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. 2024 May 30;24(1):312.
doi: 10.1186/s12905-024-03020-3.

The interrelationship between obesity and race in breast cancer prognosis: a prospective cohort study

Emma A Schindler  1 , Cristiane Takita  2   3 , Fernando Collado-Mesa  4 , Isildinha M Reis  1   2 , Wei Zhao  2 , George R Yang  1 , Laura G Acosta  1 , Jennifer J Hu  5   6
Affiliations

The interrelationship between obesity and race in breast cancer prognosis: a prospective cohort study

Emma A Schindler et al. BMC Womens Health. .

Abstract

Background: Obesity is associated with an increased breast cancer risk in postmenopausal women and may contribute to worse outcomes. Black women experience higher obesity and breast cancer mortality rates than non-Black women. We examined associations between race, obesity, and clinical tumor stage with breast cancer prognosis.

Methods: We conducted a prospective cohort study in 1,110 breast cancer patients, using univariable and multivariable Cox regression analyses to evaluate the effects of obesity, race/ethnicity, and clinical tumor stage on progression-free and overall survival (PFS and OS).

Results: 22% of participants were Black, 64% were Hispanic White, and 14% were non-Hispanic White or another race. 39% of participants were obese (body mass index [BMI] ≥ 30 kg/m2). In univariable analyses, tumor stage III-IV was associated with worse PFS and OS compared to tumor stage 0-II (hazard ratio [HR] = 4.68, 95% confidence interval [CI] = 3.52-6.22 for PFS and HR = 5.92, 95% CI = 4.00-8.77 for OS). Multivariable analysis revealed an association between Black race and worse PFS in obese (HR = 2.19, 95% CI = 1.06-4.51) and non-obese (HR = 2.11, 95% CI = 1.05-4.21) women with tumors staged 0-II. Obesity alone was not associated with worse PFS or OS.

Conclusions: Results suggest a complex interrelationship between obesity and race in breast cancer prognosis. The association between the Black race and worse PFS in tumor stages 0-II underscores the importance of early intervention in this group. Future studies are warranted to evaluate whether alternative measures of body composition and biomarkers are better prognostic indicators than BMI among Black breast cancer survivors.

Keywords: Breast cancer; Obesity; Prognosis; Race/ethnicity; Tumor stage.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Progression-free survival and overall survival by race and obesity. Kaplan-Meier curves demonstrating PFS and OS by race and obesity, stratified by clinical tumor stage. A PFS in all participants B PFS in clinical tumor stage 0-II C PFS in clinical tumor stage III-IV D OS in all participants E OS in clinical tumor stage 0-II F OS in clinical tumor stage III-IV. PFS, progression-free survival; OS, overall survival; B, Black race; NB, Non-Black race. Obese was defined as BMI ≥ 30 and non-obese was defined as BMI < 30 (kg/m2). P-values were determined using a log-rank test; a p-value < 0.05 was considered statistically significant
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