Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC).
The evidence for anthropometric factors influencing breast cancer risk is accumulating, but uncertainties remain concerning the role of fat distribution and potential effect modifiers. We used data from 73,542 premenopausal and 103,344 postmenopausal women from 9 European countries, taking part in the EPIC study. RRs from Cox regression models were calculated, using measured height, weight, BMI and waist and hip circumferences; categorized by cohort-wide quintiles; and expressed as continuous variables, adjusted for study center, age and other risk factors. During 4.7 years of follow-up, 1,879 incident invasive breast cancers were identified. In postmenopausal women, current HRT modified the body size-breast cancer association. Among nonusers, weight, BMI and hip circumference were positively associated with breast cancer risk (all ptrend < or = 0.002); obese women (BMI > 30) had a 31% excess risk compared to women with BMI < 25. Among HRT users, body measures were inversely but nonsignificantly associated with breast cancer. Excess breast cancer risk with HRT was particularly evident among lean women. Pooled RRs per height increment of 5 cm were 1.05 (95% CI 1.00-1.16) in premenopausal and 1.10 (95% CI 1.05-1.16) in postmenopausal women. Among premenopausal women, hip circumference was the only other measure significantly related to breast cancer (ptrend = 0.03), after accounting for BMI. In postmenopausal women not taking exogenous hormones, general obesity is a significant predictor of breast cancer, while abdominal fat assessed as waist-hip ratio or waist circumference was not related to excess risk when adjusted for BMI. Among premenopausal women, weight and BMI showed nonsignificant inverse associations with breast cancer.
Lahmann
Petra H
PH
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany. lahmann@mail.dife.de
Hoffmann
Kurt
K
Allen
Naomi
N
van Gils
Carla H
CH
Khaw
Kay-Tee
KT
Tehard
Bertrand
B
Berrino
Franco
F
Tjønneland
Anne
A
Bigaard
Janne
J
Olsen
Anja
A
Overvad
Kim
K
Clavel-Chapelon
Françoise
F
Nagel
Gabriele
G
Boeing
Heiner
H
Trichopoulos
Dimitrios
D
Economou
George
G
Bellos
George
G
Palli
Domenico
D
Tumino
Rosario
R
Panico
Salvatore
S
Sacerdote
Carlotta
C
Krogh
Vittorio
V
Peeters
Petra H M
PH
Bueno-de-Mesquita
H Bas
HB
Lund
Eiliv
E
Ardanaz
Eva
E
Amiano
Pilar
P
Pera
Guillem
G
Quirós
José R
JR
Martínez
Carmen
C
Tormo
María J
MJ
Wirfält
Elisabet
E
Berglund
Göran
G
Hallmans
Göran
G
Key
Timothy J
TJ
Reeves
Gillian
G
Bingham
Sheila
S
Norat
Teresa
T
Biessy
Carine
C
Kaaks
Rudolf
R
Riboli
Elio
E
D000005:Abdomen; D000273:Adipose Tissue; D000328:Adult; D000368:Aged; D001823:Body Composition; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000150:complications; D017698:Postmenopause; D017697:Premenopause; D011446:Prospective Studies; D012307:Risk Factors