Am J Epidemiol 2003; 158:963-968.
Copyright © 2003 by Johns
Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Waist-to-Hip Ratio and Breast Cancer Mortality
1 Cancer Control Research Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
2 Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
3 Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
4 Vancouver Island Cancer Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
5 Nutrition Services, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
6 Population and Preventive Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
7 Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA.
8 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA.
High insulin levels have been associated with increased risk of breast cancer and poorer survival after a breast cancer diagnosis. Waist-to-hip ratio (WHR) is a marker for insulin resistance and hyperinsulinemia. In this study, the authors tested the hypothesis that elevated WHR is directly related to breast cancer mortality. For identification of modifiable factors affecting survival, data were collected on 603 patients with incident breast cancer who visited the Vancouver Cancer Centre of the British Columbia Cancer Agency (Vancouver, British Columbia, Canada) in 1991–1992, including body measurements and information on demographic, medical, reproductive, and dietary factors. These patients were followed for up to 10 years. Cox proportional hazards regression models were used to relate the variables to breast cancer mortality (n = 112). After adjustment for age, body mass index, family history, estrogen receptor (ER) status, tumor stage at diagnosis, and systemic treatment (chemotherapy or tamoxifen), WHR was directly related to breast cancer mortality in postmenopausal women (for highest quartile vs. lowest, relative risk = 3.3, 95% confidence interval: 1.1, 10.4) but not in premenopausal women (relative risk = 1.2, 95% confidence interval: 0.4, 3.4). Stratification according to ER status showed that the increased mortality was restricted to ER-positive postmenopausal women. Elevated WHR was confirmed as a predictor of breast cancer mortality, with menopausal status and ER status at diagnosis found to be important modifiers of that relation.
body constitution; breast neoplasms; insulin resistance; mortality; receptors, estrogen
Abbreviations: Abbreviations: CI, confidence interval; ER, estrogen receptor; WHR, waist-to-hip ratio.
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