TY - JOUR
T1 - Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis
AU - Chan, Doris S.M.
AU - Vieira, Rita
AU - Abar, Leila
AU - Aune, Dagfinn
AU - Balducci, Katia
AU - Cariolou, Margarita
AU - Greenwood, Darren C.
AU - Markozannes, Georgios
AU - Nanu, Neesha
AU - Becerra-Tomás, Nerea
AU - Giovannucci, Edward L.
AU - Gunter, Marc J.
AU - Jackson, Alan A.
AU - Kampman, Ellen
AU - Lund, Vivien
AU - Allen, Kate
AU - Brockton, Nigel T.
AU - Croker, Helen
AU - Katsikioti, Daphne
AU - McGinley-Gieser, Deirdre
AU - Mitrou, Panagiota
AU - Wiseman, Martin
AU - Cross, Amanda J.
AU - Riboli, Elio
AU - Clinton, Steven K.
AU - McTiernan, Anne
AU - Norat, Teresa
AU - Tsilidis, Konstantinos K.
PY - 2023/2/15
Y1 - 2023/2/15
N2 - Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
AB - Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
KW - Body fatness
KW - breast cancer survival
KW - evidence grading
KW - systematic review
KW - weight change
U2 - 10.1002/ijc.34322
DO - 10.1002/ijc.34322
M3 - Article
C2 - 36279884
AN - SCOPUS:85140363856
SN - 0020-7136
VL - 152
SP - 572
EP - 599
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 4
ER -
