Abstract
Associations between anthropometric factors and breast cancer (BC) risk have varied inconsistently by estrogen and/or progesterone receptor (ER/PR) status. Associations between prediagnostic anthropometric factors and risk of premenopausal and postmenopausal BC overall and ER/PR status subtypes were investigated in a pooled analysis of 20 prospective cohorts, including 36,297 BC cases among 1,061,915 women, using multivariable Cox regression analyses, controlling for reproductive factors, diet and other risk factors. We estimated dose–response relationships and tested for nonlinear associations using restricted cubic splines. Height showed positive, linear associations for premenopausal and postmenopausal BC risk (6–7% RR increase per 5 cm increment), with stronger associations for receptor-positive subtypes. Body mass index (BMI) at cohort baseline was strongly inversely associated with premenopausal BC risk, and strongly positively—and nonlinearly—associated with postmenopausal BC (especially among women who never used hormone replacement therapy). This was primarily observed for receptor-positive subtypes. Early adult BMI (at 18–20 years) showed inverse, linear associations for premenopausal and postmenopausal BC risk (21% and 11% RR decrease per 5 kg/m2, respectively) with stronger associations for receptor-negative subtypes. Adult weight gain since 18–20 years was positively associated with postmenopausal BC risk, stronger for receptor-positive subtypes, and among women who were leaner in early adulthood. Women heavier in early adulthood generally had reduced premenopausal BC risk, independent of later weight gain. Positive associations between height, baseline (adult) BMI, adult weight gain and postmenopausal BC risk were substantially stronger for hormone receptor-positive versus negative subtypes. Premenopausal BC risk was positively associated with height, but inversely with baseline BMI and weight gain (mostly in receptor-positive subtypes). Inverse associations with early adult BMI seemed stronger in receptor-negative subtypes of premenopausal and postmenopausal BC.
Highlights
Body height and weight have been consistently reported to be associated with breast cancer (BC) risk [1, 2]
Positive nonlinear associations between baseline body mass index (BMI) and postmenopausal BC risk were found in women who never used hormone replacement therapy (HRT), primarily for receptor-positive subtypes; positive associations were more modest in HRT users than never users
Adult weight gain since age 18–20 years was positively associated with postmenopausal BC risk; the association was substantially stronger for receptor positive subtypes, and among women who were leaner in early adulthood
Summary
Body height and weight have been consistently reported to be associated with breast cancer (BC) risk [1, 2]. As measured with body mass index (BMI) and weight gain since adolescence (18–20 years) are inversely associated with premenopausal BC risk, but positively associated with postmenopausal BC [1, 2, 6,7,8,9,10,11]. Adult weight has been inversely, inconsistently, related to both premenopausal and postmenopausal BC risk [11, 12]. Associations with ER/PR subtypes have been investigated less extensively for early adult BMI, adult weight gain and height
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