Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality.
Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality.
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DOI：
10.1158/1055-9965.epi-08-1094
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Newcomb PA
中科院分区：
文献类型：
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作者：
Nichols HB;Trentham-Dietz A;Egan KM;Titus-Ernstoff L;Holmes MD;Bersch AJ;Holick CN;Hampton JM;Stampfer MJ;Willett WC;Newcomb PA
与改善乳腺癌幸存者预后相关的因素具有越来越重要的公共卫生意义。我们检查了一组乳腺癌幸存者的诊断后体重变化与死亡风险的关系。我们分析了居住在新罕布什尔州、马萨诸塞州或威斯康星州的 3,993 名 20-79 岁女性的数据，这些女性在 1988 年至 1999 年期间通过州登记处诊断出患有侵袭性、非转移性乳腺癌。参与者在诊断后 1-2 年完成了结构化电话访谈，并在 1998-2001 年寄回了一份邮寄的后续调查问卷，其中涉及诊断后的体重和其他因素。生命状态信息通过 2005 年 12 月的国家死亡指数获得。风险比 (HR) 和 95% 置信区间 (CI) 根据 Cox 比例风险模型估算，并根据诊断前体重、年龄、分期、吸烟、体力活动和其他重要协变量进行调整。在诊断后调查问卷平均 6.3 年的随访期间，我们总共确定了 421 例死亡，其中 121 例死于乳腺癌，95 例死于心血管疾病。诊断后体重增加和体重减轻的增加均与更高的全因死亡率相关。在乳腺癌诊断后体重增加的女性中，每增加 5 公斤，全因死亡率增加 12%（p=0.004），乳腺癌特异性死亡率增加 13%（p=0.01），心血管疾病死亡率增加 19%（p=0.04）。诊断前绝经状态、吸烟或体重指数不会改变与乳腺癌死亡率的关联。这些发现表明，在乳腺癌诊断后努力尽量减少体重增加可能会提高生存率。
Factors related to improving outcomes in breast cancer survivors are of increasing public health significance. We examined post-diagnosis weight change in relation to mortality risk in a cohort of breast cancer survivors. We analyzed data from a cohort of 3,993 women aged 20−79 living in New Hampshire, Massachusetts or Wisconsin with invasive, nonmetastatic breast cancers diagnosed in 1988−1999 identified through state registries. Participants completed a structured telephone interview 1−2 years after diagnosis and returned a mailed follow-up questionnaire in 1998−2001 that addressed post-diagnosis weight and other factors. Vital status information was obtained from the National Death Index through December 2005. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from Cox proportional hazards models and adjusted for pre-diagnosis weight, age, stage, smoking, physical activity and other important covariates. During an average 6.3 years of follow-up from the post-diagnosis questionnaire, we identified 421 total deaths, including 121 deaths from breast cancer and 95 deaths from cardiovascular disease. Increasing post-diagnosis weight gain and weight loss were each associated with greater all-cause mortality. Among women who gained weight after breast cancer diagnosis, each 5 kg gain was associated with a 12% increase in all-cause mortality (p=0.004), a 13% increase in breast cancer-specific mortality (p=0.01), and a 19% increase in cardiovascular disease mortality (p=0.04). Associations with breast cancer mortality were not modified by pre-diagnosis menopausal status, cigarette smoking, or body mass index. These findings suggest that efforts to minimize weight gain after a breast cancer diagnosis may improve survival.