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Review
. 2014;36(1):114-36.
doi: 10.1093/epirev/mxt010.

Body mass index and breast cancer risk according to postmenopausal estrogen-progestin use and hormone receptor status

Mark F Munsell  1 , Brian L Sprague, Donald A Berry, Gary Chisholm, Amy Trentham-Dietz
Affiliations
Review

Body mass index and breast cancer risk according to postmenopausal estrogen-progestin use and hormone receptor status

Mark F Munsell et al. Epidemiol Rev. 2014.

Abstract

To assess the joint relationships among body mass index, menopausal status, and breast cancer according to breast cancer subtype and estrogen-progestin medication use, we conducted a meta-analysis of 89 epidemiologic reports published in English during 1980-2012 identified through a systematic search of bibliographic databases. Pooled analysis yielded a summary risk ratio of 0.78 (95% confidence interval (CI): 0.67, 0.92) for hormone receptor-positive premenopausal breast cancer associated with obesity (body mass index (weight (kg)/height (m)(2)) ≥30 compared with <25). Obesity was associated with a summary risk ratio of 1.39 (95% CI: 1.14, 1.70) for receptor-positive postmenopausal breast cancer. For receptor-negative breast cancer, the summary risk ratios of 1.06 (95% CI: 0.70, 1.60) and 0.98 (95% CI: 0.78, 1.22) associated with obesity were null for both premenopausal and postmenopausal women, respectively. Elevated postmenopausal breast cancer risk ratios associated with obesity were limited to women who never took estrogen-progestin therapy, with risk ratios of 1.42 (95% CI: 1.30, 1.55) among never users and 1.18 (95% CI: 0.98, 1.42) among users; too few studies were available to examine this relationship according to receptor subtype. Future research is needed to confirm whether obesity is unrelated to receptor-negative breast cancer in populations of postmenopausal women with low prevalence of hormone medication use.

Keywords: body mass index; breast neoplasms; estrogen receptors; meta-analysis as topic; postmenopausal hormone replacement therapy; progesterone receptors.

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Figures

Figure 1.
Figure 1.
Identification, review, and selection of studies included in the meta-analysis of breast cancer in relation to body mass index (BMI).
Figure 2.
Figure 2.
Identification, review, and selection of studies included in the meta-analysis of breast cancer in relation to postmenopausal hormone use.
Figure 3.
Figure 3.
Summary forest plots of the association between body mass index and premenopausal breast cancer according to study design, comparing body mass index 25.0–29.9 with <25 kg/m2 (Egger's test P = 0.08). Numbers of cases are shown for women with body mass index 25.0–29.9/<25 kg/m2. If only 1 sample size is shown for the number of cases, then this number represents all cases in the study. CI, confidence interval.
Figure 4.
Figure 4.
Summary forest plots of the association between body mass index and premenopausal breast cancer according to study design, comparing body mass index ≥30 with <25 kg/m2 (Egger's test P = 0.14). Numbers of cases are shown for women with body mass index ≥30/<25 kg/m2. If only 1 sample size is shown for the number of cases, then this number represents all cases in the study. CI, confidence interval.
Figure 5.
Figure 5.
Summary forest plots of the association between body mass index and postmenopausal breast cancer according to study design, comparing body mass index 25.0–29.9 with <25 kg/m2 (Egger's test P = 0.68). Numbers of cases are shown for women with body mass index 25.0–29.9/<25 kg/m2. If only 1 sample size is shown for the number of cases, then this number represents all cases in the study. CI, confidence interval.
Figure 6.
Figure 6.
Summary forest plots of the association between body mass index and postmenopausal breast cancer according to study design, comparing body mass index ≥30 with <25 kg/m2 (Egger's test P = 0.05). Numbers of cases are shown for women with body mass index ≥30/<25 kg/m2. If only 1 sample size is shown for the number of cases, then this number represents all cases in the study. CI, confidence interval.
Figure 7.
Figure 7.
Summary forest plots of the association between body mass index ≥30 (reference value, <25 kg/m2) and postmenopausal breast cancer according to study design, among never users of postmenopausal hormones (Egger's test P = 0.53). Numbers of cases are shown for women with body mass index ≥30/<25 kg/m2. CI, confidence interval.
Figure 8.
Figure 8.
Summary forest plots of the association between body mass index ≥30 (reference value, <25 kg/m2) and postmenopausal breast cancer according to study design, among ever users of postmenopausal hormones (Egger's test P = 0.84). Numbers of cases are shown for women with body mass index ≥30/<25 kg/m2. CI, confidence interval.
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