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Weight gain associated with breast cancer survivorship


This research is relevant for:

Checked Breast cancer survivors

Checked Women under 45

Checked Women over 45

Unhecked Men with breast cancer

Unhecked Metastatic breast cancer

Unhecked Triple negative breast cancer

Unhecked Previvors

Checked BRCA mutation carriers

Unhecked ER/PR +

Unhecked Her2+ breast cancer

Checked Other mutations: People with other genes that increase the risk for breast cancer.

Checked Special populations: People with a family history of cancer

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Weight gain in breast cancer survivors can affect survival and quality-of-life. This study found that breast cancer survivors are more likely to gain weight than women of the same age who are at high risk, but have never been diagnosed with cancer. The study looked at which groups of survivors were more likely to gain weight.


STUDY AT A GLANCE

This study is about:

The weight change that is associated with being a breast cancer survivor with a family history of breast cancer.

Why is this study important?

Weight gain is associated with various health issues. Weight gain is a risk factor for postmenopausal breast cancer.  Among breast cancer survivors, higher Body Mass Index (BMI) and weight gain increases risk for breast cancer recurrence and/or a new primary cancer.  This is one of the few studies that have compared weight gain between previvors (women at increased risk of breast cancer) and breast cancer survivors and looked specifically at women with a family history of breast cancer.  

Key study findings:

  1. Breast cancer survivors gained significantly more weight than previvors (an average of approximately 3 pounds was gained by breast cancer survivors).
     
  2. Compared to previvors women, survivors who received chemotherapy were 2.1 times more likely to gain at least 11 pounds at the researchers’ follow-up point. 

What does this mean for me?  

This study shows that an association between breast cancer survivors with a family history of breast cancer and weight gain.  While this does not show that being diagnosed with breast cancer directly causes weight gain, maintaining a healthy weight is an important issue that should be discussed with your health care provider because research has shown negative associations with weight gain and increased health problems

Questions to ask your health care provider:

  • How can I manage my weight?
  • Cancer treatment is hard on my body—how do I exercise when I don’t feel like I can/want to?
  • My weight fluctuates—should I be worried if I gain a few pounds?

RESEARCH SUMMARY

Study background:

Many studies have noted weight gain in breast cancer survivors, but they do not directly compare these women with women who have never been diagnosed with cancer.  Without the comparison, it is harder to see whether breast cancer survivors are actually gaining more weight or not. 

Researchers of this study wanted to know:

Whether breast cancer survivors with a family history of breast cancer gain more weight after their diagnosis compared to previvors.

Population(s) used in the study:  

The study compared 303 breast cancer survivors with 307 previvors who had not had breast cancer.  All women had either a family history of breast or ovarian cancer, a BRCA1/2 mutation, or a diagnosis of early breast cancer (diagnosed at age 40 or younger). Participating breast cancer survivors had a personal history of breast cancer (DCIS or stage I-III breast cancer) that had been treated with surgery.  The previvors included in the study were matched to the survivors based on age and menopausal status.  The breast cancer survivors in this study were further subdivided into two categories: survivors who had been diagnosed with breast cancer 5 years or less prior to the study start date, and survivors who had been diagnosed with breast cancer more than 5 years prior to the study start date. 

Study results:

  • Overall, breast cancer survivors gained on average approximately 3 more pounds than previvors.
  • When compared with other subtypes, breast cancer survivors who were diagnosed with ER-negative invasive breast cancer within the 5 years prior to the study start date had the greatest weight gain. This group gained on average approximately 7 more pounds than previvors.
  • Premenopausal breast cancer survivors diagnosed with breast cancer within the 5 years prior to the study start date gained on average approximately 6 more pounds than premenopausal previvors.  
  • Postmenopausal breast cancer survivors diagnosed with breast cancer within the 5 years prior to the study start date gained on average approximately 4 more pounds than postmenopausal previvors.
  • Overall, breast cancer survivors who had received chemotherapy with or without hormone therapy gained on average approximately 4 pounds compared to previvors. An average weight gain of approximately 8 pounds was seen in breast cancer survivors treated with chemotherapy only.
  • Compared to previvors, survivors who received chemotherapy were 2.1 times more likely to gain at least 11 pounds at the researchers’ follow-up point.

The study had limitations. The majority of the study population was white, which means that these findings might not apply to breast cancer survivors of other racial or ethnic backgrounds.  Researchers also did not directly measure the women’s weights—they relied on self-reporting, which may not have been accurate. Additionally, breast cancer survivors who were not at elevated risk were not included in the comparisons. 

Conclusion:

This is a highly relevant study for breast cancer survivors. It shows that in women with a family history of breast cancer and/or a mutation in a gene that increases cancer risk, breast cancer survivorship is a risk factor for weight gain. However, it is important to remember that this is only an association—the study does not show that the weight gain is caused by the breast cancer or the chemotherapy used to treat the breast cancer. More research is needed to find the exact cause, but the study’s authors note that the chemotherapy associated weight gain might be due to less physical activity or with changes in the patient’s metabolism. 

It is also important to note that the average overall weight gain in this study was approximately 3 pounds in breast cancer survivors. Currently we do not know whether gaining that amount increases risk of second primary cancer development or cancer recurrence. For comparison, a study done by Dr. Michelle Holmes’ research group found that women who gained between 0.5 and 2.0 kg/m2 (average weight gain of approximately 7 pounds) and women who gained more than 2.0 kg/m2 (average weight gain of approximately 20 pounds) had elevated risk of breast cancer death compared to women who maintained their weight.

In summary, there is an association between breast cancer and weight gain, and potential health problems are associated with weight gain. Researchers do not know the exact effect that gaining 3 pounds will have on breast cancer survivors. American Cancer Society guidelines say women should try to maintain their weight after a breast cancer diagnosis. 

References

Gross A, May B, Axilbund J, et al. “Weight Change in Breast Cancer Survivors Compared to Cancer-Free Women: A Prospective Study in Women at Familial Risk of Breast Cancer.” Cancer Epidemiology, Biomarkers & Prevention, published online first July 15, 2015.

Kroenke C, Chen W, Rosner B, Holmes M. “Weight, Weight Gain, and Survival After Breast Cancer Diagnosis.” Journal of Clinical Oncology (2005) 23:1370-78.

posted 8/24/15

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