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BACKGROUND Although a large body of research exists concerning pathologic prognostic indicators of the rate of incidence and survival from breast carcinoma, to the authors' knowledge very few studies have examined the effects of anthropometric variables such as height, obesity, weight gain in adulthood, timing of weight gain, and body composition to survival, although these variables are related to the incidence rate. METHODS The survival status of 166 patients diagnosed with primary breast carcinoma and followed for at least 10 years was obtained from the Cancer Center's registry, and significant anthropometric and other known prognostic indicators regarding survival after diagnosis were determined by Cox proportional hazards analysis. RESULTS Eighty-three of 166 breast carcinoma patients (50%) with up to 10 years of follow-up died of disease. Android body fat distribution, as indicated by a higher suprailiac:thigh ratio, was a statistically significant (P < 0.0001) prognostic indicator for survival after controlling for stage of disease, with a hazards ratio of 2.6 (95% confidence interval [95% CI], 1.63–4.17). Adult weight gain, as indicated specifically by weight at age 30 years, was a statistically significant (P < 0.05) prognostic indicator for survival with a hazards ratio of 1.15 (95% CI, 1.0–1.28). In addition, the authors observed the Quatelet Index, a negatively significant (P < 0.01) prognostic indicator for survival with a hazards ratio of 0.92 (95% CI, 0.87–0.98). Other markers of general obesity such as weight at diagnosis, percent body fat, and body surface area were not significant markers influencing survival. Similarly, height; triceps, biceps; subscapular, suprailiac, abdominal, and thigh skinfolds; waist and hip circumferences; family history; and reproductive and hormonal variables at the time of diagnosis showed no apparent significant relation to survival. CONCLUSIONS The results of the current study provide some evidence that android body fat distribution at diagnosis and increased weight at age 30 years increases a woman's risk of dying of breast carcinoma. Cancer 2000;88:2751–7. © 2000 American Cancer Society.

Background. Obesity and body-fat distribution have been associated with the incidence of breast and endometrial cancers. It may be critical to determine if the timing of weight gain during periods of hormonal change, such as menarche, pregnancy, or menopause, has different biologic effects, especially secondary to differences in the localization of body fat during these periods. The objective of the current study was to determine if excess weight in any particular decade of life or the timing of weight gain was more significant relative to breast cancer risk. Methods. Anthropometric, medical, and hormonal histories were obtained from 218 consecutively recruited, newly diagnosed patients with breast cancer admitted to the H. Lee Moffitt Cancer Center and Research Institute (Tampa, FL) and 436 control subjects, matched in a two to one ratio for age and menopausal status. Results. A weight gain of 15 pounds or more was observed for 63.8% of the patients compared with 49.3% control subjects (P = 0.0006) from age 30 to current age. Similarly, more than 48% of cases gained more than 15 pounds from ages 16 to 30 compared with 37% (P = 0.01) of the control population. Although weight gain from age 16 to adulthood was significantly higher in patients with breast cancer at each decade when compared with control subjects, a significant and independent association between weight at age 30 (P < 0.0001) and risk of breast cancer was noted. Conclusion. Women who progressively gain weight from puberty to adulthood, and specifically in the third decade of life, should be considered at a higher risk for developing breast cancer. Cancer 1995 76:243–9.

Background. The risk for breast cancer and the sex hormone abnormalities noted in breast cancer patients have been demonstrated in women with upper body fat obesity. The objective of this study was to determine if the visceral component of upper body fat obesity was correlated with breast cancer risk. Methods. A case-control study of 40 consecutively enrolled women with breast cancer and 40 community based age, weight, and waist circumference-matched control subjects was conducted. The areas of visceral fat, subcutaneous fat, and total fat were measured using computed tomography at the 1, -4 vertebral body. Calculations of relative risk for breast cancer were based on these fat compartments. Results. Patients with breast cancer had a significantly greater visceral fat area (P = 0.01), visceral-to-to-tal-fat area ratio (VT ratio) (P 0.24 = 9.5) (P < 0.0001) and decreasing SV ratio (≥3.64 = 1.0

BACKGROUND The pattern of body fat distribution in women has been correlated with the risk of developing breast and endometrial cancer. The authors determined whether body fat distribution varied between first-degree relatives of patients with breast cancer and in cancer-free families by comparing the body fat distribution of first-degree relatives of patients with breast cancer with age and Quetelet Index-matched controls. METHODS Fifty-six first-degree relatives of newly diagnosed patients with breast cancer were compared with 56 controls (non-cancer family members) matched for age and Quetelet Index and were studied for variation in body fat distribution. Anthropometric measurements were taken for the abdomen, thigh, suprailiac, subscapular, biceps, and triceps skinfold thickness; waist and hip circumference; weight; and height. The distribution of body measurements and derived ratios in both case and control family members were compared using the Student t test. RESULTS A significant variation in body fat distribution occurred among first-degree relatives in breast cancer and control families. In families with a history of breast cancer, first-degree family members were found to have significantly greater waist:hip ratio (P < 0.001) compared with controls without family history matched for age and Quetelet Index. Other variables indicating upper body fat localization, such as abdomen and suprailiac skinfold were significantly greater in family members of patients with breast cancer compared with controls. CONCLUSIONS A marked variation occurred in body fat localization among first-degree relatives of patients with breast cancer and in cancer-free families. This finding implies a variation in breast cancer risk in these families. Identifying family members with upper body fat distribution in breast cancer families would allow targeting of these individuals for energetic screening and risk factor reduction interventions.

Background. Americans visit their primary care physicians several times a year. These visits provide physicians with many opportunities to reduce cancer risk in their patients by recommending periodic cancer screening. There is evidence of noncompliance among primary care physicians and their patients with regard to periodic cancer screening. Barriers to screening may be perceived by physicians and patients. Results. The authors found that when physicians recommended cancer screening tests, the compliance among patients was relatively high. Conclusion. Primary care physicians can take the opportunity to recommend cancer screening tests during routine patient visits, and this strategy may well increase cancer screening rates in the population.

Background. Screening for breast cancer using mammography has been shown to be effective in reducing mortality from breast cancer. The authors attempted to determine if use of a wallet-size plastic screening “credit” card would increase participants' compliance for subsequent mammograms when compared with traditional methods of increasing compliance. Methods. Two hundred and twenty consecutive women, ages 40-70 years, undergoing their first screening mammography were recruited and assigned randomly to four groups receiving (1) a reminder plastic credit card (2) reminder credit card with written reminder; (3) appointment card; and (4) verbal recommendation. Return rates of the four groups were determined after 15 months. Results. The return rate for subsequent mammograms was significantly higher for participants (72.4%) using the credit card than for participants (39.8%) exposed to traditional encouragement/reminders (P < 0.0001). Conclusions. The credit card was designed to show the participant's screening anniversary, and the durability of the card may have been a factor in increasing the return rate. The use of reminder credit cards may increase compliance for periodic screening examinations for other cancers and other chronic diseases. Cancer 1992; 701509-512.

Upper body fat localization has been associated with an increased risk of cancer. This study demonstrated that 64.2% of 124 women with at least a 4.5-kg weight loss decreased their upper body fat localization, as measured by a reduction in their suprailiac-thigh skin fold ratio and other skin fold thicknesses associated with upper body fat localization. Based on a risk model previously developed for breast cancer and upper body fat localization, a reduction in estimated breast cancer relative risk of 45% was calculated for the entire group of women who lost 4.5 kg or more in weight. Greater weight loss further reduced upper body fat localization and estimated breast cancer risk based on this model.

This study addresses the relationship between female sex hormones, obesity, body fat distribution, and breast cancer. Increasing obesity correlated with a progressive fall in sex hormone-binding globulin (SHBG) level and an increase in testosterone level. Premenopausal breast cancer patients were found to have significantly lower levels of SHBG compared with age-matched and weight-matched controls. This difference in SHBG level was not noted in postmenopausal breast cancer patients. The SHBG level decreased with increasing upper body fat localization in breast cancer patients and controls. This effect was more marked in breast cancer patients which may explain our earlier finding that women with upper body fat localization are at increased risk for developing breast cancer.

There is increasing evidence that dietary factors may play a role in the production, metabolism, and bioavailability of sex hormones and their impact on target tissues. The specific objective of this study was to evaluate the effectiveness of supplementing a group of premenopausal women who were free of breast carcinoma with a dietary supplement of isoflavones (40 mg per day) in producing a change in steroid hormones and menstrual cycle length.Sixty-eight consecutively recruited, premenopausal, omnivorous women of all races and ethnicities between the ages of 25 years and 55 years were admitted to the study and randomized to an experimental group supplemented with soy (40 mg genistein per day) or to a control group that consumed a placebo for a 12-week period. Changes in their anthropometric, nutritional, and hormonal biomarkers from early follicular phase were analyzed at baseline and post-intervention.Serum-free estradiol and estrone levels decreased moderately in the experimental group. Serum hormone-binding globulin levels increased in 41.4% of women in the experimental group compared with 37.5% of women in the placebo group. Free estradiol decreased in 53.85% of women in the experimental group compared with 37.5% of women in the placebo group. Estrone decreased in 55.56% of women in the experimental group compared with 42.86% in the placebo group. Those women in the experimental group who were consuming soy had their mean menstrual cycle length increased by 3.52 days compared with a mean decrease of 0.06 days for women in the placebo group (P = 0.04) from baseline to the third menstrual cycle. In addition, women who were taking soy had their mean follicular phase increase by 1.46 days compared with a mean increase of 0.14 days for women who were taking the placebo (P = 0.08).These data suggest that increased isoflavone intake affects estrogen metabolism by altering the steroid hormone concentrations and menstrual cycle length, thereby demonstrating a potential to reduce the risk for breast carcinoma.