Abstract
The relationship between body mass index (BMI, Quetelet's index, kg m(-2)) and post-menopausal breast cancer risk was considered in age-specific strata on the basis of a pooled analysis of three Italian case-control studies, including a total of 3108 post-menopausal breast cancer patients aged 50 years or over and 2664 control subjects. Overall, there was a moderate, but significant, association between BMI and post-menopausal breast cancer: the odds ratios (ORs) were around 1.3 for the three intermediate quintiles compared with the lowest one, and 1.4 for the highest one. The association was moderate among women aged 50-59 years and 60-69 years, with ORs around 1.3 for the highest BMI quintiles, but stronger among elderly women, with ORs of 1.6 for the fourth and 2.1 for the fifth quintile. An 8-unit increase in BMI involved an OR of 1.18 at age 50-59 years, of 1.14 at age 60-69 years and of 1.59 above age 70 years. This pattern of risk is similar to that observed for post-menopausal hormone replacement treatment and is consistent with a duration-risk relationship in the exposure to high oestrogen levels and with a greater differential in oestrogen levels in overweight elderly women. In terms of population attributable risk, 19.6% of all post-menopausal breast cancer patients and 27.1% of those in women above age 70 years were attributable to overweight and obesity in this population. This has, therefore, major preventive implications as to reduce breast cancer risk late in life, it is essentially important to control weight gain in elderly women.
Highlights
Summary The relationship between body mass index (BMI, Quetelet's index, kg m-2) and post-menopausal breast cancer risk was considered in age-specific strata on the basis of a pooled analysis of three Italian case-control studies, including a total of 3108 postmenopausal breast cancer patients aged 50 years or over and 2664 control subjects
The association was moderate among women aged 50-59 years and 60-69 years, with odds ratios (ORs) around 1.3 for the highest BMI quintiles, but stronger among elderly women, with ORs of 1.6 for the fourth and 2.1 for the fifth quintile
An 8-unit increase in BMI involved an OR of 1.18 at age 50-59 years, of 1.14 at age 60-69 years and of 1.59 above age 70 years. This pattern of risk is similar to that observed for post-menopausal hormone replacement treatment and is consistent with a duration-risk relationship in the exposure to high oestrogen levels and with a greater differential in oestrogen levels in overweight elderly women
Summary
The design and methods of the original investigations and their pooled analysis have been described in detail (Negri et al, 1988a). Cases were matched for age (± 5 years) with 368 controls recruited in the same region and admitted to the same hospital for acute, non-neoplastic and non-hormone-related conditions that were unrelated to nutrition or diet. The third study (Tavani et al, 1993) was a hospital-based case-control investigation conducted between 1983 and 1991 in the Greater Milan area on a total of 3425 histologically confirmed breast cancer cases below age 75 years who were admitted to a network including the major teaching and general hospitals in the area. The comparison group included 2926 women admitted to the same network of hospitals for acute conditions (35% traumas, 13% other orthopaedic disorders, 22% surgical, 30% other miscellaneous disorders) that were unrelated to long-term modification of diet and similar to cases in terms of age and area of residence
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