Breast Cancer Research and Treatment

, Volume 120, Issue 1, pp 185–193 | Cite as

Impact of obesity on diagnosis and treatment of breast cancer

  • Carole Deglise
  • Christine Bouchardy
  • Mafalda Burri
  • Massimo Usel
  • Isabelle Neyroud-Caspar
  • Georges Vlastos
  • Pierre Olivier Chappuis
  • Michela Ceschi
  • Silvia Ess
  • Monica Castiglione
  • Elisabetta Rapiti
  • Helena Marieke Verkooijen


In this population-based study, we evaluated the impact of obesity on presentation, diagnosis and treatment of breast cancer. Among all women diagnosed with invasive breast cancer in the canton Geneva (Switzerland) between 2003 and 2005, we identified those with information on body mass index (BMI) and categorized them into normal/underweight (BMI <25 kg/m2), overweight (BMI ≥–<30 kg/m2) and obese (BMI ≥30 kg/m2) women. Using multivariate logistic regression, we compared tumour, diagnosis and treatment characteristics between groups. Obese women presented significantly more often with stage III–IV disease (adjusted odds ratio [ORadj]: 1.8, 95% CI: 1.0–3.3). Tumours ≥1 cm and pN2-N3 lymph nodes were significantly more often impalpable in obese than in normal/underweight patients (ORadj 2.4, [1.1–5.3] and ORadj 5.1, [1.0–25.4], respectively). Obese women were less likely to have undergone ultrasound (ORadj 0.5, [0.3–0.9]) and MRI (ORadj 0.3, [0.1–0.6]) and were at increased risk of prolonged hospital stay (ORadj 4.7, [2.0–10.9]). This study finds important diagnostic and therapeutic differences between obese and lean women, which may impair survival of obese women with breast cancer. Specific strategies are needed to optimize the care of obese women with or at risk of breast cancer.


Obesity Breast cancer Diagnosis Treatment Population-based 



We thank Stina Blagojevic for technical and editorial assistance and the registry team for providing data and support. This study was financially supported by the Swiss Cancer League.

Conflicts of interest

The authors indicate no potential conflict of interest.


  1. 1.
    Reeves GK, Pirie K, Beral V, Green J, Spencer E (2007) Bull D cancer incidence and mortality in relation to body mass index in the million women study: cohort study. BMJ 335(7630):1134CrossRefPubMedGoogle Scholar
  2. 2.
    Lahmann PH, Hoffmann K, Allen N, Van Gils CH, Khaw KT, Tehard B, Berrino F, Tjonneland A, Bigaard J, Olsen A, Overvad K, Clavel-Chapelon F, Nagel G, Boeing H, Trichopoulos D, Economou G, Bellos G, Palli D, Tumino R, Panico S (2004) Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC). Int J Cancer 111(5):762–771CrossRefPubMedGoogle Scholar
  3. 3.
    Bouchardy C, Le MG, Hill C (1990) Risk factors for breast cancer according to age at diagnosis in a French case-control study. J Clin Epidemiol 43(3):267–275CrossRefPubMedGoogle Scholar
  4. 4.
    Loi S, Milne RL, Friedlander ML, McCredie MR, Giles GG, Hopper JL, Phillips KA (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14(7):1686–1691CrossRefPubMedGoogle Scholar
  5. 5.
    Litton JK, Gonzalez-Angulo AM, Warneke CL, Buzdar AU, Kau SW, Bondy M, Mahabir S, Hortobagyi GN, Brewster AM (2008) Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol 26(25):4072–4077CrossRefPubMedGoogle Scholar
  6. 6.
    Carmichael AR, Bates T (2004) Obesity and breast cancer: a review of the literature. Breast 13(2):85–92CrossRefPubMedGoogle Scholar
  7. 7.
    Majed B, Moreau T, Senouci K, Salmon RJ, Fourquet A, Asselain B (2008) Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 111(2):329–342CrossRefPubMedGoogle Scholar
  8. 8.
    Carmichael AR (2006) Obesity as a risk factor for development and poor prognosis of breast cancer. BJOG 113(10):1160–1166CrossRefPubMedGoogle Scholar
  9. 9.
    Enger SM, Greif JM, Polikoff J, Press M (2004) Body weight correlates with mortality in early-stage breast cancer. Arch Surg 139(9):954–958CrossRefPubMedGoogle Scholar
  10. 10.
    Bouchardy C, Geneva, Switzerland (2003) Cancer incidence in five continents. In: Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB (eds) International agency for research on cancer, vol VIII. IARC, Lyon, pp 448–449Google Scholar
  11. 11.
    World Health Organization (WHO) (2008) WHO, global database on body mass index, BMI classification. 30-4-2008Google Scholar
  12. 12.
    Sobin LH, Ch Wittekind (eds) (2002) TNM classification of malignant tumours. UICC, New YorkGoogle Scholar
  13. 13.
    ICD-O International classification of diseases for oncology (1975) World Health Organization, GenèveGoogle Scholar
  14. 14.
    Breslow NE, Day NE (1987) Statistical methods in cancer research: the design and analysis of cohort studies, vol II. International Agency for Research on Cancer, IARC Scientific Publications no 82, LyonGoogle Scholar
  15. 15.
    Porter GA, Inglis KM, Wood LA, Veugelers PJ (2006) Effect of obesity on presentation of breast cancer. Ann Surg Oncol 13(3):327–332CrossRefPubMedGoogle Scholar
  16. 16.
    Kim YA, Lee CW (2004) Effects of obesity on breast cancer stage at diagnosis in Korean women. Eur J Cancer Prev 13(1):13–17CrossRefPubMedGoogle Scholar
  17. 17.
    Cui Y, Whiteman MK, Flaws JA, Langenberg P, Tkaczuk KH, Bush TL (2002) Body mass and stage of breast cancer at diagnosis. Int J Cancer 98(2):279–283CrossRefPubMedGoogle Scholar
  18. 18.
    Hahn KM, Bondy ML, Selvan M, Lund MJ, Liff JM, Flagg EW, Brinton LA, Porter P, Eley JW, Coates RJ (2007) Factors associated with advanced disease stage at diagnosis in a population-based study of patients with newly diagnosed breast cancer. Am J Epidemiol 166(9):1035–1044CrossRefPubMedGoogle Scholar
  19. 19.
    Cui Y, Whiteman MK, Langenberg P, Sexton M, Tkaczuk KH, Flaws JA, Bush TL (2002) Can obesity explain the racial difference in stage of breast cancer at diagnosis between black and white women? J Womens Health Gend Based Med 11(6):527–536CrossRefPubMedGoogle Scholar
  20. 20.
    Vona-Davis L, Howard-McNatt M, Rose DP (2007) Adiposity, type 2 diabetes and the metabolic syndrome in breast cancer. Obes Rev 8(5):395–408CrossRefPubMedGoogle Scholar
  21. 21.
    Verreault R, Brisson J, Deschenes L, Naud F (1989) Body weight and prognostic indicators in breast cancer. Modifying effect of estrogen receptors. Am J Epidemiol 129(2):260–268PubMedGoogle Scholar
  22. 22.
    Maehle BO, Tretli S (1996) Pre-morbid body-mass-index in breast cancer: reversed effect on survival in hormone receptor negative patients. Breast Cancer Res Treat 41(2):123–130CrossRefPubMedGoogle Scholar
  23. 23.
    Suzuki R, Rylander-Rudqvist T, Ye W, Saji S, Wolk A (2006) Body weight and postmenopausal breast cancer risk defined by estrogen and progesterone receptor status among Swedish women: a prospective cohort study. Int J Cancer 119(7):1683–1689CrossRefPubMedGoogle Scholar
  24. 24.
    Colditz GA, Rosner BA, Chen WY, Holmes MD, Hankinson SE (2004) Risk factors for breast cancer according to estrogen and progesterone receptor status. J Natl Cancer Inst 96(3):218–228PubMedCrossRefGoogle Scholar
  25. 25.
    Potter JD, Cerhan JR, Sellers TA, McGovern PG, Drinkard C, Kushi LR, Folsom AR (1995) Progesterone and estrogen receptors and mammary neoplasia in the Iowa Women’s Health Study: how many kinds of breast cancer are there? Cancer Epidemiol Biomarkers Prev 4(4):319–326PubMedGoogle Scholar
  26. 26.
    Li CI, Malone KE, Daling JR (2006) Interactions between body mass index and hormone therapy and postmenopausal breast cancer risk (United States). Cancer Causes Control 17(5):695–703CrossRefPubMedGoogle Scholar
  27. 27.
    Yoo K, Tajima K, Park S, Kang D, Kim S, Hirose K, Takeuchi T, Miura S (2001) Postmenopausal obesity as a breast cancer risk factor according to estrogen and progesterone receptor status (Japan). Cancer Lett 167(1):57–63CrossRefPubMedGoogle Scholar
  28. 28.
    Honda H, Ohi Y, Umekita Y, Takasaki T, Kuriwaki K, Ohyabu I, Yoshioka T, Yoshida A, Taguchi S, Ninomiya K, Akiba S, Nomura S, Sagara Y, Yoshida H (1999) Obesity affects expression of progesterone receptors and node metastasis of mammary carcinomas in postmenopausal women without a family history. Pathol Int 49(3):198–202CrossRefPubMedGoogle Scholar
  29. 29.
    Althuis MD, Fergenbaum JH, Garcia-Closas M, Brinton LA, Madigan MP, Sherman ME (2004) Etiology of hormone receptor-defined breast cancer: A systematic review of the literature. Cancer Epidemiol Biomarkers Prev 13(10):1558–1568PubMedGoogle Scholar
  30. 30.
    Horwitz KB, Mcguire WL (1978) Estrogen control of progesterone receptor in human breast-cancer—correlation with nuclear processing of estrogen-receptor. J Biol Chem 253(7):2223–2228PubMedGoogle Scholar
  31. 31.
    Vona-Davis L, Rose DP (2007) Adipokines as endocrine, paracrine, and autocrine factors in breast cancer risk and progression. Endocr Relat Cancer 14(2):189–206CrossRefPubMedGoogle Scholar
  32. 32.
    Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7(4):333–340CrossRefPubMedGoogle Scholar
  33. 33.
    Wolpin BM, Meyerhardt JA, Chan AT, Ng K, Chan JA, Wu K, Pollak MN, Giovannucci EL, Fuchs CS (2009) Insulin, the insulin-like growth factor axis, and mortality in patients with nonmetastatic colorectal cancer. J Clin Oncol 27(2):176–185CrossRefPubMedGoogle Scholar
  34. 34.
    Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293(20):2479–2486CrossRefPubMedGoogle Scholar
  35. 35.
    Reeves MJ, Newcomb PA, Remington PL, Marcus PM, MacKenzie WR (1996) Body mass and breast cancer. Relationship between method of detection and stage of disease. Cancer 77(2):301–307CrossRefPubMedGoogle Scholar
  36. 36.
    Hall HI, Coates RJ, Uhler RJ, Brinton LA, Gammon MD, Brogan D, Potischman N, Malone KE, Swanson CA (1999) Stage of breast cancer in relation to body mass index and bra cup size. Int J Cancer 82(1):23–27CrossRefPubMedGoogle Scholar
  37. 37.
    Hoe AL, Mullee MA, Royle GT, Guyer PB, Taylor I (1993) Breast size and prognosis in early breast cancer. Ann R Coll Surg Engl 75(1):18–22PubMedGoogle Scholar
  38. 38.
    Ferrante JM, Chen PH, Crabtree BF, Wartenberg D (2007) Cancer screening in women: body mass index and adherence to physician recommendations. Am J Prev Med 32(6):525–531CrossRefPubMedGoogle Scholar
  39. 39.
    Cohen SS, Signorello LB, Gammon MD, Blot WJ (2007) Obesity and recent mammography use among black and white women in the Southern Community Cohort Study (United States). Cancer Causes Control 18(7):765–773CrossRefPubMedGoogle Scholar
  40. 40.
    Fontaine KR, Heo M, Allison DB (2001) Body weight and cancer screening among women. J Womens Health Gend Based Med 10(5):463–470CrossRefPubMedGoogle Scholar
  41. 41.
    Wee CC, McCarthy EP, Davis RB, Phillips RS (2000) Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med 132(9):697–704PubMedGoogle Scholar
  42. 42.
    Arndt V, Sturmer T, Stegmaier C, Ziegler H, Dhom G, Brenner H (2002) Patient delay and stage of diagnosis among breast cancer patients in Germany—a population based study. Br J Cancer 86(7):1034–1040CrossRefPubMedGoogle Scholar
  43. 43.
    Wadden TA, Anderson DA, Foster GD, Bennett A, Steinberg C, Sarwer DB (2000) Obese women’s perceptions of their physicians’ weight management attitudes and practices. Arch Fam Med 9(9):854–860CrossRefPubMedGoogle Scholar
  44. 44.
    El Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W (2007) Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg 245(5):665–671CrossRefPubMedGoogle Scholar
  45. 45.
    Forouhi P, Dixon JM, Leonard RC, Chetty U (1995) Prospective randomized study of surgical morbidity following primary systemic therapy for breast cancer. Br J Surg 82(1):79–82CrossRefPubMedGoogle Scholar
  46. 46.
    Munhoz AM, Montag E, Arruda EG, Aldrighi C, Gemperli R, Aldrighi JM, Ferreira MC (2006) Critical analysis of reduction mammaplasty techniques in combination with conservative breast surgery for early breast cancer treatment. Plast Reconstr Surg 117(4):1091–1103CrossRefPubMedGoogle Scholar
  47. 47.
    Vilar-Compte D, Jacquemin B, Robles-Vidal C, Volkow P (2004) Surgical site infections in breast surgery: case-control study. World J Surg 28(3):242–246CrossRefPubMedGoogle Scholar
  48. 48.
    Buist DS, Ichikawa L, Prout MN, Yood MU, Field TS, Owusu C, Geiger AM, Quinn VP, Wei F, Silliman RA (2007) Receipt of appropriate primary breast cancer therapy and adjuvant therapy are not associated with obesity in older women with access to health care. J Clin Oncol 25(23):3428–3436CrossRefPubMedGoogle Scholar
  49. 49.
    Griggs JJ, Culakova E, Sorbero ME, van Ryn M, Poniewierski MS, Wolff DA, Crawford J, Dale DC, Lyman GH (2007) Effect of patient socioeconomic status and body mass index on the quality of breast cancer adjuvant chemotherapy. J Clin Oncol 25(3):277–284CrossRefPubMedGoogle Scholar
  50. 50.
    Griggs JJ, Sorbero ME, Lyman GH (2005) Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med 165(11):1267–1273CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Carole Deglise
    • 1
  • Christine Bouchardy
    • 1
  • Mafalda Burri
    • 1
  • Massimo Usel
    • 1
  • Isabelle Neyroud-Caspar
    • 1
  • Georges Vlastos
    • 2
  • Pierre Olivier Chappuis
    • 3
    • 4
  • Michela Ceschi
    • 6
  • Silvia Ess
    • 7
  • Monica Castiglione
    • 1
  • Elisabetta Rapiti
    • 1
  • Helena Marieke Verkooijen
    • 1
    • 5
  1. 1.Geneva Cancer Registry, Institute of Social and Preventive MedicineGeneva UniversityGenevaSwitzerland
  2. 2.Senology Unit, Division of GynaecologyGeneva University HospitalsGenevaSwitzerland
  3. 3.Division of Oncology, Department of Internal MedicineGeneva University HospitalsGenevaSwitzerland
  4. 4.Division of Genetic Medicine, Department of Genetic Medicine and LaboratoryGeneva University HospitalsGenevaSwitzerland
  5. 5.Department of Epidemiology and Public HealthNational University of SingaporeSingaporeSingapore
  6. 6.Zurich Cancer Registry, Institutes of Social and Preventive Medicine, Surgical PathologyUniversity of ZurichZurichSwitzerland
  7. 7.St. Gallen Cancer RegistrySt. GallenSwitzerland

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