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. 2024 Jul 1;7(7):e2421846.
doi: 10.1001/jamanetworkopen.2024.21846.

Obesity and Early-Onset Breast Cancer and Specific Molecular Subtype Diagnosis in Black and White Women: NIMHD Social Epigenomics Program

Sarabjeet Kour Sudan  1   2   3 , Amod Sharma  1   2   3 , Kunwar Somesh Vikramdeo  1   2   3 , Wade Davis  1   2 , Sachin K Deshmukh  1   2 , Teja Poosarla  4 , Nicolette P Holliday  5 , Pranitha Prodduturvar  1 , Cindy Nelson  1 , Karan P Singh  6 , Ajay P Singh  1   2   3   7 , Seema Singh  1   2   3   7
Affiliations

Obesity and Early-Onset Breast Cancer and Specific Molecular Subtype Diagnosis in Black and White Women: NIMHD Social Epigenomics Program

Sarabjeet Kour Sudan et al. JAMA Netw Open. .

Abstract

Importance: Epidemiologic data suggest an association of obesity with breast cancer (BC); however, obesity's contribution to early onset and risk of diagnosis with specific molecular subtypes by race is uncertain.

Objective: To examine the race-specific association of body mass index with early onset and diagnosis of specific molecular subtypes.

Design, setting, and participants: This retrospective cohort study included patients with BC diagnosed between October 1, 2017, and March 31, 2022, at 3 University of South Alabama Mitchell Cancer Institute clinics. Participants were also prospectively enrolled for serum leptin measurement.

Main outcomes and measures: The primary outcome was age at BC onset and specific subtype diagnosis. The secondary outcome was race-specific differences. Odds ratios (ORs) for associations of body mass index with age at onset and subtype were estimated using the Fisher exact test. Race was self-reported.

Results: Of the 1085 study patients, 332 (30.6%) were Black with a median age of 58 (IQR, 50-66) years, and 753 (69.4%) were White with a median age of 63 (IQR, 53-71) years. A total of 499 patients (46.0%) had obesity, with Black women with obesity receiving more frequent BC diagnosis than their White counterparts (OR, 2.40; 95% CI, 1.87-3.15; P < .001). In addition, Black women had a significantly higher incidence of early-onset disease (OR, 1.95; 95% CI, 1.33-2.86; P = .001) than White women, and obesity increased this risk significantly in Black women (OR, 2.92; 95% CI, 1.35-6.22; P = .006). Black women with obesity also had a significantly higher risk of luminal A BC (OR, 2.53; 95% CI, 1.81-3.56; P < .001) and triple-negative BC (TNBC) (OR, 2.48; 95% CI, 1.43-4.22; P = .002) diagnosis than White counterparts. Black women, with or without BC, had significantly higher serum leptin levels (median [IQR], 55.3 [40.3-66.2] ng/mL and 29.1 [21.1-46.5] ng/mL, respectively, P < .001) than White women (median [IQR], 33.4 [18.9-47.7] ng/mL and 16.5 [10.0-22.9] ng/mL, respectively), which was associated with higher odds of luminal A disease (OR, 5.25; 95% CI, 1.69-14.32, P = .003). Higher odds of early-onset disease (OR, 3.50; 95% CI, 0.43-23.15; P = .33 for trend), and TNBC diagnosis (OR, 6.00; 95% CI, 0.83-37.27; P = .14 for trend) were also seen, although these outcomes were not statistically significant.

Conclusions and relevance: In this cohort study of patients with BC, obesity and high serum leptin levels were associated with an enhanced risk of early-onset BC and diagnosis of luminal A and TNBC subtypes in Black women. These findings should help in developing strategies to narrow the existing disparity gaps.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Prodduturvar reported receiving personal fees from the Bristol Myers Squibb speaker’s bureaus outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association of Breast Cancer (BC) With Body Mass Index (BMI) and Age
A, Distribution of BMI (calculated as weight in kilograms divided by height in meters squared) in patients with BC (n = 1085). All patients were divided into 3 BMI categories: less than 24.9 (normal weight), 25.0 to 29.9 (overweight), and greater than 30.0 (obesity). B, Distribution of BMI in patients with BC by race. C, Distribution of age between Black and White women. Total patients were divided into 3 age categories: younger than 45, 45 to 65, and older than 65 years. D, Association of BMI with BC among the early age group (aged <45 years) between Black and White women.
Figure 2.
Figure 2.. Prevalence of Breast Cancer (BC) Subtypes in Association With Body Mass Index (BMI)
A, Percentage distribution of BC subtypes from a retrospective cohort among total, Black, and White women. B, Percentage distribution of BC subtypes under 3 BMI (calculated as weight in kilograms divided by height in meters squared) groups in the total cohort of patients. C and D, Percentage distribution of BC subtypes under 3 BMI groups between White (C) and Black (D) women. TNBC indicates triple-negative BC.
Figure 3.
Figure 3.. Levels of Serum Leptin and Association With Early-Onset Breast Cancer (BC)
A, Serum levels of leptin in patients without BC (n = 100) and patients with BC (n = 99). B, Serum levels of leptin in Black and White women (n = 50 each for non-BC group and n = 53 and 46 for the BC groups, respectively. C, Distribution of leptin levels between Black and White women in patients with BC. D, Association of leptin levels with BC incidence among the early age group (aged <45 years) between Black and White women.
Figure 4.
Figure 4.. Association of Serum Leptin Levels With Breast Cancer (BC) Subtype Diagnosis
Percentage distribution of BC subtypes among 3 leptin groups between White and Black women. TNBC indicates triple-negative BC.
See this image and copyright information in PMC

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