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Early breast cancer: why does obesity affect prognosis?

Early breast cancer: why does obesity affect prognosis?
Early breast cancer: why does obesity affect prognosis?
High body mass index (BMI) is associated with an increased risk of breast cancer in post-menopausal women but poorer outcomes in all age groups. The underlying mechanism is likely to be multi-factorial. Patients with a high BMI may present later due to body habitus. Some studies have also indicated an increased incidence of biologically adverse features, including a higher frequency of oestrogen receptor (ER negative) tumours, in obese patients. Obese patients have a higher frequency of surgical complications, potentially delaying systemic therapies, and reports suggest that chemotherapy and endocrine therapy are less effective in patients with BMIs of ≥30 kg/m2 High BMI is generally interpreted as excess adiposity and a World Cancer Research Fund report judged that the associations between BMI and incidence of breast cancer were due to body fatness. However, BMI cannot distinguish lean mass from fat mass, or characterise body fat distribution. Most chemotherapy drugs are dosed according to calculated body surface area (BSA). Patients with a similar BSA or BMI may have wide variations in their distribution of adipose tissue and skeletal muscle (body composition); however few studies have looked at the effect of this on chemotherapy tolerance or effectiveness. Finally, adjuvant treatments for breast cancer can themselves result in body composition changes. Research is required to fully understand the biological mechanisms by which obesity influences cancer behaviour, and the impact of obesity on treatment effectiveness and tolerance so that specific management strategies can be developed to improve the prognosis of this patient group.
0029-6651
Copson, Ellen
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Heetun, Mohammad, Adam
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Cutress, Ramsey
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Copson, Ellen
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
Heetun, Mohammad, Adam
40ba9eee-8ec3-428e-9994-9baae9363864
Cutress, Ramsey
68ae4f86-e8cf-411f-a335-cdba51797406

Copson, Ellen, Heetun, Mohammad, Adam and Cutress, Ramsey (2018) Early breast cancer: why does obesity affect prognosis? Proceedings of the Nutrition Society. (doi:10.1017/S0029665118000447).

Record type: Review

Abstract

High body mass index (BMI) is associated with an increased risk of breast cancer in post-menopausal women but poorer outcomes in all age groups. The underlying mechanism is likely to be multi-factorial. Patients with a high BMI may present later due to body habitus. Some studies have also indicated an increased incidence of biologically adverse features, including a higher frequency of oestrogen receptor (ER negative) tumours, in obese patients. Obese patients have a higher frequency of surgical complications, potentially delaying systemic therapies, and reports suggest that chemotherapy and endocrine therapy are less effective in patients with BMIs of ≥30 kg/m2 High BMI is generally interpreted as excess adiposity and a World Cancer Research Fund report judged that the associations between BMI and incidence of breast cancer were due to body fatness. However, BMI cannot distinguish lean mass from fat mass, or characterise body fat distribution. Most chemotherapy drugs are dosed according to calculated body surface area (BSA). Patients with a similar BSA or BMI may have wide variations in their distribution of adipose tissue and skeletal muscle (body composition); however few studies have looked at the effect of this on chemotherapy tolerance or effectiveness. Finally, adjuvant treatments for breast cancer can themselves result in body composition changes. Research is required to fully understand the biological mechanisms by which obesity influences cancer behaviour, and the impact of obesity on treatment effectiveness and tolerance so that specific management strategies can be developed to improve the prognosis of this patient group.

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Proc of Nutrition review v4.0 26.4.18 docx - Accepted Manuscript
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Accepted/In Press date: 30 April 2018
e-pub ahead of print date: 4 June 2018

Identifiers

Local EPrints ID: 421448
URI: https://eprints.soton.ac.uk/id/eprint/421448
ISSN: 0029-6651
PURE UUID: b15d49b1-d9b7-45f4-8429-1a8b9ec0848b

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Date deposited: 12 Jun 2018 16:30
Last modified: 14 Mar 2019 05:06

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