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Adiposity and Sex Hormones in Postmenopausal Breast Cancer Survivors

Anne McTiernan, Kumar B. Rajan, Shelley S. Tworoger, Melinda Irwin, Leslie Bernstein, Richard Baumgartner, Frank Gilliland, Frank Z. Stanczyk, Yutaka Yasui, Rachel Ballard-Barbash

From the Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center; Department of Epidemiology, School of Public Health, and Department of Medicine, School of Medicine, University of Washington, Seattle, WA; Department of Epidemiology and Public Health, Yale University, New Haven, CT; University of Southern California, Los Angeles, CA; University of New Mexico, Albuquerque, NM; and Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.

Address reprint requests to Anne McTiernan, MD, PhD, Cancer Prevention Research Program, MP-900, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109; email: amctiern{at}fhcrc.org.

Purpose: Overweight and obese women with breast cancer have poorer survival compared with thinner women. One possible reason is that breast cancer survivors with higher degrees of adiposity have higher concentrations of tumor-promoting hormones. This study examined the association between adiposity and concentrations of estrogens, androgens, and sex hormone–binding globulin (SHBG) in a population-based sample of postmenopausal women with breast cancer.

Methods: We studied the associations between body mass index (BMI), body fat mass, and percent body fat, measured by dual-energy x-ray absorptiometry scan, waist circumference, and waist-to-hip circumference ratio, with concentrations of estrone, estradiol, testosterone, SHBG, dehydroepiandrosterone sulfate, free estradiol, and free testosterone in 505 postmenopausal women in western Washington and New Mexico with incident stage 0 to IIIA breast cancer. Blood and adiposity measurements were performed between 4 and 12 months after diagnosis.

Results: Obese women (BMI 30) had 35% higher concentrations of estrone and 130% higher concentrations of estradiol compared with lighter-weight women (BMI < 22.0; P = .005 and .002, respectively). Similar associations were observed for body fat mass, percent body fat, and waist circumference. Testosterone concentrations also increased with increasing levels of adiposity (P = .0001). Concentrations of free estradiol and free testosterone were two to three times greater in overweight and obese women compared with lighter-weight women (P = .0001).

Conclusion: These data provide information about potential hormonal explanations for the association between adiposity and breast cancer prognosis. These sex hormones may be useful biomarkers for weight loss intervention studies in women with breast cancer.

Supported by grant nos. N01-CN-75036-20, NO1-CN-05228, and N01-PC-67010, and training grant no. T32 CA09661 from the National Cancer Institute, Bethesda, MD. A portion of this work was conducted through the Clinical Research Center Facility at the University of Washington and supported by grant no. M01-RR-00037 from the National Institutes of Health, Bethesda, MD.

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