Pre-diagnostic changes in body mass index and mortality among breast cancer patients

Signe Benzon Larsen; Maia Torstensson; Line Kenborg; Jane Christensen; Niels Kroman; Susanne Oksbjerg Dalton; Anne Tjønneland; Christoffer Johansen; Pernille Envold Bidstrup

doi:10.1007/s10549-018-4771-5

Pre-diagnostic changes in body mass index and mortality among breast cancer patients

Signe Benzon Larsen, Maia Torstensson, Line Kenborg, Jane Christensen, Niels Kroman, Susanne Oksbjerg Dalton, Anne Tjønneland, Christoffer Johansen, Pernille Envold Bidstrup

Abstract

PURPOSE: We investigated whether changes in body mass index (BMI) before a breast cancer diagnosis affected mortality and whether trajectories more accurately predict overall mortality compared to a single measure of BMI.

METHODS: Our prospective cohort comprised 2012 women with breast cancer who reported their weight in each decade from 20 to 50-64 years of age. We used trajectory analysis to identify groups with similar development patterns in BMI and Cox proportional hazards models to examine the association between trajectory groups and mortality, and interactions with oestrogen receptor status and smoking. We used c-index statistics to compare the trajectory model with the single measure model of BMI.

RESULTS: We identified three distinct trajectory groups, with a mean BMI at age 20 of 19, 22 and 24 increasing to 23 (normal-to-normal), 29 (normal-to-overweight) and 37 (normal-to-obese) at 50-64 years of age, respectively. Women in the normal-to-obese trajectory group experienced significantly higher overall mortality than those in the normal-to-normal trajectory group (HR 1.76, 95% CI 1.21‒2.56). The association declined to a non-significant level after adjustments for clinical prognostic factors. Although not significant, the same tendency was seen for breast cancer-specific mortality. The association was strongest in women with oestrogen receptor-negative tumours. Weight changes over time were not significantly different from a single BMI measure before diagnosis to predict survival.

CONCLUSION: Weight gain affects overall mortality after breast cancer but clinical prognostic factors largely eliminate the association. Using trajectories of weight changes did not improve the predictive value compared to a single measure of BMI.

Originalsprog	Engelsk
Tidsskrift	Breast Cancer Research and Treatment
Vol/bind	170
Udgave nummer	3
Sider (fra-til)	605-612
Antal sider	8
ISSN	0167-6806
DOI	https://doi.org/10.1007/s10549-018-4771-5
Status	Udgivet - 1 aug. 2018

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title = "Pre-diagnostic changes in body mass index and mortality among breast cancer patients",

abstract = "PURPOSE: We investigated whether changes in body mass index (BMI) before a breast cancer diagnosis affected mortality and whether trajectories more accurately predict overall mortality compared to a single measure of BMI.METHODS: Our prospective cohort comprised 2012 women with breast cancer who reported their weight in each decade from 20 to 50-64 years of age. We used trajectory analysis to identify groups with similar development patterns in BMI and Cox proportional hazards models to examine the association between trajectory groups and mortality, and interactions with oestrogen receptor status and smoking. We used c-index statistics to compare the trajectory model with the single measure model of BMI.RESULTS: We identified three distinct trajectory groups, with a mean BMI at age 20 of 19, 22 and 24 increasing to 23 (normal-to-normal), 29 (normal-to-overweight) and 37 (normal-to-obese) at 50-64 years of age, respectively. Women in the normal-to-obese trajectory group experienced significantly higher overall mortality than those in the normal-to-normal trajectory group (HR 1.76, 95% CI 1.21‒2.56). The association declined to a non-significant level after adjustments for clinical prognostic factors. Although not significant, the same tendency was seen for breast cancer-specific mortality. The association was strongest in women with oestrogen receptor-negative tumours. Weight changes over time were not significantly different from a single BMI measure before diagnosis to predict survival.CONCLUSION: Weight gain affects overall mortality after breast cancer but clinical prognostic factors largely eliminate the association. Using trajectories of weight changes did not improve the predictive value compared to a single measure of BMI.",

keywords = "Adult, Aged, Body Mass Index, Body Weight, Breast Neoplasms/diagnosis, Denmark/epidemiology, Disease Management, Female, Humans, Middle Aged, Mortality, Prognosis, Proportional Hazards Models, Public Health Surveillance, Registries, Risk Factors, Young Adult",

author = "Larsen, {Signe Benzon} and Maia Torstensson and Line Kenborg and Jane Christensen and Niels Kroman and Dalton, {Susanne Oksbjerg} and Anne Tj{\o}nneland and Christoffer Johansen and Bidstrup, {Pernille Envold}",

year = "2018",

month = aug,

day = "1",

doi = "10.1007/s10549-018-4771-5",

language = "English",

volume = "170",

pages = "605--612",

journal = "Breast Cancer Research and Treatment",

issn = "0167-6806",

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TY - JOUR

T1 - Pre-diagnostic changes in body mass index and mortality among breast cancer patients

AU - Larsen, Signe Benzon

AU - Torstensson, Maia

AU - Kenborg, Line

AU - Christensen, Jane

AU - Kroman, Niels

AU - Dalton, Susanne Oksbjerg

AU - Tjønneland, Anne

AU - Johansen, Christoffer

AU - Bidstrup, Pernille Envold

PY - 2018/8/1

Y1 - 2018/8/1

N2 - PURPOSE: We investigated whether changes in body mass index (BMI) before a breast cancer diagnosis affected mortality and whether trajectories more accurately predict overall mortality compared to a single measure of BMI.METHODS: Our prospective cohort comprised 2012 women with breast cancer who reported their weight in each decade from 20 to 50-64 years of age. We used trajectory analysis to identify groups with similar development patterns in BMI and Cox proportional hazards models to examine the association between trajectory groups and mortality, and interactions with oestrogen receptor status and smoking. We used c-index statistics to compare the trajectory model with the single measure model of BMI.RESULTS: We identified three distinct trajectory groups, with a mean BMI at age 20 of 19, 22 and 24 increasing to 23 (normal-to-normal), 29 (normal-to-overweight) and 37 (normal-to-obese) at 50-64 years of age, respectively. Women in the normal-to-obese trajectory group experienced significantly higher overall mortality than those in the normal-to-normal trajectory group (HR 1.76, 95% CI 1.21‒2.56). The association declined to a non-significant level after adjustments for clinical prognostic factors. Although not significant, the same tendency was seen for breast cancer-specific mortality. The association was strongest in women with oestrogen receptor-negative tumours. Weight changes over time were not significantly different from a single BMI measure before diagnosis to predict survival.CONCLUSION: Weight gain affects overall mortality after breast cancer but clinical prognostic factors largely eliminate the association. Using trajectories of weight changes did not improve the predictive value compared to a single measure of BMI.

AB - PURPOSE: We investigated whether changes in body mass index (BMI) before a breast cancer diagnosis affected mortality and whether trajectories more accurately predict overall mortality compared to a single measure of BMI.METHODS: Our prospective cohort comprised 2012 women with breast cancer who reported their weight in each decade from 20 to 50-64 years of age. We used trajectory analysis to identify groups with similar development patterns in BMI and Cox proportional hazards models to examine the association between trajectory groups and mortality, and interactions with oestrogen receptor status and smoking. We used c-index statistics to compare the trajectory model with the single measure model of BMI.RESULTS: We identified three distinct trajectory groups, with a mean BMI at age 20 of 19, 22 and 24 increasing to 23 (normal-to-normal), 29 (normal-to-overweight) and 37 (normal-to-obese) at 50-64 years of age, respectively. Women in the normal-to-obese trajectory group experienced significantly higher overall mortality than those in the normal-to-normal trajectory group (HR 1.76, 95% CI 1.21‒2.56). The association declined to a non-significant level after adjustments for clinical prognostic factors. Although not significant, the same tendency was seen for breast cancer-specific mortality. The association was strongest in women with oestrogen receptor-negative tumours. Weight changes over time were not significantly different from a single BMI measure before diagnosis to predict survival.CONCLUSION: Weight gain affects overall mortality after breast cancer but clinical prognostic factors largely eliminate the association. Using trajectories of weight changes did not improve the predictive value compared to a single measure of BMI.

KW - Adult

KW - Aged

KW - Body Mass Index

KW - Body Weight

KW - Breast Neoplasms/diagnosis

KW - Denmark/epidemiology

KW - Disease Management

KW - Female

KW - Humans

KW - Middle Aged

KW - Mortality

KW - Prognosis

KW - Proportional Hazards Models

KW - Public Health Surveillance

KW - Registries

KW - Risk Factors

KW - Young Adult

U2 - 10.1007/s10549-018-4771-5

DO - 10.1007/s10549-018-4771-5

M3 - Journal article

C2 - 29637418

SN - 0167-6806

VL - 170

SP - 605

EP - 612

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

IS - 3

ER -

Pre-diagnostic changes in body mass index and mortality among breast cancer patients

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