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Open Access Publications from the University of California

Obesity and mortality after breast cancer by race/ethnicity: The California Breast Cancer Survivorship Consortium.

  • Author(s): Kwan, Marilyn L
  • John, Esther M
  • Caan, Bette J
  • Lee, Valerie S
  • Bernstein, Leslie
  • Cheng, Iona
  • Gomez, Scarlett Lin
  • Henderson, Brian E
  • Keegan, Theresa H M
  • Kurian, Allison W
  • Lu, Yani
  • Monroe, Kristine R
  • Roh, Janise M
  • Shariff-Marco, Salma
  • Sposto, Richard
  • Vigen, Cheryl
  • Wu, Anna H
  • et al.

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We investigated body size and survival by race/ethnicity in 11,351 breast cancer patients diagnosed from 1993 to 2007 with follow-up through 2009 by using data from questionnaires and the California Cancer Registry. We calculated hazard ratios and 95% confidence intervals from multivariable Cox proportional hazard model-estimated associations of body size (body mass index (BMI) (weight (kg)/height (m)(2)) and waist-hip ratio (WHR)) with breast cancer-specific and all-cause mortality. Among 2,744 ascertained deaths, 1,445 were related to breast cancer. Being underweight (BMI <18.5) was associated with increased risk of breast cancer mortality compared with being normal weight in non-Latina whites (hazard ratio (HR) = 1.91, 95% confidence interval (CI): 1.14, 3.20), whereas morbid obesity (BMI ≥ 40) was suggestive of increased risk (HR = 1.43, 95% CI: 0.84, 2.43). In Latinas, only the morbidly obese were at high risk of death (HR = 2.26, 95% CI: 1.23, 4.15). No BMI-mortality associations were apparent in African Americans and Asian Americans. High WHR (quartile 4 vs. quartile 1) was associated with breast cancer mortality in Asian Americans (HR = 2.21, 95% CI: 1.21, 4.03; P for trend = 0.01), whereas no associations were found in African Americans, Latinas, or non-Latina whites. For all-cause mortality, even stronger BMI and WHR associations were observed. The impact of obesity and body fat distribution on breast cancer patients' risk of death may vary across racial/ethnic groups.

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