Receipt of appropriate primary breast cancer therapy and adjuvant therapy are not associated with obesity in older women with access to health care.
OBJECTIVE
Many studies have reported body mass index (BMI) increases the risk of breast cancer recurrence and breast cancer-specific mortality. Few studies have reported or examined whether breast cancer treatment differs by BMI. The purpose of this study was to examine the association between BMI at breast cancer diagnosis and receipt of appropriate primary tumor therapy and adjuvant therapy.


METHODS
We identified 897 women age >or= 65 years diagnosed with stage I or II breast cancer from 1990 to 1999 at five health care organizations. We used medical records to confirm demographics, tumor characteristics, treatment, comorbid conditions, and to calculate BMI at diagnosis (< 25 kg/m(2), n = 328; 25 to < 30 kg/m(2), n = 305; 30 to < 35 kg/m(2), n = 188; >or= 35 kg/m(2), n = 76). We defined primary therapy based on National Guidelines as receiving breast-conserving surgery with radiation therapy and axillary node dissection, simple mastectomy with axillary node dissection, or modified radical mastectomy (73% overall); adjuvant therapy was defined as receipt of hormonal therapy, chemotherapy, or both (60% overall).


RESULTS
The median BMI was 26.7 kg/m(2) (range, 14.6 to 61.2). The proportion of women receiving primary therapy and adjuvant therapy was lowest for women less than 25 kg/m(2) (69% and 56%, respectively) and greatest for obese I (78% and 64%, respectively). There were no differences in receipt of primary or adjuvant treatment across BMI in univariate or multivariable models (after adjusting for age, stage, comorbidity, diagnosis year, and hormone receptor positivity).


CONCLUSIONS
Receipt of appropriate primary therapy and adjuvant therapy is not associated with BMI in older women with access to health care. Additional research in larger samples and more diverse settings is needed.
Group Health Center for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. buist.d@ghc.org
Diana S M
DS
Buist
Laura
L
Ichikawa
Marianne N
MN
Prout
Marianne Ulcickas
MU
Yood
Terry S
TS
Field
Cynthia
C
Owusu
Ann M
AM
Geiger
Virginia P
VP
Quinn
Feifei
F
Wei
Rebecca A
RA
Silliman
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003695:Delivery of Health Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D009765:Obesity / Q000150:complications*; D012008:Recurrence; D016896:Treatment Outcome