mass index (BMI) could be computed. About 60% of height and weight values were recorded within 2 months of cancer diagnosis, with most values (71%) recorded after cancer diagnosis. The availability of BMI varied somewhat by race/ethnicity, cancer site, initial treatment, and hospital characteristics. CONCLUSIONS BMI may be sufficiently available to be included routinely in the population-based cancer registries, and, if so, would be useful for studies of cancer diagnoses and outcomes and permit nationwide surveillance of BMI in a large population-representative cohort of cancer patients.
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Buist DSM, Ichikawa L, Prout MN, Yood MU, Field TS, Owusu C, Geiger AM, Quinn VP, Wei F, Silliman RA. Receipt of appropriate primary breast cancer therapy and adjuvant therapy are not associated with obesity in older women with access to health care. J Clin Oncol 2007; 25:3428-36. [PMID: 17687148 DOI: 10.1200/jco.2007.11.4918] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Many studies have reported body mass index (BMI) increases the risk of breast cancer recurrence and breast cancer-specific mortality. Few studies have reported or examined whether breast cancer treatment differs by BMI. The purpose of this study was to examine the association between BMI at breast cancer diagnosis and receipt of appropriate primary tumor therapy and adjuvant therapy. METHODS We identified 897 women age >or= 65 years diagnosed with stage I or II breast cancer from 1990 to 1999 at five health care organizations. We used medical records to confirm demographics, tumor characteristics, treatment, comorbid conditions, and to calculate BMI at diagnosis (< 25 kg/m(2), n = 328; 25 to < 30 kg/m(2), n = 305; 30 to < 35 kg/m(2), n = 188; >or= 35 kg/m(2), n = 76). We defined primary therapy based on National Guidelines as receiving breast-conserving surgery with radiation therapy and axillary node dissection, simple mastectomy with axillary node dissection, or modified radical mastectomy (73% overall); adjuvant therapy was defined as receipt of hormonal therapy, chemotherapy, or both (60% overall). RESULTS The median BMI was 26.7 kg/m(2) (range, 14.6 to 61.2). The proportion of women receiving primary therapy and adjuvant therapy was lowest for women less than 25 kg/m(2) (69% and 56%, respectively) and greatest for obese I (78% and 64%, respectively). There were no differences in receipt of primary or adjuvant treatment across BMI in univariate or multivariable models (after adjusting for age, stage, comorbidity, diagnosis year, and hormone receptor positivity). CONCLUSION Receipt of appropriate primary therapy and adjuvant therapy is not associated with BMI in older women with access to health care. Additional research in larger samples and more diverse settings is needed.
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Affiliation(s)
- Diana S M Buist
- Group Health Center for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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Ferrante JM, Chen PH, Crabtree BF, Wartenberg D. Cancer screening in women: body mass index and adherence to physician recommendations. Am J Prev Med 2007; 32:525-31. [PMID: 17533069 PMCID: PMC1986842 DOI: 10.1016/j.amepre.2007.02.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 01/16/2007] [Accepted: 02/02/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND The reasons that obese women are less likely to obtain mammograms and Papanicolaou tests (Pap smears) are poorly understood. This study evaluated associations between body mass index (BMI) and receipt of and adherence to physician recommendations for mammography and Pap smear. METHODS Data from the 2000 National Health Interview Survey (8289 women aged 40 to 74 years) were analyzed in 2006 using logistic regression. Women with previous hysterectomy were excluded from Pap smear analyses (n=5521). Outcome measures were being up-to-date with screening, receipt of physician recommendations, and women's adherence to physician recommendations for mammography and Pap smear. RESULTS After adjusting for sociodemographic variables, healthcare access, health behaviors, and comorbidity, severely obese women (BMI > 40 kg/m(2)) were less likely to have had mammography within 2 years (odds ratio [OR]=0.50, 95% confidence interval [CI]=0.37-0.68) and a Pap smear within 3 years (OR=0.43, 95% CI=0.27-0.70). Obese women were as likely as normal-weight women to receive physician recommendations for mammography and Pap smear. Severely obese women were less likely to adhere to physician recommendations for mammography (OR=0.49, 95% CI=0.32-0.76). Women in all obese categories (BMI > 30 kg/m(2)) were less likely to adhere to physician recommendations for Pap smear (ORs ranged from 0.17 to 0.28, p<0.001). CONCLUSIONS Obese women are less likely to adhere to physician recommendations for breast and cervical cancer screening. Interventions focusing solely on increasing physician recommendations for mammography and Pap smears will probably be insufficient for obese women. Additional strategies are needed to make cancer screening more acceptable for this high-risk group.
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Affiliation(s)
- Jeanne M Ferrante
- Department of Family Medicine, UMDNJ-New Jersey Medical School, Newark, NJ 07101, USA.
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Abstract
Body mass index (BMI) is associated with breast cancer risk, but its relationship with stage at diagnosis is unclear. BMI was calculated for patients in the North American Fareston and Tamoxifen Adjuvant trial, and was correlated with clinicopathologic factors, including stage at diagnosis. One thousand eight hundred fourteen patients were enrolled in the North American Fareston and Tamoxifen Adjuvant study; height and weight were recorded in 1451 (80%) of them. The median BMI was 27.1 kg/m2 (range, 14.7–60.7). The median patient age was 68 years (range, 42–100); median tumor size was 1.3 cm (range, 0.1–14 cm). One thousand seven hundred ninety-three (99.0%) patients were estrogen receptor positive, and 1519 (84.7%) were progesterone receptor positive. There was no significant relationship between BMI (as a continuous variable) and nodal status ( P = 0.469), tumor size ( P = 0.497), American Joint Committee on Cancer stage ( P = 0.167), grade ( P = 0.675), histologic subtype ( P = 0.179), or estrogen receptor status ( P = 0.962). Patients with palpable tumors, however, had a lower BMI than those with nonpalpable tumors (median 26.4 kg/m2 vs 27.5 kg/m2, P < 0.001). Similar results were found when BMI was classified as a categorical variable (<25 vs 25–29.9 vs ≥30). Increased BMI does not lead to a worse stage at presentation. Obese patients, however, tend to have nonpalpable tumors. Mammography in this population is especially important.
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Ferrante JM, Chen PH, Jacobs A. Breast and cervical cancer screening in obese minority women. J Womens Health (Larchmt) 2006; 15:531-41. [PMID: 16796480 DOI: 10.1089/jwh.2006.15.531] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Studies using survey data from mostly white women showed that obese women are less likely than nonobese women to undergo breast and cervical cancer screening. It is unclear if these findings are true in nonwhite women. Using chart audit data, we examined the relationship between obesity and mammography and Pap smear screening among minority women. METHODS Data from retrospective chart review of women in three urban New Jersey academic family medicine practices were analyzed (n = 1809) using hierarchical logistic regression models. Outcome measures were being up-to-date in mammography and Pap smears among obese and nonobese women. RESULTS There was no difference in mammography rates among obese and nonobese women. Independent risk factors for not being up-to-date in mammography included age 40-49, smoking, and comorbidity. Obese women were less likely than nonobese women to be upto- date in Pap smears (69% vs. 77%, p = 0.001). In multivariate analysis, obesity was associated with 25% decreased odds of being up-to-date on Pap smears (OR, 0.75, 95% CI, 0.58-0.99, p = 0.041). Age >or=65 years was also associated with decreased odds of being up-to-date in Pap smears. Hispanic women had increased odds of being up-to-date in mammography (OR 2.43, 95% CI 1.63-3.63) and Pap smears (OR 1.94, 95% CI 1.24-3.03) compared with white women. CONCLUSIONS Obesity was associated with decreased Pap smear screening but not with decreased mammography. Further studies are needed to determine barriers and effective interventions to improve screening in obese minority women.
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Affiliation(s)
- Jeanne M Ferrante
- Department of Family Medicine, UMDNJ-New Jersey Medical School, Newark, New Jersey 07101-1709, USA.
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García-Closas M, Brinton LA, Lissowska J, Chatterjee N, Peplonska B, Anderson WF, Szeszenia-Dabrowska N, Bardin-Mikolajczak A, Zatonski W, Blair A, Kalaylioglu Z, Rymkiewicz G, Mazepa-Sikora D, Kordek R, Lukaszek S, Sherman ME. Established breast cancer risk factors by clinically important tumour characteristics. Br J Cancer 2006; 95:123-9. [PMID: 16755295 PMCID: PMC2360503 DOI: 10.1038/sj.bjc.6603207] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Breast cancer is a morphologically and clinically heterogeneous disease; however, it is less clear how risk factors relate to tumour features. We evaluated risk factors by tumour characteristics (histopathologic type, grade, size, and nodal status) in a population-based case-control of 2386 breast cancers and 2502 controls in Poland. Use of a novel extension of the polytomous logistic regression permitted simultaneous modelling of multiple tumour characteristics. Late age at first full-term birth was associated with increased risk of large (> 2 cm) tumours (odds ratios (95% confidence intervals) 1.19 (1.07-1.33) for a 5-year increase in age), but not smaller tumours (P for heterogeneity adjusting for other tumour features (Phet) = 0.007). On the other hand, multiparity was associated with reduced risk for small tumours (0.76 (0.68-0.86) per additional birth; Phet = 0.004). Consideration of all tumour characteristics simultaneously revealed that current or recent use of combined hormone replacement therapy was associated with risk of small (2.29 (1.66-3.15)) and grade 1 (3.36 (2.22-5.08)) tumours (Phet = 0.05 for size and 0.0008 for grade 1 vs 3), rather than specific histopathologic types (Phet = 0.63 for ductal vs lobular). Finally, elevated body mass index was associated with larger tumour size among both pre- and postmenopausal women (Phet = 0.05 and 0.0001, respectively). None of these relationships were explained by hormone receptor status of the tumours. In conclusion, these data support distinctive risk factor relationships by tumour characteristics of prognostic relevance. These findings might be useful in developing targeted prevention efforts.
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Affiliation(s)
- M García-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD 20852-7234, USA.
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Kjaerbye-Thygesen A, Frederiksen K, Høgdall EV, Glud E, Christensen L, Høgdall CK, Blaakaer J, Kjaer SK. Smoking and Overweight: Negative Prognostic Factors in Stage III Epithelial Ovarian Cancer. Cancer Epidemiol Biomarkers Prev 2006; 15:798-803. [PMID: 16614126 DOI: 10.1158/1055-9965.epi-05-0897] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Smoking and overweight are associated with poorer prognosis in several cancer types. The prognostic effect of smoking and body mass index (BMI) on ovarian cancer is unknown. METHODS Ovarian cancer cases were from the Danish MALOVA (MALignant OVArian cancer) study. Information on smoking status and BMI was obtained from a personal interview conducted closely after primary surgery. Cox regression models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for ovarian cancer-specific death in relation to smoking variables and BMI. RESULTS A total of 295 women with stage III epithelial ovarian cancer were identified and followed to death or for a median of 7.3 years (range, 5.4-9.5 years). Median survival time for normal-weight never smokers was 2.8 years (95% CI, 2.3-3.2) compared with 1.2 years (95% CI, 0.8-2.3) for overweight current smokers. Current smokers had a significantly increased risk of ovarian cancer death compared with never smokers in multivariate Cox analysis (HR, 1.65; 95% CI, 1.22-2.24). The negative effect of smoking diminished with increasing time since a former smoker had stopped smoking (HR, 0.89; 95% CI, 0.80-0.98 per 5 years since stop of smoking). Overweight women also had an increased risk of ovarian cancer death (HR, 1.83; 95% CI, 1.38-2.42) compared with normal-weight women. CONCLUSION Smoking at the time of diagnosis and premorbid overweight were negative prognostic factors for ovarian cancer-specific survival. The negative effect of smoking decreased with increasing time since stop of smoking.
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Caan BJ, Emond JA, Natarajan L, Castillo A, Gunderson EP, Habel L, Jones L, Newman VA, Rock CL, Slattery ML, Stefanick ML, Sternfeld B, Thomson CA, Pierce JP. Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer. Breast Cancer Res Treat 2006; 99:47-57. [PMID: 16541317 DOI: 10.1007/s10549-006-9179-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 01/22/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine whether weight gain after diagnosis of breast cancer affects the risk of breast cancer recurrence. PATIENT AND METHODS Patients included 3215 women diagnosed with early stage breast cancer (Stage I >1 cm., II, and IIIA) who were enrolled either in an observational cohort of breast cancer survivors or were part of the comparison group of a dietary intervention trial to prevent breast cancer recurrence. We computed weight change from 1 year prior to diagnosis to study enrollment. Delayed entry Cox proportional hazards models were used to evaluate associations of categories of weight change with time to recurrence, controlling for known prognostic factors. RESULTS Neither moderate (5-10%) nor large (> 10%) weight gain (HR 0.8, 95% CI, 0.6-1.1; HR 0.9, 95% CI, 0.7-1.2, respectively) after breast cancer diagnosis was associated with an increased risk of breast cancer recurrence in the early years post-diagnosis (median time of 73.7 months from diagnosis). CONCLUSION Our research provides evidence that weight gain commonly seen in the first several years following a breast cancer diagnosis does not increase a woman's risk for breast cancer recurrence in the first 5-7 years post-diagnosis. However, this research does not address the effects of weight gain on overall survival or on the risk of other new cancers, other prognostic outcomes of concern to the breast cancer survivor.
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Affiliation(s)
- Bette J Caan
- Division of Research, Kaiser Permanente Medical Group, 2000 Broadway, 94612 Oakland, CA, USA.
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Porter GA, Inglis KM, Wood LA, Veugelers PJ. Effect of obesity on presentation of breast cancer. Ann Surg Oncol 2006; 13:327-32. [PMID: 16485153 DOI: 10.1245/aso.2006.03.049] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 08/31/2005] [Indexed: 01/01/2023]
Abstract
BACKGROUND Obesity has been shown to be associated with reduced survival in patients with invasive breast cancer (IBC), although the mechanisms for this finding are unclear. The objective of this study was to examine the effect of obesity on the presentation and pathologic staging of IBC. METHODS From February 15, 2002, to February 15, 2004, all patients undergoing surgery for primary IBC at two institutions were enrolled in a prospective cohort study. National Institutes of Health criteria were used to categorize patients: normal or underweight (NW; body mass index <25 kg/m(2)), overweight (OW; body mass index 25-29.9 kg/m(2)), and obese or severely obese (OB; body mass index > or =30 kg/m(2)). Presentation and pathologic factors were then compared among groups. RESULTS The study cohort consisted of 519 patients; 166 (32%) were NW, 177 (34%) were OW, and 176 (34%) were OB. OW (46%) and OB (39%) patients were more likely to be diagnosed with IBC via screening mammography compared with NW (31%) patients (P = .01), although no differences were found between groups with respect to previous use of screening mammography. Aggressive pathologic features, including lymph node metastases, advanced tumor-node-metastasis stage, and grade were found more commonly among OB patients. CONCLUSIONS OW and OB patients were more likely to receive a diagnosis via screening mammography, thus suggesting that mammography may play a more important role in OW and OB patients. Despite this, OB patients presented with larger, more advanced tumors; this may help to explain obesity-associated survival differences in IBC patients. This is important information given the prevalence of obesity in North America.
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Affiliation(s)
- Geoffrey A Porter
- Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center, 7-007 Victoria Building, 1278 Tower Road, Halifax, Nova Scotia, B3H 2Y9, Canada.
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Feigelson HS, Patel AV, Teras LR, Gansler T, Thun MJ, Calle EE. Adult weight gain and histopathologic characteristics of breast cancer among postmenopausal women. Cancer 2006; 107:12-21. [PMID: 16718671 DOI: 10.1002/cncr.21965] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although the link between postmenopausal breast cancer and adiposity is well established, the association between weight gain and specific histopathologic characteristics of breast carcinoma has not been studied carefully. METHODS Using 1200 incident invasive breast cancers among 44,161 postmenopausal women who were not taking hormone therapy in the American Cancer Society's Cancer Prevention Study II Nutrition Cohort, the authors computed age-adjusted rates and rate ratios (RR) for breast cancer by histology, stage, grade, and estrogen receptor (ER) and progesterone receptor (PR) status by categories of adult weight gain. RESULTS Age-adjusted rates of breast cancer were highest for women who reported the most weight gain, regardless of histologic type. For weight gain >60 pounds, compared with weight gain < or =20 pounds the RR for ductal carcinoma was 1.89 (95% confidence interval [95%CI], 1.53-2.34), and the RR for lobular carcinoma was 1.54 (95%CI. 1.01-2.33). Weight gain was associated with increased risk at every tumor stage and grade. The risk for regional or distant stage was elevated significantly in every category of weight gain and was 3 times higher among women who had the greatest weight gain (RR, 3.15; 95%CI, 2.21-4.48). Weight gain was associated with increased risk of ER-positive/PR-positive tumors (P for trend <.0001) but not ER-negative/PR-negative tumors (P for trend = .09). The results essentially remained unchanged when the analysis was restricted to women who had regular screening mammograms. CONCLUSIONS Excess adiposity is an important contributor to breast cancer risk among postmenopausal women, regardless of histologic type, and especially for tumors of advanced stage and high grade.
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Affiliation(s)
- Heather Spencer Feigelson
- Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia 30329, USA.
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Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA. Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 2005; 14:2009-14. [PMID: 16103453 DOI: 10.1158/1055-9965.epi-05-0106] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Obesity is an established risk factor for some breast cancers, but less is known about its effect on breast cancer prognosis. Understanding this relationship is important, given the increasing number of women diagnosed with breast cancer and the growing prevalence of obesity. We conducted a cohort analysis of 3,924 women ages 20 to 54 with incident breast cancer enrolled between 1980 and 1982 in the Cancer and Steroid Hormone study, a case-control study. Interview data were linked to survival information from the Surveillance, Epidemiology, and End Results Program. We used proportional hazards models to examine the relationship between breast cancer mortality and adult body mass index (BMI; calculated using usual adult weight), BMI at age 18, and weight change from age 18 to adulthood. Hazard ratios (HR) were adjusted for cancer stage and other factors. During a median follow-up of 14.6 years, 1,347 women died of breast cancer. Obese women (adult BMI>or=30.00) were significantly more likely than lean women (BMI<or=22.99) to die of breast cancer [HR, 1.34; 95% confidence interval (CI), 1.09-1.65]. Women with BMIs of 25.00-29.99 (HR, 1.25; 95% CI, 1.08-1.44) or 23.00-24.99 (HR, 1.20; 95% CI, 1.04-1.39) also had higher breast cancer mortality (P for trend <0.0001). BMI at age 18 and weight change were not associated with breast cancer mortality independently of other factors. Obesity could be a preventable risk factor for death among breast cancer patients. Further study is needed to determine how these findings might affect recommendations to reduce breast cancer mortality.
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Affiliation(s)
- Maura K Whiteman
- Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Mailstop K-34, Atlanta, GA 30341-3724, USA.
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Zhu K, Caulfield J, Hunter S, Roland CL, Payne-Wilks K, Texter L. Body mass index and breast cancer risk in African American women. Ann Epidemiol 2005; 15:123-8. [PMID: 15652717 DOI: 10.1016/j.annepidem.2004.05.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 05/25/2004] [Indexed: 11/22/2022]
Abstract
PURPOSE Studies of the relationship between body mass index (BMI) and breast cancer in African American women have been few. We conducted a case-control study to examine whether BMI is associated with risk of breast cancer in this population. METHODS Cases were 304 women diagnosed with breast cancer at the ages of 20 to 64 years. Controls were 305 women without a history of breast cancer. Telephone interviews were conducted to collect data on history of exposure to various factors at or before the date of diagnosis in cases or equivalent date in controls (reference date). Using logistic regression, we compared cases and controls in BMI at age 18, BMI at the reference date, and change in BMI between the two dates. RESULTS Using BMI at reference date, we found an odds ratio (OR) of 1.75 (95% confidence interval [CI], 1.02-3.02) and 2.32 (95% CI, 1.33-4.03) for women with BMI of 25 to 29.9 and 30 or higher, respectively, compared with women having BMI lower than 25. The corresponding OR estimates for BMI at age 18 were not significantly different from the unity. The average annual change in BMI between age 18 and date of diagnosis or reference date was associated with breast cancer risk, as shown that more BMI change tended to increase breast cancer risk compared with the baseline quartile of change. When data were analyzed by menopausal status, the association was found for both post-menopausal and pre-menopausal tumors for BMI at reference date but not for BMI at age 18. There was a higher risk for more annual BMI change compared with the baseline for both pre-menopausal and post-menopausal women. CONCLUSION Our results suggest that BMI at reference date and change in BMI were associated with increased risk of breast cancer in African American women, and the association might be found for both post-menopausal and pre-menopausal tumors.
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Affiliation(s)
- Kangmin Zhu
- United States Military Cancer Institute, Washington, DC 20307-5001, USA.
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Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 2005; 23:1370-8. [PMID: 15684320 DOI: 10.1200/jco.2005.01.079] [Citation(s) in RCA: 462] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To determine whether weight prior to diagnosis and weight gain after diagnosis are predictive of breast cancer survival. METHODS Patients included 5,204 Nurses' Health Study participants diagnosed with incident, invasive, nonmetastatic breast cancer between 1976 and 2000; 860 total deaths, 533 breast cancer deaths, and 681 recurrences (defined as secondary lung, brain, bone, or liver cancer, and death from breast cancer) accrued to 2002. We computed the change in body mass index (BMI) from before to the first BMI reported > or = 12 months after the date of diagnosis. Cox proportional hazards models were used to evaluate associations of categories of BMI before diagnosis and of BMI change with time to event. We stratified by smoking, menopausal status, and breast cancer-related variables. RESULTS In multivariate-adjusted analyses, weight before diagnosis was positively associated with breast cancer recurrence and death, but this was apparent only in never smokers. Similarly, among never-smoking women, those who gained between 0.5 and 2.0 kg/m(2) (median gain, 6.0 lb; relative risk [RR], 1.35; 95% CI, 0.93 to 1.95) or more than 2.0 kg/m(2) (median gain, 17.0 lb; RR, 1.64; 95% CI, 1.07 to 2.51) after diagnosis had an elevated risk of breast cancer death during follow-up (median, 9 years), compared with women who maintained their weight (test for linear trend, P = .03). Associations with weight were stronger in premenopausal than in postmenopausal women. Similar findings were noted for breast cancer recurrence and all-cause mortality. CONCLUSION Weight and weight gain were related to higher rates of breast cancer recurrence and mortality, but associations were most apparent in never-smoking women.
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Affiliation(s)
- Candyce H Kroenke
- Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, 181 Longwood Ave, 3rd floor, Boston, MA 02115, USA.
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Van Poznak C, Sauter NP. Clinical management of osteoporosis in women with a history of breast carcinoma. Cancer 2005; 104:443-56. [PMID: 15968687 DOI: 10.1002/cncr.21201] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Osteoporosis is a skeletal disorder that is characterized by low bone mass and compromised bone strength. Fractures are the clinically important consequence of osteoporosis and result not only in disability but also in excess mortality. Women who have a history of breast carcinoma may represent a unique population for whom screening and treatment for osteoporosis should be modified. A review of the English literature was performed that included original, review, consensus, and statement articles that were identified through Medline or National Institutes of Health-related links. According to the literature, osteoporosis constitutes a major public health problem. Approximately 55% of the U.S. population > or = 50 years of age has low bone mass (osteopenia or osteoporosis). Annually, > 200,000 women in the U.S. are diagnosed with breast carcinoma. Due to the high prevalence rates of both low bone mass and breast carcinoma in women, these two diseases commonly coexist in the same individuals. Women with a history of breast carcinoma may be at increased risk of developing bone loss and fragility fractures as a consequence of antineoplastic therapies. The majority of women treated for early-stage breast carcinoma do not develop recurrences, as a result of recent advances in therapy. Ensuring the diagnosis, prevention, and treatment of long-term toxicities and comorbid conditions like osteoporosis in breast carcinoma survivors is a serious concern and is of increasing importance. In this article, the authors address the evaluation and treatment of osteoporosis in women who have a history of early-stage breast carcinoma.
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Affiliation(s)
- Catherine Van Poznak
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Maehle BO, Tretli S, Thorsen T. The associations of obesity, lymph node status and prognosis in breast cancer patients: dependence on estrogen and progesterone receptor status. APMIS 2004; 112:349-57. [PMID: 15511272 DOI: 10.1111/j.1600-0463.2004.apm1120605.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Breast cancer patients who are obese have a higher risk of lymph node metastases and a poorer prognosis than those who are slim. It has been claimed that estrogens derived from fat are important for these associations. If estrogens are important, these relationships must be stronger in the hormone receptor-positive than in the hormone receptor-negative groups. Body mass index (BMI) was used as a measure of obesity. The second, third, and fourth quintiles of BMI were treated as one group and termed 'medium'. Patients in the fifth quintile were termed 'obese' and those in the first quintile 'slim'. The number of women with unilateral disease treated with modified radical mastectomy and included in the study was 1211. Of all patients included, obese patients had a 1.53 higher risk of lymph node metastases compared to slim patients (p=0.02). In the PgR-negative group, obesity gave a 3.08 times higher risk of lymph node metastases (p=0.03). The risk of dying of breast cancer tended to be higher in obese than in slim patients when all patients in the study were compared (relative risk=1.38, p=0.06). BMI did not show a statistically significant relationship with prognosis if only hormone receptor status was considered. However, if lymph node status and hormone receptor status were taken together, the association was strong and reversed in the lymph node-positive group with ER-negative tumours. The adjusted relative risk was 0.33, showing that slim patients had a 3.03 (1.0/0.33) times higher risk of dying of breast cancer compared to obese patients (p=0.002). These results indicate that non-hormonal mechanisms could be important.
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Affiliation(s)
- Bjørn Ove Maehle
- The Gade Institute, Department of Pathology, Haukeland University Hospital, Bergen, Norway.
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Carmichael AR, Bates T. Obesity and breast cancer: a review of the literature. Breast 2004; 13:85-92. [PMID: 15019686 DOI: 10.1016/j.breast.2003.03.001] [Citation(s) in RCA: 232] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2002] [Revised: 03/10/2003] [Accepted: 03/20/2003] [Indexed: 12/31/2022] Open
Abstract
A woman's build, the risk of breast cancer and its subsequent prognosis seem to be related. In most but not all case-control and prospective cohort studies, an inverse relationship has been found between weight and breast cancer among premenopausal women. However, most large epidemiological studies have found that overweight or obese women are at increased risk of developing postmenopausal breast cancer. It is suggested that higher body mass index is associated with a more advanced stage of breast cancer at diagnosis in terms of tumour size but data on lymph node status is not so consistent. All treatment modalities for breast cancer such as surgery, radiotherapy, chemotherapy and hormonal treatment may be adversely affected by the presence of obesity. The overall and disease-free survival is worse in most but not all studies of prognosis of obese pre- and postmenopausal women with breast cancer.
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Affiliation(s)
- A R Carmichael
- The Princess Royal Hospital, Haywards Heath, Sussex, UK.
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Abstract
This study was carried out to test the hypothesis that palpation for lumps may be more difficult in large breasts than in small breasts, resulting in a delay in the detection and diagnosis of breast cancer, and to determine whether this hypothesis is confirmed in Asian women. Of 833 new breast cancer patients registered in the Daegu Cancer Registry in 1997-1999, 579 were used in the final data analysis, after excluding patient records containing many missing data on study variables related with cancer staging. There was no difference in means of body mass index (BMI) according to tumour, either in all cases or in those under 49 years of age. In the 50+ age group, the means+/-standard deviations of BMI of T1, T2 and T3 were 23.7+/-2.8, 24.2+/-3.0, and 26.2+/-4.3, respectively (P=0.01). In univariate logistic regression of tumour characteristics with BMI, no statistically significant odds ratios were found either by continuous or quartiles of BMI. In conclusion, these results suggest that the hypothesis is partially confirmed in Korean breast cancer patients and further studies are needed to clarify the relationship between BMI and tumour stage at diagnosis.
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Affiliation(s)
- Y A Kim
- Dalsung-Gun Health Center, South Korea.
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Abstract
Obesity has a complicated relationship to both breast cancer risk and the clinical behavior of the established disease. In postmenopausal women, particularly the elderly, various measures of obesity have been positively associated with risk. However, before menopause increased body weight is inversely related to breast cancer risk. In both premenopausal and postmenopausal breast cancer, the mechanisms by which body weight and obesity affect risk have been related to estrogenic activity. Obesity has also been related to advanced disease at diagnosis and with a poor prognosis in both premenopausal and postmenopausal breast cancer. Breast cancer in African-American women, considering its relationship to obesity, exhibits some important differences from those described in white women, although the high prevalence of obesity in African-American women may contribute to the relatively poor prognosis compared with white American women. Despite the emphasis on estrogens to explain the effects of obesity on breast cancer, other factors may prove to be equally or more important, particularly as they relate to expression of an aggressive tumor phenotype. Among these, this review serves to stress insulin, insulin-like growth factor-I, and leptin, and their relationship to angiogenesis, and transcriptional factors.
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Affiliation(s)
- Gina Day Stephenson
- Institute for Cancer Prevention, American Health Foundation Cancer Center, One Dana Road, Valhalla, NY 10595, USA
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Abstract
Clinical trials of the selective oestrogen receptor modulator (SERM), tamoxifen, have shown an early reduction in risk of breast cancer in healthy women of approximately 40%, but with associated risks and benefits to normal tissues. An overall clinical benefit and the identification of the women at risk of breast cancer who may gain benefit from tamoxifen has not been clearly established. The identification of those women at risk who are most likely to gain benefit, and the development of other SERMs and aromatase inhibitors which might be more active and have a more beneficial spectrum of activity on normal tissues in healthy women is essential, if the aim of preventing breast cancer in healthy women is to be achieved.
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Affiliation(s)
- Trevor J Powles
- Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK.
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Oestreicher N, White E, Lehman CD, Mandelson MT, Porter PL, Taplin SH. Predictors of sensitivity of clinical breast examination (CBE). Breast Cancer Res Treat 2002; 76:73-81. [PMID: 12408378 DOI: 10.1023/a:1020280623807] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Clinical breast examination (CBE) is one of the most common breast cancer screening modalities, but factors that affect its sensitivity are not well understood. We examined the association between CBE sensitivity and tumor, breast and personal characteristics among members of a managed care organization's Breast Cancer Screening Program (BCSP). The study population was 468 screened women 40 years and older diagnosed with invasive breast cancer between 1988 and 1994 within 1 year of a screening CBE. Logistic regression was used to evaluate the likelihood of a true positive versus a false negative CBE result, after adjustment for age, body weight and tumor size. CBE sensitivity increased with larger tumor size (17% for tumors < or = 0.5 cm and 58% for tumors > or = 2.1 cm, adjusted p for trend < 0.001) and decreased with higher body weight (48 and 23% for the lowest and highest quartiles, adjusted p for trend < 0.001). CBE was more sensitive in Asian women compared to white women (88% v.s. 35%, adjusted p = 0.04) and in current users of estrogen and progesterone combination therapy compared to never/former users (52% v.s. 33%, adjusted p = 0.08). There was an inverted U-shaped association between age and CBE sensitivity (40-49: 26%, 50-59: 48%, 60-69: 36%, 70-79: 33%, 80+: 18%, significant for oldest and youngest groups v.s. age 50-59 years). These findings suggest certain groups of women, for example, obese women and younger women, receive less benefit from CBE.
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Affiliation(s)
- Nina Oestreicher
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, USA.
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Abstract
Clinical trials have shown that giving anti-oestrogens to healthy women can reduce the early incidence of breast cancer by approximately 40%. However, the large numbers of women treated, compared with the few who get breast cancer, together with the not insignificant toxicity and the unknown long-term clinical benefits and risks, makes this strategy of prevention versus treatment precarious. So how can we improve the odds for the successful use of endocrine chemoprevention?
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Affiliation(s)
- Trevor J Powles
- Breast Cancer Unit at the Royal Marsden Hospital, London SW2 5PT, UK.
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Cui Y, Whiteman MK, Langenberg P, Sexton M, Tkaczuk KH, Flaws JA, Bush TL. Can obesity explain the racial difference in stage of breast cancer at diagnosis between black and white women? JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2002; 11:527-36. [PMID: 12225626 DOI: 10.1089/152460902760277886] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Black women are more likely to be diagnosed at a more advanced stage of breast cancer than are white women. Traditionally, this has been attributed in part to social or cultural factors. Given that black women are more likely to be obese than white women and that being obese is associated with a more advanced stage at diagnosis, this study aims to assess to what extent the racial difference in stage at diagnosis can be explained by racial differences in obesity. METHODS Incident cases of breast cancer between 1991 and 1997 (white, n = 585; black, n = 381) were identified from hospitals in the Baltimore metropolitan area. Information, including age, race, weight, height, and pathology reports, was obtained from hospital medical records. RESULTS Black women were more likely than white women to be diagnosed with breast cancer at tumor-node-metastasis (TNM) stage II or greater (age-adjusted odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.15-1.99). Further, black women were more likely than white women to be overweight or obese. A high body mass index (BMI) was significantly associated with an advanced stage of breast cancer at diagnosis. Adjustment for the higher prevalence of obesity in black women attenuated the risk estimate of more advanced stage of breast cancer at diagnosis in black women compared with white women by approximately 30%. CONCLUSIONS Our results suggest that the higher prevalence of obesity among black women plays an important role in explaining their relative disadvantage in stage at diagnosis of breast cancer. Nonetheless, a racial difference in stage of breast cancer at diagnosis persists after adjustment for obesity.
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Affiliation(s)
- Yadong Cui
- Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA
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Cui Y, Whiteman MK, Flaws JA, Langenberg P, Tkaczuk KH, Bush TL. Body mass and stage of breast cancer at diagnosis. Int J Cancer 2002; 98:279-83. [PMID: 11857420 DOI: 10.1002/ijc.10209] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Obesity is a well-known risk factor for postmenopausal breast cancer. In contrast, the relationship between obesity and stage of breast cancer at diagnosis is less clear. We hypothesized that increased breast size in obese women may delay discovery of breast tumors. Thus, the purpose of our study was to examine whether there is an association between body mass and stage of breast cancer at diagnosis using hospital medical records. Newly diagnosed breast cancer cases (n = 966) in the Baltimore metropolitan area from 1991 to 1997 were included in our study. Patient information including age, ethnicity, weight, height and pathology data were obtained from hospital medical records. High body mass was significantly associated with late stage of breast cancer at diagnosis. Women who were obese (body mass index [BMI] > or = 27.3) were more likely to be at an advanced stage at diagnosis compared with women with a BMI of < 27.3 (multivariate-adjusted odds ratio [OR] 1.57, 95% confidence interval [CI] 1.15-2.14). The association between body mass and stage at diagnosis was stronger among women younger than 50 years (OR 2.34, 95% CI 1.34-4.08) compared with women 50 years or older (OR 1.30, 95% CI 0.89-1.91). Our study suggests that higher body mass is associated with advanced stage of breast cancer at diagnosis. This finding may be of considerable concern, given the increasing prevalence of obesity in women in the United States and the poor prognosis associated with late-stage tumors.
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Affiliation(s)
- Yadong Cui
- Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
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Daling JR, Malone KE, Doody DR, Johnson LG, Gralow JR, Porter PL. Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma. Cancer 2001; 92:720-9. [PMID: 11550140 DOI: 10.1002/1097-0142(20010815)92:4<720::aid-cncr1375>3.0.co;2-t] [Citation(s) in RCA: 186] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Obesity has been shown to affect breast carcinoma prognosis, with the heaviest women having a higher mortality due to breast carcinoma. Few studies have focused on premenopausal women or the correlation of body mass index (BMI) to tumor characteristics related to prognosis. METHODS The authors conducted a population-based follow-up study for mortality of 1177 women younger than 45 years of age who had invasive ductal breast carcinoma diagnosed from 1983 through 1992. Histologic slides and/or tumor tissue were collected for pathologic review, immunohistochemistry assays, and bivariate flow cytometric analysis. RESULTS Women with breast carcinoma who were in the highest quartile of BMI were 2.5 times as likely (95% confidence interval [CI], 1.6-3.9) to die of their disease within 5 years of diagnosis compared with women in the lowest quartile of BMI. The tumors of the women in the highest quartile of BMI were more likely to be estrogen receptor negative (odds ratio [OR], 1.5; 95% CI, 1.0-2.2) and to have a high S-phase fraction (OR, 1.9; 95% CI, 1.2-3.1), high histologic grade (OR, 1.7; 95% CI, 1.0-2.9), high mitotic cell count (OR, 2.0; 95% CI, 1.2-3.1), and large tumor size (2 to < 5 cm: OR, 2.3; 95% CI, 1.5-3.1; or > or = 5 cm: OR, 2.7; 95% CI, 1.5-4.8) compared with the tumors of women whose BMI was in the first quartile. Relative to the large tumors (> or = 2 cm) in women in the lowest BMI quartile, the large tumors in women in the highest BMI quartile were more likely to express markers of high proliferation, indicating they may have grown faster than similar size tumors of the thinnest women. In a multivariate analysis including the tumor characteristics, obesity, as measured by being in the highest quartile of BMI, remained an independent prognostic factor for mortality (hazard ratio, 1.7; 95% CI, 1.0-2.9; P < 0.05. CONCLUSIONS Our study results indicated that being in the highest quartile of BMI was a strong predictor of mortality in women with breast carcinoma diagnosed at a young age. The tumors of the heavy women were larger and more likely to have markers of high cellular proliferation than those of thinner women.
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MESH Headings
- Adult
- Biomarkers, Tumor/metabolism
- Body Mass Index
- Breast Neoplasms/complications
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/complications
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Female
- Humans
- Multivariate Analysis
- Obesity/complications
- Prognosis
- Survival Analysis
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Affiliation(s)
- J R Daling
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA.
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Lippman ME, Krueger KA, Eckert S, Sashegyi A, Walls EL, Jamal S, Cauley JA, Cummings SR. Indicators of lifetime estrogen exposure: effect on breast cancer incidence and interaction with raloxifene therapy in the multiple outcomes of raloxifene evaluation study participants. J Clin Oncol 2001; 19:3111-6. [PMID: 11408508 DOI: 10.1200/jco.2001.19.12.3111] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To test the hypothesis that risk factors related to lifetime estrogen exposure predict breast cancer incidence and to test if any subgroups experience enhanced benefit from raloxifene. PATIENTS AND METHODS Postmenopausal women with osteoporosis (N = 7,705), enrolled onto the Multiple Outcomes of Raloxifene Evaluation (MORE) trial, were randomly assigned to receive placebo, raloxifene 60 mg/d, or raloxifene 120 mg/d for 4 years. Breast cancer risk was analyzed by the following baseline characteristics indicative of estrogen exposure: previous hormone replacement therapy, prevalent vertebral fractures, family history of breast cancer, estradiol level, bone mineral density (BMD), body mass index, and age at menopause. Therapy-by-subgroup interactions were assessed using a logistic regression model. RESULTS Overall, women with the highest one-third estradiol levels (> or = 12 pmol/L) had a 2.07-fold increased invasive breast cancer risk compared with women with lower levels. Raloxifene significantly reduced breast cancer risk in both the low- and high-estrogen subgroups for all risk factors examined (P <.05 for each comparison). The women with the highest BMD and those with a family history of breast cancer experienced a significantly greater therapy benefit with raloxifene, compared with the two thirds of patients with lower BMD or those without a family history, respectively; the subgroup-by-therapy interactions were significant (P =.005 and P =.015, respectively). CONCLUSION The MORE trial confirms that increased lifetime estrogen exposure increases breast cancer risk. Raloxifene therapy reduces breast cancer risk in postmenopausal osteoporotic women regardless of lifetime estrogen exposure, but the reduction is greater in those with higher lifetime exposure to estrogen.
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Affiliation(s)
- M E Lippman
- Osteoporosis Research Program, Women's College Hospital, Toronto, Ontario, Canada.
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Moorman PG, Jones BA, Millikan RC, Hall IJ, Newman B. Race, anthropometric factors, and stage at diagnosis of breast cancer. Am J Epidemiol 2001; 153:284-91. [PMID: 11157416 DOI: 10.1093/aje/153.3.284] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A recent study suggested that the greater prevalence of severe obesity among African-American women explained almost one third of the observed differences between African-American and White women in stage at diagnosis of breast cancer. The objective of this investigation was to attempt to replicate these findings in a second, larger population and to expand the analyses by including a measure of body fat distribution, the waist:hip ratio. The authors used data from a population-based study in North Carolina comprising 791 breast cancer cases (302 in African-American women and 489 in White women) diagnosed between 1993 and 1996. African-American women were more likely to have later-stage (TNM stage >/=II) breast cancer (odds ratio (OR) = 2.2; 95% confidence interval (CI): 1.6, 2.9). They also were much more likely to be severely obese (body mass index >/=32.3) (OR = 9.7; 95% CI: 6.5, 14.5) and to be in the highest tertile of waist:hip ratio (OR = 5.7; 95% CI: 3.8, 8.6). In multivariate logistic regression models, adjustment for waist:hip ratio reduced the odds ratio for later-stage disease in African-American women by 20%; adjustment for both waist:hip ratio and severe obesity reduced the odds ratio by 27%. These observations suggest that obesity and body fat distribution, in addition to socioeconomic and medical care factors, contribute to racial differences in stage at breast cancer diagnosis.
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Affiliation(s)
- P G Moorman
- Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, CT, USA.
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