Breast Cancer Research and Treatment

, Volume 132, Issue 2, pp 729–739 | Cite as

Pre-diagnosis body mass index and survival after breast cancer in the After Breast Cancer Pooling Project

  • Marilyn L. Kwan
  • Wendy Y. Chen
  • Candyce H. Kroenke
  • Erin K. Weltzien
  • Jeannette M. Beasley
  • Sarah J. Nechuta
  • Elizabeth M. Poole
  • Wei Lu
  • Michelle D. Holmes
  • Charles P. QuesenberryJr.
  • John P. Pierce
  • Xiao Ou Shu
  • Bette J. Caan


Obese and underweight women who develop breast cancer may have poorer survival compared with normal-weight women. However, the optimal weight for best prognosis is still under study. We conducted a prospective investigation of pre-diagnosis body mass index (BMI) and mortality among 14,948 breast cancer patients in the After Breast Cancer Pooling Project. Breast cancer patients diagnosed from 1990 to 2006 with AJCC Stage I–III breast tumors were drawn from four prospective cohorts. Hazard ratios (HR) and 95% confidence intervals (CI) representing the associations of BMI categories (World Health Organization international classifications) with recurrence and mortality were estimated using delayed entry Cox proportional hazards models. Obese (30 to <35 kg/m2), severely obese (35 to <40 kg/m2), and morbidly obese (≥40 kg/m2) were examined. After a mean follow-up of 7.8 years, 2,140 deaths and 2,065 recurrences were documented. Both underweight (HR = 1.59; 95% CI: 1.18, 2.13) and morbidly obese women (HR = 1.81; 95% CI: 1.42, 2.32) had the greatest risk of overall mortality compared with normal weight (18.5–24.9 kg/m2) women. Severe obesity (HR = 1.09; 95% CI: 0.88, 1.36) and obesity (HR = 1.11; 95% CI: 0.97, 1.27) were related to small non-significant increased risks. Overweight (25.0–29.9 kg/m2) was not associated with any excess risk compared with normal weight. Similar associations were found for breast cancer death and non-breast cancer death but not recurrence. Women who were underweight and morbidly obese before breast cancer diagnosis were at the greatest risk of all-cause mortality. Morbidly obese women were also at increased risk of death from breast cancer. These results suggest that degree of obesity confers differential risk on survival.


Body mass index Weight Obesity Breast cancer Survival Prognosis Mortality 



After Breast Cancer Pooling Project


Shanghai Breast Cancer Survival Study


Life After Cancer Epidemiology


Women’s Healthy Eating and Living


Nurses’ Health Study


Kaiser Permanente Northern California


Institutional review board


Body mass index


Metabolic equivalents


Myocardial infarction


Estrogen receptor


Progesterone receptor


Hazard ratio


Confidence interval



This work was supported by the National Cancer Institute (3R01CA118229-03S1). Funding for each individual cohort participating in the After Breast Cancer Pooling Project is as follows: The SBCSS was supported by the Department of Defense (DAMD 17-02-1-0607) and the National Cancer Institute (R01 CA118229). The WHEL Study was supported by the Susan G. Komen Foundation (#KG100988). The LACE Study was supported by the National Cancer Institute (R01 CA129059). The NHS was supported by the National Cancer Institute (P01 CA87969). We thank Dr. Shannon M. Conroy at the University of Hawaii Cancer Center for her expertise on creating the cubic spline curves.


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Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Marilyn L. Kwan
    • 1
  • Wendy Y. Chen
    • 2
    • 3
  • Candyce H. Kroenke
    • 1
  • Erin K. Weltzien
    • 1
  • Jeannette M. Beasley
    • 4
  • Sarah J. Nechuta
    • 5
  • Elizabeth M. Poole
    • 2
  • Wei Lu
    • 6
  • Michelle D. Holmes
    • 2
  • Charles P. QuesenberryJr.
    • 1
  • John P. Pierce
    • 7
  • Xiao Ou Shu
    • 5
  • Bette J. Caan
    • 1
  1. 1.Division of ResearchKaiser PermanenteOaklandUSA
  2. 2.Channing Laboratory, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  4. 4.Fred Hutchinson Cancer Research CenterSeattleUSA
  5. 5.Division of Epidemiology, Department of MedicineVanderbilt University School of MedicineNashvilleUSA
  6. 6.Shanghai Institute for Preventive MedicineShanghaiChina
  7. 7.Cancer Prevention and Control Program, Moores UCSD Cancer CenterUniversity of California, San DiegoSan DiegoUSA

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