Abstract
BackgroundAdult body fatness is a convincing risk factor for postmenopausal breast cancer. With the aim to compare the different breast cancer (BC) features in Northern and Southern Italy, we investigated the relationship between BMI and BC characteristic in two groups of patients referred in the Modena and Lecce breast units.Materials and MethodsA retrospective analysis of a continuous series of BC patients referred to the Città di Lecce Hospital and the Modena Cancer Center, from January 2019 to December 2020 was performed. We identified four groups of BMI at BC diagnosis: underweight, BMI <18.5 kg/m2; normal weight, BMI ≥ 18.5–24.9 kg/m2; overweight, BMI ≥ 25.0–29.9 kg/m2; obese, BMI ≥30.0 kg/m2. BC characteristics and clinical outcomes were analyzed by the Kolmogorov-Smirnov test and Mann-Whitney U test; categorical data were compared using Pearson’s chi-square test, and dicotomic data were compared by odds ratio.ResultsNine hundred seventy-seven BC patients were included in the analysis. Overall, 470 were from Modena and 507 from Lecce. No differences were observed in the mean age of BC patients of Modena (61,42) and Lecce (62,08). No statistical differences between the two populations were shown in terms of tumor characteristics and pathological stage. Conversely, a statistical difference of BMI between the BC patients coming from Modena and Lecce (25.87 and 27.81, respectively; p = 0.000001) was found. BC patients diagnosed in Lecce at age ≥70 years had higher median BMI compared with the ones from Modena (p = 0.000002). The increased BMI in this aged population was also associated to larger tumor size (p = 0.040).ConclusionThe rate of overweight and obesity was higher in BC women living in Southern Italy, despite the presumed nutrition according to the so-called Mediterranean type dietary pattern. Unexpectedly, an increased BMI rate and a relationship with larger tumor size were found in Southern BC patients aged ≥70 years. Our findings strongly support the need for promoting a healthier lifestyle model in Italy, with the aim of reducing the rate of the obesity and, consequently, the increased risk of BC.
Highlights
Breast cancer (BC) is the most frequent malignancy in women worldwide
By separately analyzing the pathological tumor size as continues variable, we found that Modena BC patients had smaller tumor size compared with Lecce BC patients (p < 0.001)
Obese BC patients diagnosed at the Modena hospital that underwent lifestyle intervention for 1 year, showed a body mass index (BMI) decrease and a statistically significant better outcome than overweight patients who did not obtain a BMI reduction [34]
Summary
Breast cancer (BC) is the most frequent malignancy in women worldwide. In the USA, it is estimated that there are currently 3.8 million breast cancer survivors [1], while in Italy, in 2020, breast cancer reached 13% of the whole population [2]. In Italy, geographical comparisons were conducted based on AIRTUM 2008–2016 data, highlighting a North-South geographical gradient in breast cancer incidence affecting the female population. In this contest, BC level decrease from the Northern (162.6/cases/year/100,000) to the Southern and islands (123.6/cases/year/100,000) [3]. The American Institute for Cancer Research (AICR) and World Cancer Research Fund (WCRF) continuous updated report on nutrition and cancer [18] currently defines “adult body fatness” as a convincing risk factor for postmenopausal breast cancer and as a probably decreasing breast cancer risk for premenopausal women. With the aim to compare the different breast cancer (BC) features in Northern and Southern Italy, we investigated the relationship between BMI and BC characteristic in two groups of patients referred in the Modena and Lecce breast units
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