title: Obesity and survival among black women and white women 35 to 64 years of age at diagnosis with invasive breast cancer.
abstract: OBJECTIVE
  To evaluate the effect of obesity on survival among black women and white women with invasive breast cancer and to determine whether obesity explains the poorer survival of black women relative to white women.
  
  
  METHODS
  We observed 4,538 (1,604 black, 2,934 white) women who were 35 to 64 years of age when diagnosed with incident invasive breast cancer between 1994 and 1998. Multivariate Cox regression models were used to examine the effect of body mass index (BMI, in kilograms per square meter) 5 years before diagnosis on risk of death from any cause and from breast cancer.
  
  
  RESULTS
  During a median of 8.6 years of follow-up, 1,053 women died (519 black, 534 white), 828 as a result of breast cancer (412 black, 416 white). Black women were more likely to die than white women (multivariate-adjusted relative risk [RR], 1.33; 95% CI, 1.16 to 1.53). Compared with women with BMI of 20 to 24.9 kg/m(2), those who were obese (BMI ≥ 30 kg/m(2)) had a greater risk of all-cause mortality (RR, 1.23; 95% CI, 1.04 to 1.47) and breast cancer-specific mortality (RR, 1.20; 95% CI, 0.99 to 1.46). These associations were observed among white women (all-cause RR, 1.54; 95% CI, 1.21 to 1.96; breast cancer RR, 1.46; 95% CI, 1.11 to 1.92), but not among black women (all-cause RR, 1.03; 95% CI, 0.81 to 1.29; breast cancer RR, 1.02; 95% CI, 0.79 to 1.33).
  
  
  CONCLUSIONS
  Obesity may play an important role in mortality among white but not black patients with breast cancer. It is unlikely that differences in obesity distributions between black women and white women account for the poorer survival of black women.
authors.affiliation: Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Rd, Duarte, CA 91010, USA. yalu@coh.org
authors.forename: Yani
authors.initials: Y
authors.lastname: Lu
authors.forename: Huiyan
authors.initials: H
authors.lastname: Ma
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Malone
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Norman
authors.forename: Jane
authors.initials: J
authors.lastname: Sullivan-Halley
authors.forename: Brian L
authors.initials: BL
authors.lastname: Strom
authors.forename: Polly A
authors.initials: PA
authors.lastname: Marchbanks
authors.forename: Robert
authors.initials: R
authors.lastname: Spirtas
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Burkman
authors.forename: Dennis
authors.initials: D
authors.lastname: Deapen
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Folger
authors.forename: Michael S
authors.initials: MS
authors.lastname: Simon
authors.forename: Michael F
authors.initials: MF
authors.lastname: Press
authors.forename: Jill A
authors.initials: JA
authors.lastname: McDonald
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001823:Body Composition; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality*; D002140:California; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*