International Journal of Epidemiology, Vol 28, 1026-1031, Copyright © 1999 by International Epidemiological Association
E Sonnenschein, P Toniolo, MB Terry, PF Bruning, I Kato, KL Koenig and RE Shore
BACKGROUND: Excessive body weight is known to increase the risk of
postmenopausal, but not premenopausal breast cancer. Some studies have
suggested that being overweight is protective against premenopausal breast
cancer, but the evidence is not compelling. Much less is known about the
role of body fat distribution in either pre- or postmenopausal breast
cancer. METHODS: Breast cancer risk was examined in relation to body
weight, height, Quetelet index (kg/m2), and waist/hip ratio (WHR) in the
New York University Women's Health Study, a prospective cohort study. Cases
were 109 premenopausal and 150 postmenopausal women diagnosed with breast
cancer between 1985 and 1994. Non-cases were 8,157 cohort members free of
breast cancer. RESULTS: Among premenopausal women, there was an increasing
risk of breast cancer with increasing WHR. The relative risk (RR) of breast
cancer increased to 1.72 (95% confidence interval [CI]: 1.0-3.1) in the
upper quartile of WHR. The association was limited to subjects who had
elevated Quetelet index, but not among those with lower weight. Overall,
Quetelet index itself was not related to breast cancer risk in the
premenopausal group, but there was a protective association among those
ranking below the median WHR. In postmenopausal women, the RR for breast
cancer increased to 2.36 (95% CI: 1.4-3.9) in the upper quartile of
Quetelet index, but there was no association with WHR. Height was not
associated with breast cancer in this study. CONCLUSIONS: The study
confirms that excessive body weight increases breast cancer risk in
postmenopausal women. On the contrary, in premenopausal women, excessive
body weight may be protective among women who have a lower- body type of
fat accumulation (low WHR). An upper-body fat accumulation (high WHR) is a
predictor of breast cancer risk in premenopausal women, and this effect is
especially pronounced among subjects who are overweight.
Body fat distribution and obesity in pre- and postmenopausal breast cancer
Nelson Institute of Environmental Medicine, New York University School of Medicine, NY, USA.
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