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- Title
Obesity and Risk of Recurrence in Patients With Breast Cancer Treated With Aromatase Inhibitors.
- Authors
Harborg, Sixten; Cronin-Fenton, Deirdre; Jensen, Maj-Britt Raaby; Ahern, Thomas P.; Ewertz, Marianne; Borgquist, Signe
- Abstract
Key Points: Question: Is obesity associated with increased recurrence risk in patients with breast cancer treated with adjuvant aromatase inhibitors? Findings: In this nationwide cohort study of 13 230 patients with hormone receptor–positive breast cancer, 1587 had a recurrence over 6.2 years of follow-up. The risk of recurrence was higher among patients with obesity and severe obesity compared with those with healthy weight. Meaning: This study suggests that obesity is associated with an increased risk of recurrence among patients with hormone receptor–positive breast cancer treated with aromatase inhibitors, highlighting the need for optimization of care in patients with breast cancer and obesity. This cohort study examines the associations of body mass index (BMI) with recurrence among patients with breast cancer treated with aromatase inhibitors in Denmark. Importance: Clinical studies confirm that obesity is a risk factor for recurrence in postmenopausal women with hormone receptor–positive (HR+) breast cancer. Evidence suggests that women with obesity do not obtain similar protection from aromatase inhibitors as women with healthy weight. Objective: To examine the associations of body mass index (BMI) with recurrence. Design, Setting, and Participants: The cohort study was conducted using data from the Danish Breast Cancer Group and enrolled postmenopausal women diagnosed with stage I to III HR+ breast cancer from 1998 through 2016. Data analysis was conducted from November 2022 to April 2023. Exposures: BMI was classified as (1) healthy weight (18.5-24.9), (2) overweight (25.0-29.9), (3) obesity (30.0-34.9), and (4) severe obesity (≥35.0) using the World Health Organization guidelines. Healthy weight was considered the reference group in statistical analyses. Main Outcomes and Measures: Follow-up began 6 months after breast cancer surgery and continued until the first event of recurrence, contralateral breast cancer, new primary malignant neoplasm, death, emigration, end of clinical follow-up at 10 years, or September 25, 2018. Cox regression was used to estimate crude and adjusted hazard ratios with 95% CIs, adjusting for patient, tumor, and treatment characteristics. Results: A total of 13 230 patients (median [IQR] age at diagnosis, 64.4 [58.6-70.2] years) with information on BMI were enrolled. There were 1587 recurrences with a median (IQR) potential estimated follow-up of 6.2 (3.6-8.5) years. Multivariable analyses revealed increased recurrence hazards associated with obesity (adjusted hazard ratio, 1.18 [95% CI, 1.01-1.37]) and severe obesity (adjusted hazard ratio, 1.32 [95% CI, 1.08-1.62]) vs patients with healthy weight. Patients with overweight had a greater risk, but the results were not statistically significant (adjusted hazard ratio, 1.10 [95% CI, 0.97-1.24]). Conclusions and Relevance: In this study, obesity was associated with an increased risk of breast cancer recurrence among postmenopausal patients with HR+ early-stage breast cancer treated with aromatase inhibitors. Physicians should be aware of the significance of obesity on breast cancer outcomes to secure optimal treatment benefit in all patients.
- Subjects
OBESITY; CONFIDENCE intervals; MULTIVARIATE analysis; CANCER relapse; RISK assessment; TUMOR classification; AROMATASE inhibitors; PSYCHOLOGY of women; DESCRIPTIVE statistics; RESEARCH funding; POSTMENOPAUSE; BODY mass index; ODDS ratio; DATA analysis software; BREAST tumors; LONGITUDINAL method; DISEASE risk factors
- Publication
JAMA Network Open, 2023, Vol 6, Issue 10, pe2337780
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.37780