title: Body mass index and survival after breast cancer diagnosis in Japanese women.
abstract: BACKGROUND
  Body mass index (BMI) may be an important factor affecting breast cancer outcome. Studies conducted mainly in Western countries have reported a relationship between higher BMI and a higher risk of all-cause death or breast cancer-specific death among women with breast cancer, but only a few studies have been reported in Japan so far. In the present prospective study, we investigated the associations between BMI and the risk of all-cause and breast cancer-specific death among breast cancer patients overall and by menopausal status and hormone receptor status.
  
  
  METHODS
  The study included 653 breast cancer patients admitted to a single hospital in Japan, between 1997 and 2005. BMI was assessed using a self-administered questionnaire. The patients were completely followed up until December, 2008. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated according to quartile points of BMI categories, respectively: <21.2, ≥21.2 to <23.3 (reference), ≥23.3 to <25.8 and ≥25.8 kg/m2.
  
  
  RESULTS
  During the follow-up period, 136 all-cause and 108 breast cancer-specific deaths were observed. After adjustment for clinical and confounding factors, higher BMI was associated with an increased risk of all-cause death (HR = 2.61; 95% CI: 1.01-6.78 for BMI ≥25.8 vs. ≥21.2 to <23.3 kg/m²) among premenopausal patients. According to hormonal receptor status, BMI ≥25.8 kg/m² was associated with breast cancer-specific death (HR = 4.95; 95% CI: 1.05-23.35) and BMI <21.2 kg/m2 was associated with all-cause (HR = 2.91; 95% CI: 1.09-7.77) and breast cancer-specific death (HR = 7.23; 95% CI: 1.57-33.34) among patients with ER + or PgR + tumors. Analysis by hormonal receptor status also showed a positive association between BMI and mortality risk among patients with ER + or PgR + tumors and with BMI ≥21.2 kg/m² (p for trend: 0.020 and 0.031 for all-cause and breast cancer-specific death, respectively).
  
  
  CONCLUSIONS
  Our results suggest that both higher BMI and lower BMI are associated with an increased risk of mortality, especially among premenopausal patients or among patients with hormonal receptor positive tumors. Breast cancer patients should be informed of the potential importance of maintaining an appropriate body weight after they have been diagnosed.
authors.affiliation: Division of Community Health, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan. kawai@med.tohoku.ac.jp
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kawai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Minami
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nishino
authors.forename: Kayoko
authors.initials: K
authors.lastname: Fukamachi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ohuchi
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Kakugawa
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008593:Menopause; D008875:Middle Aged; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D011795:Surveys and Questionnaires
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone