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Effect of Obesity on Presentation of Breast Cancer

¹ Department of Surgery, Dalhousie University, 7-007 Victoria Building, Queen Elizabeth II Health Sciences Center, 1278 Tower Road, Halifax, Nova Scotia, B3H 2Y9, Canada
² Department of Medicine, Dalhousie University, 4th Floor Bethune, 1278 Tower Road, Halifax, Nova Scotia, B3H 2Y9, Canada
³ Department of Public Health Sciences, University of Alberta, 13-106D Clinical Sciences Building, Edmonton, Alberta, Canada

Correspondence: Address correspondence and reprint requests to: Geoffrey A. Porter, MD, FRCSC; E-mail: geoff.porter{at}dal.ca.

Background: Obesity has been shown to be associated with reduced survival in patients with invasive breast cancer (IBC), although the mechanisms for this finding are unclear. The objective of this study was to examine the effect of obesity on the presentation and pathologic staging of IBC.

Methods: From February 15, 2002, to February 15, 2004, all patients undergoing surgery for primary IBC at two institutions were enrolled in a prospective cohort study. National Institutes of Health criteria were used to categorize patients: normal or underweight (NW; body mass index <25 kg/m²), overweight (OW; body mass index 25–29.9 kg/m²), and obese or severely obese (OB; body mass index 30 kg/m²). Presentation and pathologic factors were then compared among groups.

Results: The study cohort consisted of 519 patients; 166 (32%) were NW, 177 (34%) were OW, and 176 (34%) were OB. OW (46%) and OB (39%) patients were more likely to be diagnosed with IBC via screening mammography compared with NW (31%) patients (P = .01), although no differences were found between groups with respect to previous use of screening mammography. Aggressive pathologic features, including lymph node metastases, advanced tumor-node-metastasis stage, and grade were found more commonly among OB patients.

Conclusions: OW and OB patients were more likely to receive a diagnosis via screening mammography, thus suggesting that mammography may play a more important role in OW and OB patients. Despite this, OB patients presented with larger, more advanced tumors; this may help to explain obesity-associated survival differences in IBC patients. This is important information given the prevalence of obesity in North America.

Key Words: Breast cancer • Presentation • Obesity • Mammography

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