20 december 2010: Bron: J Clin Oncol. November 29, 2010

Een borstkankerpatiënte die te zwaar is heeft een groter risico dat de borstkanker uitzaait naar andere organen in het lichaam en ook een groter risico om te overlijden aan haar borstkanker. Hoe dikker iemand is hoe groter het risico. Gemiddeld blijkt het risico 48% om binnen 30 jaar te overlijden aan borstkanker. Dit blijkt uit een groot bevolkingsonderzoek in Denemarken over een periode van 30 jaar.  En hoe groter het BMI, hoe groter het risico op overlijden gerelateerd aan borstkanker. ook het effect van de behandeling, of dat nu chemo of hormoontherapie is,  is evenredig minder hoe dikker men is. Het lijkt dus van groot belang om iets te doen aan overgewicht. Hier de cijfers uit de studie bij elkaar gezet.

High BMI Increases Risk for Metastasis and Death

In the current study, Marianne Ewertz, MD, DMSc, from the Department of Oncology, Odense University Hospital in Denmark, and colleagues, used the Danish Breast Cancer Cooperative Group to identify 53,816 women treated for early-stage breast cancer in Denmark between 1977 and 2006. These patients all had complete follow-up information for first events (locoregional recurrences and distant metastases) up to 10 years, and mortality data up to 30 years.

Within this group, information on BMI at diagnosis was available for 18,967 (35%) patients. The cohort was divided into 4 categories, according to BMI: less than 25 kg/m2, 25 to 29 kg/m2, 30+ kg/m2, and unknown.

Patients with a BMI of 30 kg/m2 or greater tended to be older, were more often postmenopausal, had larger tumors, and had both more lymph nodes removed and more positive lymph nodes, but had less invasion into deep fascia (P < .001 for all), compared with those with a BMI of less than 25 kg/m2.

At a median estimated potential follow-up period of 7.1 years, there were 4180 locoregional recurrences and 7278 distant metastases as first events. Although BMI did not seem to influence the risk for locoregional recurrences, risk for distant metastases rose with increasing BMI. At 10 years, the cumulative incidences were

  • 20.1% (95% confidence interval , 19.2% - 20. 9%) for patients with a BMI of less than 25 kg/m2,
  • 22.4% (95% CI, 21.1% - 23.8%) for patients with a BMI of 25 to 29 kg/m2, and
  • 24.3% (95% CI, 22.1% - 26.5%) for patients with a BMI of 30 kg/m2 or more.

The authors noted that among the group of patients whose BMI was unknown, the risk of developing distant metastases throughout the 10 years of follow-up was consistently lower: At 10 years, the cumulative incidence was 16.1% (95% CI, 15.6% - 16.6%).

At a median estimated potential follow-up of 11.4 years, 15,197 patients had died of breast cancer, and 5967 had succumbed to other causes. There was a trend of increasing risk for breast cancer–specific mortality with increasing BMI. At 30 years, the cumulative risks of dying from breast cancer were

  • 46.4% (95% CI, 44.8% - 48.0%) for patients with a BMI of less than 25 kg/m2,
  • 53.4% (95% CI, 50.5% - 56.2%) for patients with a BMI of 25 to 29 kg/m2, and
  • 57.2% (95% CI, 51.8% - 62.2%) for patients with a BMI of 30 kg/m2 or more.

Those with unknown BMI had a consistently lower risk of dying from breast cancer; the cumulative risk at 30 years was 41.1% (95% CI, 40.2% - 42.0%). The risk for death from other causes was also higher among patients with the greatest BMI compared with those in the other weight categories.

The authors also evaluated the efficacy of adjuvant treatment in lean and obese women. Although they did not observe a specific pattern during the first 10 years of follow-up, both chemotherapy and endocrine therapy seemed to be less effective in patients with BMIs of 30 kg/m2 or greater after 10 or more years.

The authors have disclosed no relevant financial relationships.

J Clin Oncol. Published online November 29, 2010.


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