Influence of height,weight, and obesity on breast cancer incidence and recurrence in Auckland,New Zealand

Summary The relationship between obesity and breast cancer has been investigated in 1281 Auckland breast cancer patients. Using a definition of obesity as a Body Mass Index (BMI) of 28 kg/m², 179 (14%) breast cancer patients were classified as obese. The heights, weights, and BMI of 822 breast cancer patients aged 35–64 compared to 518 randomly selected Auckland women of similar age showed no significant difference. Within the breast cancer patients, there was no variation in nodal status or estrogen and progesterone receptor status between obese and non-obese women. However, tumours > 5 cm occurred significantly more often in obese patients. Time to recurrence was reduced in obese women with tumours 5 cm, no tumour in the axillary nodes, positive estrogen or progesterone receptor, and without metastases at the time of presentation of the disease. Although obesity has not been shown to influence breast cancer incidence, an effect on tumour recurrence is seen in patients with less advanced disease. This is similar to other reports which suggest that obesity is a weak but positive risk factor for recurrence.     

Influence of height, weight and obesity on risk of breast cancer in an unselected Swedish population.

A number of recent studies have shown an association between breast-cancer risk and height, weight and dietary habits, especially fat consumption. In the present study, height and weight were determined for 179 consecutive, unselected, breast-cancer patients and age-matched controls selected from a computerized population register. Height and weight for these two groups were compared, including two different indices for overweight (Quetelet''s index and Broca''s index). Comparisons were repeated after subdivision into pre- and postmenopausal women. In all calculations, the mean values of patients and controls were very similar and without significant difference. It therefore seems improbable that increased height and weight or obesity constitute risk factors for breast cancer. Earlier studies may have shown differences as the result of selection mechanisms not present in this study.     

Ethnic and socioeconomic trends in breast cancer incidence in New Zealand

Background  

Breast cancer incidence varies between social groups, but differences have not been thoroughly examined in New Zealand. The objectives of this study are to determine whether trends in breast cancer incidence varied by ethnicity and socioeconomic position between 1981 and 2004 in New Zealand, and to assess possible risk factor explanations.     

Cholesterol, weight, height, Quetelet's index, and colon cancer recurrence

The association of low serum cholesterol with colon cancer mortality suggests that low serum cholesterol promotes colon cancer recurrence. We compared cumulative 5-year recurrence-free rates of 279 colon cancer patients in relation to serum cholesterol, weight, height, and Quetelet's index. The median value for each variable was used to divide patients into those above the median, or at the median and below. Patients with median and lower serum cholesterol exhibited an 11% lower disease-free rate at 5 years. Patients above median weight were at significantly increased risk of recurrence in both sexes (76 vs 54%, z = 3.0026, p = 0.003). Progressively decreasing weight was noted with advancing stage in males but not in females. Women above median Quetelet's index were also at significantly greater risk of recurrence (74 vs 52%, z = 2.6109, p = 0.009). Patients above median height were at insignificantly increased risk of recurrence. This study indicates that body weight is a significant prognostic factor for patients with colon cancer.     

Adult height, age at attained height, and incidence of breast cancer in premenopausal women

Adult height has been positively associated with breast cancer risk in epidemiologic studies, and recent evidence suggests that the timing and rate of growth may also influence risk. We examined both adult height and age at attained height, an indicator of the timing of the pubertal growth spurt, in relation to incidence of premenopausal breast cancer in the Nurses' Health Study II. Participants were 108,829 premenopausal women who reported their height in 1989; of these, 37,572 provided information on their age at attained height on a later supplementary questionnaire. During 12 years of follow-up, 1,041 cases of invasive breast cancer were identified (402 with age at attained height). Cox proportional hazards models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). Adult height was positively associated with breast cancer incidence; the multivariate RR for participants 1.75 m or taller compared to those shorter than 1.60 m was 1.57 (95% CI: 1.23-2.01, p trend < 0.0001), and each 5-cm increment corresponded to an 11% increase in risk (95% CI: 6-17%). There was no overall association for age at attained height, however, with a multivariate RR of 0.96 (95% CI: 0.66-1.39) for women who attained their maximum height at age 18 or older compared to those who reached it before age 14 (p trend = 0.65). These results confirm previous findings that taller adult height is associated with increased risk of premenopausal breast cancer but do not provide evidence that age at attained height is related to risk.     

Patterns of care for cervical cancer in Auckland, New Zealand, 2003-2007

Introduction: The purpose of this review is to document current patterns of care for the International Federation of Gynecology and Obstetrics (FIGO) stage IB1 to IVA cervical cancer in a New Zealand cancer centre. Methods: This is a retrospective review of women with newly diagnosed FIGO Stage IB1–IVA cervical cancer in the Auckland/Northland regions between 2003 and 2007. Results: Two hundred seven patients were identified. Fifty‐three percent were stage IB, 24% stage II, 19% stage III and 3% stage IVA. Factors associated with stage ≥IIB were age >50, lack of participation in cervical screening and public first specialist assessment. Ninety percent (90/100) of stage IB1 patients and 73% (8/11) of stage IB2 patients were treated with primary surgery. Thirty‐eight percent of surgically treated stage IB1 and 100% of surgically treated stage IB2 tumours had indications for adjuvant radiotherapy. Radiotherapy utilisation rates were: stage IB 49% (IB1 44%, IB2 91%); stage II 93%; stage III 90%; and stage IVA 71%. Brachytherapy utilisation rate (BTU) for stages IIB to IVA was 64% overall and 75% in definitively treated patients. Seventy‐five percent of patients treated with definitive radiotherapy received concurrent cisplatin chemotherapy. Conclusion: Both radiotherapy and brachytherapy utilization rates were below optimal and are being addressed. No formal surgical or chemotherapy utilisation estimates exist for comparison; however, the use of concurrent cisplatin chemotherapy was similar to other groups. A high rate of adjuvant (chemo)radiotherapy was noted in surgically treated Stage IB patients, suggesting a need for an increased consideration of primary chemoradiotherapy in these patients to avoid the unnecessary toxicity of trimodality therapy. Future outcome analysis is planned.     

Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer

SummaryPurpose 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.For the Life After Cancer Epidemiology (LACE) Study group (Bette J. Caan, Adrienne Castillo, Erica P. Gunderson, Laurel Habel, Martha L. Slattery, Barbara Sternfeld), For the Women’s Healthy Eating and Living (WHEL) Study Group (Jennifer A. Emond, Loki Natarajan, Lovell Jones, Vicky A. Newman, Cheryl L. Rock, Marcia L. Stefanick, Cynthia A. Thomson, John P. Pierce)     

Reproductive factors and breast cancer in New Zealand

A national population-based case-control study was used to assess the influence on breast cancer risk of reproductive factors and the possibility of an interaction with age at diagnosis. A total of 891 women aged 25 to 54 with a first diagnosis of breast cancer, and 1864 control subjects, randomly selected from the electoral rolls, were interviewed. There was a declining risk of breast cancer with increasing age at menarche (p = 0.06), the strongest effect being seen in women aged less than 40. Parous women had a 27% lower risk of breast cancer than nulliparous women, a reduced risk being evident in all but the youngest age group. A falling risk of breast cancer with rising parity was clear only in women diagnosed when aged at least 45 years. Breast cancer risk tended to fall amongst parous women with increasing duration of breastfeeding (p = 0.14); the association was most apparent in the youngest women, while those over 40 years at diagnosis showed no clear negative trend. There was no association of breast cancer risk with age at first full-term pregnancy, time since last full-term pregnancy, abortion (spontaneous or induced), abortion before first full-term pregnancy, or ability to conceive, and there was no trend in risk with age at natural menopause. Women in the highest category of body mass index at age 20 had the lowest risk of breast cancer in the age group studied. When each reproductive factor was formally tested for effect modification by age at diagnosis, the interaction term in logistic models approached statistical significance only for parity (p = 0.07). Int. J. Cancer 76:182–188, 1998.© 1998 Wiley-Liss, Inc.     

Abstracting height and weight from medical records, and breast cancer pathologic factors

Cancer registries routinely collect data on clinicopathologic factors, but rarely abstract anthropometric variables. We conducted a chart review study, examining the feasibility of abstracting weight, height, alcohol use, and smoking from medical records in women (n = 1,974) diagnosed with invasive breast cancer, and investigated the association between the abstracted variables with clinicopathologic features. Qualitative data were reviewed and categorized. Frequencies of the abstracted data, and demographic and clinicopathologic variables were calculated. Logistic regression models measured the relationship between the outcome variables, tumor size, stage of disease, and estrogen/progesterone (ER/PR) status with the abstracted variables. Data on current alcohol-use/no-use, current-smoker/non-smoker, and height/weight data were obtained on 96%, 97%, and 88–89% of the participants, respectively. The multivariate analysis showed that overweight (≥25 kg/m²) women had significantly larger (≥2 cm) tumor size compared with normal weight for both women <50 years (OR = 1.79; 95% CI = 1.14–2.81; p ≤ 0.05) and for women ≥50 years at diagnosis (OR = 1.58; 95% CI = 1.19–2.09; p ≤ 0.05). These results suggest that abstracting current height and weight via medical records is feasible, and at minimum, current alcohol use and smoking status can be ascertained. In addition, being overweight was significantly associated with cancer clinicopathologic/prognostic factors, which has implications for monitoring etiologic factors that could be associated with cancer trends, incidence, and survival. Therefore routine collection of height and weight via cancer registries should be explored further.     

Adult weight change and incidence of premenopausal breast cancer

Overweight and obesity are inversely related to the risk of breast cancer among premenopausal women. We assessed the association between adult weight change since age 18 years with the risk of breast cancer among premenopausal women to explore whether weight gain was associated with a decrease in risk and weight loss was associated with an increase in risk. A total of 56,223 premenopausal participants in the Nurses' Health Study and 109,385 premenopausal participants in the Nurses' Health Study II were prospectively followed for up to 32 years and 18 years, respectively, and weight change since age 18 years was assessed biennially. The incidence of invasive breast cancer was assessed throughout follow-up. Weight loss of 5 kg or more since age 18, maintained for at least 4 years, was related to lower incidence of premenopausal breast cancer, compared to maintaining a stable weight, but this relation was of borderline statistical significance (covariate-adjusted HR = 0.75; 95% CI 0.52-1.09). Weight gain since age 18 years was also inversely related to breast cancer incidence among premenopausal women (covariate-adjusted p for trend = 0.01), but the association weakened after controlling for weight at age 18 and did not reach statistical significance (p for trend = 0.08). Although obesity and breast cancer among premenopausal women are inversely related, weight loss since age 18 years did not increase and weight gain did not significantly decrease the risk of premenopausal breast cancer among participants in the large prospective cohorts of NHS and NHS II.     

Antibiotic exposure and breast cancer in New Zealand

Summary Aims To investigate the hypothesis that use of antibiotics is related to subsequent development of breast cancer and also to apply this theory to other cancer types. Materials and methods A nested case–control study was conducted, using data linkage between the RNZCGP Research Unit database and the New Zealand Hospital Separation Diagnosis database. Cancer related hospital admissions were identified between 1998 and 2002, and prior antibiotic exposure in these patients was then found.Results A total of 6678 patients were identified with a newly diagnosed cancer in this time period. A slightly increased odds ratio (OR) (95% CI) for breast cancer was seen with penicillin, 1.07 (1.02–1.13). Penicillin was also associated with an increased OR with lung and respiratory cancer, 1.13 (1.06–1.21), and skin neoplasms, 1.05 (1.02–1.08). Significant associations were seen between macrolides and leukaemia, 1.15 (1.01–1.30), lung and respiratory cancers, 1.23 (1.10–1.38) and non-Hodgkin’s lymphoma, 1.26 (1.02–1.55). Tetracyclines were significantly associated with non-Hodgkin’s lymphoma, 1.12 (1.01–1.24). Cephalosporins only showed a significant association with leukaemia, 1.35 (1.06–1.71), sulphonamides with colorectal cancers, 1.12 (1.01–1.24), and ‘other‘ antibiotic classes with bladder and renal cancers, 1.34 (1.07–1.67). Conclusions It is most likely that antibiotic exposure represents a confounding factor rather than a causation for breast cancer and other cancer types.     

A 20-year review of haemangiopericytoma in Auckland, New Zealand

The records of all patients registered with a histological diagnosis of haemangiopericytoma in Auckland between 1970 and 1990 were reviewed retrospectively, with the aim of determining the natural history of the disease and the response to various treatment modalities. A total of 24 patients were identified, having a median age of 45 years.Twenty-one patients (87.5%) underwent surgery; the remaining three were deemed to be unfit for surgery. Seven patients (29%) were treated with surgery alone; nine (37.5%) received a radical course of radiotherapy and three (12.5%) received palliative radiation therapy for pain relief and/or dyspnoea. Five patients (21%) received chemotherapy during the course of their disease.Eight of the 24 patients (33%) were alive and disease free, 13 (54%) having died and three (13%) being lost to follow-up. Seven patients (29%) died as a result of metastatic disease. Three of the seven (43%) who were treated with surgery alone are known to be alive and disease free. The three patients who had received palliative radiotherapy, died within 2 months of completing the latter treatment. Five of the nine patients (56%) receiving a course of radical radiotherapy are alive and disease free at present. No local recurrence was noted following surgical excision and postoperative radical radiotherapy, whilst eight (67%) of those initially treated by excision alone developed recurrent disease. None of the patients treated with chemotherapy obtained significant palliation.Results suggest that adequate surgical excision followed by postoperative radiotherapy is effective in controlling haemangiopericytoma and that metastatic disease is at present invariably fatal. The role of chemotherapy needs further investigation.     

Influence of obesity on breast cancer receptor status and prognosis

Pre-existing obesity and postoperative weight gain are related to a poor prognosis in breast cancer regardless of menopausal status. Delayed diagnosis may be one cause, but of more biological significance, especially in younger women, is the association of adiposity with estrogen receptor-negative tumors with a propensity for distant metastasis. After the menopause, the major mechanism for the relationship is the elevated estrogen synthesis by adipose tissue; these hormone-dependent tumors are estrogen receptor-positive. Insulin and some adipokines also stimulate breast cancer growth and metastasis, both directly and most probably by enhanced angiogenesis. Weight control is important, not only to target breast cancer progression, but also to reduce the risk of nonbreast cancer mortality risk associated with excess adiposity.     

Ethnic and socioeconomic trends in testicular cancer incidence in New Zealand

Ethnic differences in testicular cancer incidence within countries are often sizeable, with white populations consistently having the highest ethnic‐specific rates. Many studies have found that high socioeconomic status is a risk factor for testicular cancer. The objectives of this article are to test whether trends in testicular cancer incidence have varied by ethnicity and socioeconomic position in New Zealand between 1981 and 2004. Five cohorts of the entire New Zealand population for 1981–1986, 1986–1991, 1991–1996, 1996–2001 and 2001–2004 were created, and probabilistically linked to cancer registry records, allowing direct determination of ethnic and household income trends in testicular cancer incidence. There were more than 2,000 cases of testicular cancer over the study period. We found increasing rates of testicular cancer for all ethnic and income groups since 1990s. Ma ori had higher rates, and Pacific and Asian lower rates than European/other men with rate ratios pooled over time of 1.51 (95% CI 1.31–1.74), 0.40 (95% CI 0.26–0.61) and 0.54 (95% CI 0.31–0.94), respectively. Overall, men with low incomes had higher risk of testicular cancer than those with high incomes (pooled rate ratio for lowest to highest income groups = 1.23; 95% CI 1.05–1.44). There was no strong evidence that disparities in testicular cancer incidence have varied by ethnicity or household income over time. Given the lack of understanding of the etiology of testicular cancer, the unusual patterns identified in the New Zealand context may provide some etiological clues for future novel research.     

Body weight loss as an indicator of breast cancer recurrence

Body weight loss (BWL), a major prognostic factor in breast cancer, was included as a parameter to be monitored in the recent breast cancer surveillance guidelines of the American Society of Clinical Oncology. The aim of this work was prospectively to evaluate BWL as an indicator of breast cancer recurrence. Body weight was measured every 2 months for 10.4+/-3.7 (SD) months in 109 disease-free breast cancer patients in stage II node-positive and stage III disease. The correlation between unexplained BWL and recurrence was studied. Attempts were made to define the limits in weight variations among disease-free patients beyond which recurrence could be suspected. Unexplained BWL was observed in 16/19 (84%) patients developing recurrence, versus 9/90 (10%) patients remaining disease-free. There was a significant (p < 0.001) correlation between BWL and recurrence. BWL anticipated the diagnosis of recurrence by 6 (range 4-12) months. Based on the average percentage weight variation +/- 2 SD (95% confidence interval) of the disease-free group, the limits for BWL beyond which recurrence could be suspected were a 5.8% decrease in the last 6 months, 3.6% in the last 2 months or 3.0% of the patient's mean weight. However, because of the large variation in the amplitude of individual weight oscillations among disease-free patients (from < 0.5% to > 5.9% of the mean weight), individual limits derived from the patient's own body weight curve seemed more reliable. The results suggest that unexplained BWL is a valuable indicator of incipient breast cancer recurrence. Careful monitoring of body weight in breast cancer patients during follow-up is encouraged.     

The role of obesity and bariatric surgery-induced weight loss in breast cancer

Cancer and Metastasis Reviews - Obesity is a complex metabolic condition considered a worldwide public health crisis, and a deeper mechanistic understanding of obesity-associated diseases is...     

Family history and risk of breast cancer in New Zealand

A national population-based case-control study was used to assess the influence on breast cancer risk of a family history of the disease and the possibility of an interaction with reproductive risk factors. A total of 891 women aged 25–54 years with a first diagnosis of breast cancer and 1,864 control subjects randomly selected from the electoral rolls were interviewed. Age-adjusted relative risks (RR) of breast cancer were similar for mothers (RR = 2.3) and sisters (RR = 2.7) but somewhat higher for first-degree (RR = 2.6) than for second-degree (RR = 1.7) relatives. Cases reporting a first- or second-degree relative with breast cancer were no more likely to be diagnosed at an early age than those with no family history. With regard to the age at diagnosis of the relative, the RR was higher if breast cancer had been diagnosed before the age of 45 years than later; this was true for first-degree as well as for second-degree relatives. In women with no family history, the falling RRs with increasing age at menarche reflected the usual pattern, but no such trend was apparent in those reporting a mother or sister with breast cancer. For age at first full-term pregnancy, parity, breast-feeding, menopausal status, infertility, history of benign breast disease and body mass index, no evidence was seen of effect modification by a family history of breast cancer. Mothers of cases had about twice the cumulative rate of breast cancer as mothers of controls, a similar difference being seen between sisters of cases and sisters of controls. Int. J. Cancer 73:503–507, 1997. © 1997 Wiley-Liss, Inc.     

New prognostic factors for breast cancer recurrence

Decisions regarding the use of adjuvant therapy for breast cancer are strongly influenced by the risk of disease recurrence and death. These risks are now determined by examining the currently recognized breast cancer prognostic factors including clinical stage, axillary nodal status, tumor size and grade, hormone receptor status, and presence of lymphovascular involvement. Newer factors are being evaluated in an attempt to more precisely define disease-related prognosis. This article provides an overview of issues that need to be considered when analyzing studies of prognostic factors, as well as a review of the currently recognized and the newer candidate prognostic factors.     

The effect of pre-morbid height and weight on the survival of breast cancer patients

A total of 8,427 women with breast cancer with height and weight measured prior to the diagnosis were followed up for on average 4.3 years. 2,383 women died from breast cancer and 430 from other causes. Among women diagnosed without any metastasis (stage I) the death rate was 1.70 times higher for those belonging to the highest quintile of body mass with respect to age compared to those in the lowest quintile. For patients with involved lymph nodes at diagnosis (stage II) the death rate was 1.42 times higher. Overweight was not a prognostic factor for stages III and IV patients. The prognostic effect of body mass in stages I and II was mainly connected to those in the highest quintile and was found for women in pre- as well as post-menopausal age. The effect did not depend on the length of time between measurement and diagnosis. Height was not found to be of prognostic relevance. The idea of the feasibility of a dietary trial in terms of the minimum trial size is given.     

Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer

The majority of breast cancers are diagnosed in postmenopausal women. Competing comorbidities, particularly cardiovascular disease (CVD), should be considered when individualizing adjuvant therapies for these women. We compared the 10-year predicted breast cancer recurrence risk with CVD risk among postmenopausal women with hormone receptor-positive (HR+), non-metastatic breast cancer. CVD risk factor data were prospectively collected from postmenopausal women with stage I-III, HR+?breast cancer initiating adjuvant aromatase inhibitor therapy. We compared predicted 10-year CVD risk, including the composite index heart age, computed from modified Framingham risk score, with predicted 10-year risk of breast cancer recurrence using Adjuvant! Online. We created multivariable logistic regression models to estimate the odds ratios (OR) and 95% confidence intervals (CI) for greater CVD risk than breast cancer recurrence risk. Among 415 women, mean age and heart age were 60 and 67?years, respectively. Overall, 43% of women had a predicted 10-year CVD risk equivalent to breast cancer recurrence risk and 37% had CVD risk higher than breast cancer recurrence risk. Predicted CVD risk was higher than breast cancer recurrence risk for stage I disease (OR: 6.1, 95% CI: 3.4-11.2) or heart age >65 (OR: 12.4, 95% CI: 7.0-22.6). The majority of postmenopausal women with HR+ early breast cancer had a predicted 10-year CVD risk that was equivalent to or higher than breast cancer recurrence risk. Physicians should weigh competing risks and offer early screening and cardiac prevention strategies for women at a greater risk for CVD.