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Normal BMI? You might still have a higher risk of breast cancer

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Women who have a normal BMI may still have an elevated risk of breast cancer if they have excess body fat, according to an international study. The researchers say it is important to accurately measure a women’s body fat because obesity is associated with a higher risk of breast cancer. But because BMI doesn't measure this, the researchers suggest a focus on body fat measurements alone.

Journal/conference: JAMA

Organisation/s: Weill Cornell Medical College

Media Release

From: JAMA

IMPORTANCE
Obesity is associated with an increased risk of breast cancer, including the estrogen receptor (ER)–positive subtype in postmenopausal women. Whether excess adiposity is associated with increased risk in women with a normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is unknown.

OBJECTIVE
To investigate the association between body fat and breast cancer risk in women with normal BMI.

DESIGN, SETTING, AND PARTICIPANTS
This ad hoc secondary analysis of the Women’s Health Initiative (WHI) clinical trial and observational study cohorts was restricted to postmenopausal participants with a BMI ranging from 18.5 to 24.9. Women aged 50 to 79 years were enrolled from October 1, 1993, through December 31, 1998. Of these, 3460 participants underwent body fat measurement with dual-energy x-ray absorptiometry (DXA) at 3 US designated centers with follow-up. At a median follow-up of 16 years (range, 9-20 years), 182 incident breast cancers had been ascertained, and 146 were ER positive. Follow-up was complete on September 30, 2016, and data from October 1, 1993, through September 30, 2016, was analyzed August 2, 2017, through August 21, 2018.

MAIN OUTCOMES AND MEASURES
Body fat levels were measured at baseline and years 1, 3, 6, and 9 using DXA. Information on demographic data, medical history, and lifestyle factors was collected at baseline. Invasive breast cancers were confirmed via central review of medical records by physician adjudicators. Blood analyte levels were measured in subsets of participants.

RESULTS
Among the 3460 women included in the analysis (mean [SD] age, 63.6 [7.6] years), multivariable-adjusted hazard ratios for the risk of invasive breast cancer were 1.89 (95% CI, 1.21-2.95) for the highest quartile of whole-body fat and 1.88 (95% CI, 1.18-2.98) for the highest quartile of trunk fat mass. The corresponding adjusted hazard ratios for ER-positive breast cancer were 2.21 (95% CI, 1.23-3.67) and 1.98 (95% CI, 1.18-3.31), respectively. Similar positive associations were observed for serial DXA measurements in time-dependent covariate analyses. Circulating levels of insulin, C-reactive protein, interleukin 6, leptin, and triglycerides were higher, whereas levels of high-density lipoprotein cholesterol and sex hormone–binding globulin were lower in those in the uppermost vs lowest quartiles of trunk fat mass.

CONCLUSIONS AND RELEVANCE
In postmenopausal women with normal BMI, relatively high body fat levels were associated with an elevated risk of invasive breast cancer and altered levels of circulating metabolic and inflammatory factors. Normal BMI categorization may bean inadequate proxy for the risk of breast cancer in postmenopausal women.

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