Triple negative (TN, tumors that do not express estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2)) and HER2-overexpressing (H2E, ER−/HER2+) tumors are two particularly aggressive subtypes of breast cancer. There is a lack of knowledge regarding the etiologies of these cancers and in particular how anthropometric factors are related to risk. We conducted a population-based case–case study consisting of 2659 women aged 20–69 years diagnosed with invasive breast cancer from 2004 to 2012. Four case groups defined based on joint ER/PR/HER2 status were included: TN, H2E, luminal A (ER+/HER2−), and luminal B (ER+/HER2+). Polytomous logistic regression was used to estimate odds ratios (ORs) and associated 95 % confidence intervals (CIs) where luminal A patients served as the reference group. Obese premenopausal women [body mass index (BMI) ≥30 kg/m2] had an 82 % (95 % CI 1.32–2.51) increased risk of TN breast cancer compared to women whose BMI <25 kg/m2, and those in the highest weight quartile (quartiles were categorized based on the distribution among luminal A patients) had a 79 % (95 % CI 1.23–2.64) increased risk of TN disease compared to those in the lowest quartile. Among postmenopausal women obesity was associated with reduced risks of both TN (OR = 0.74, 95 % CI 0.54–1.00) and H2E (OR = 0.47, 95 % CI 0.32–0.69) cancers. Our results suggest obesity has divergent impacts on risk of aggressive subtypes of breast cancer in premenopausal versus postmenopausal women, which may contribute to the higher incidence rates of TN cancers observed among younger African American and Hispanic women.
Breast cancer Triple negative Obesity BMI
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Lu Chen had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: L. Chen, L.S. Cook, C.I. Li. Acquisition, analysis, or interpretation of data: L.Chen, L.S. Cook, C.I. Li, M.C. Tang, P. Porter, D.A. Hill, C.L. Wiggins, L.S. Cook, C.I. Li. Drafting of the manuscript: L. Chen. Critical revision of the manuscript for important intellectual content: L.Chen, C.I. Li, M.C. Tang, P. Porter, D.A. Hill, C.L. Wiggins, L.S. Cook. Administrative, technical, or material support: M.C. Tang, P. Porter, D.A. Hill, C.L. Wiggins, L.S. Cook, C.I. Li. Study supervision: L.S. Cook, C.I. Li.
Compliance with ethical standards
Conflict of interest
No potential conflicts of interest were disclosed.
This study was supported by the National Cancer Institute 261201000029C (C.I. Li), P50 CA148143 (C.I. Li, L.S. Cook, D.A. Hill), and 261201000033C (C.L.Wiggins). The National Cancer Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
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