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Receipt of Appropriate Primary Breast Cancer Therapy and Adjuvant Therapy Are Not Associated With Obesity in Older Women With Access to Health Care

Diana S.M. Buist, Laura Ichikawa, Marianne N. Prout, Marianne Ulcickas Yood, Terry S. Field, Cynthia Owusu, Ann M. Geiger, Virginia P. Quinn, Feifei Wei, Rebecca A. Silliman

From the Group Health Center for Health Studies, Seattle, WA; Boston University School of Public Health and Boston University Medical Center, Boston; Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, Fallon Foundation, Worcester, MA; Josephine Ford Cancer Center, Henry Ford Health System, Detroit, MI; Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; Case Western Reserve University School of Medicine, Division of Hematology/Oncology, Cleveland, OH; Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC; Kaiser Permanente Southern California, Pasadena, CA; and HealthPartners Research Foundation, Minneapolis, MN

Address reprint requests to Diana S.M. Buist, PhD, Group Health Center for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA 98101; e-mail: buist.d{at}ghc.org.

Purpose Many studies have reported body mass index (BMI) increases the risk of breast cancer recurrence and breast cancer–specific mortality. Few studies have reported or examined whether breast cancer treatment differs by BMI. The purpose of this study was to examine the association between BMI at breast cancer diagnosis and receipt of appropriate primary tumor therapy and adjuvant therapy.

Methods We identified 897 women age 65 years diagnosed with stage I or II breast cancer from 1990 to 1999 at five health care organizations. We used medical records to confirm demographics, tumor characteristics, treatment, comorbid conditions, and to calculate BMI at diagnosis (< 25 kg/m², n = 328; 25 to < 30 kg/m², n = 305; 30 to < 35 kg/m², n = 188; 35 kg/m², n = 76). We defined primary therapy based on National Guidelines as receiving breast-conserving surgery with radiation therapy and axillary node dissection, simple mastectomy with axillary node dissection, or modified radical mastectomy (73% overall); adjuvant therapy was defined as receipt of hormonal therapy, chemotherapy, or both (60% overall).

Results The median BMI was 26.7 kg/m² (range, 14.6 to 61.2). The proportion of women receiving primary therapy and adjuvant therapy was lowest for women less than 25 kg/m² (69% and 56%, respectively) and greatest for obese I (78% and 64%, respectively). There were no differences in receipt of primary or adjuvant treatment across BMI in univariate or multivariable models (after adjusting for age, stage, comorbidity, diagnosis year, and hormone receptor positivity).

Conclusion Receipt of appropriate primary therapy and adjuvant therapy is not associated with BMI in older women with access to health care. Additional research in larger samples and more diverse settings is needed.

Supported by the American Cancer Society (Grant No. CRTG-03-024-01-CCE; D.B.) and the National Cancer Institute (Grant No. R01 CA093772; R.S.).

Presented in part at the International Epidemiology Congress Meeting, June 21-24, 2006, Seattle, WA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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