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Shelley M. Enger, PhD; Jon M. Greif, DO; Jonathan Polikoff, MD; Michael Press, MD, PhD

Arch Surg. 2004;139:954-960.

Hypothesis  Body weight correlates with risk of breast cancer death.

Design  A retrospective cohort study using patient medical records, electronic cancer registry data, and archived tissue specimens.

Setting  A 395-bed, comprehensive community hospital.

Patients  One thousand three hundred seventy-six women, aged 24 to 81 years, who were diagnosed with breast cancer between January 1, 1988, and December 31, 1995, and for whom complete medical records and adequate tissue specimens existed.

Main Outcome Measures  Body weight at the time of diagnosis and patient status (ie, alive and free of breast cancer, living with breast cancer, dead of breast cancer, or dead of other cause) at the time of longest follow-up. Additional data collected, including age at diagnosis, menopausal status, tumor size, tumor grade, lymph node status, stage at diagnosis, race, estrogen-receptor (ER) status, and treatment information, were used to create multivariate Cox proportional hazards models to estimate hazard rate (HR) ratios and 95% confidence intervals (CIs) for breast cancer death. We collected ER status from the patients' medical records, when available, and supplemented the information by using immunohistochemical techniques to determine ER status from archived paraffin-embedded tumor blocks.

Results  Patients were followed up for a median of 6.8 years after diagnosis. Two hundred forty-six patients died from breast cancer. Among patients with early-stage disease (I and IIA), we observed a dose-response relationship of increasing weight with increasing likelihood of dying of breast cancer. Compared with women in the lowest category of weight (<133 lb [60 kg] at diagnosis), women in the highest category (175 lb [79 kg]) experienced a 2.5-fold increased risk of dying from breast cancer (HR ratio, 2.54 [95% CI, 1.08-6.00]; trend P = .02). Women with ER-negative cancer experienced an approximately 2-fold higher risk of dying from breast cancer compared with women with ER-positive cancer, regardless of stage at diagnosis. Women in the upper 50th percentile of weight with early-stage disease and with ER-negative tumors had a nearly 5-fold increased risk of dying (HR ratio, 4.99 [95% CI, 2.17-11.48]; P for interaction = .10) compared with women in the lower 50th percentile of weight and ER-positive tumors. The results were similar for body mass index, a measure of obesity in which weight is adjusted for height.

Conclusion  Body weight at diagnosis and ER status are important predictors of breast cancer death in early-stage disease.

From the Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, Calif (Dr Enger); the Departments of Surgery (Dr Greif) and Oncology (Dr Polikoff), Kaiser Permanente Medical Center, San Diego, Calif; and the Department of Pathology, University of Southern California, Los Angeles (Dr Press).

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