Study: Weight gain associated with breast cancer survivorship

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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. (8/24/15)


At a glance                  Questions for your doctor
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Guidelines Resources and references


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 study 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.  

Study findings:

  • Overall, breast cancer survivors gained about 3 pounds more weight than previvors.
  • Women who received chemotherapy were twice as likely to gain at least 11 pounds at the researchers’ follow-up point compared with women who were never diagnosed with cancer. 
  • ER-negative breast cancer survivors had the greatest weight gain. This group gained on average approximately 7 more pounds than previvors.
  • On average, premenopausal survivors gained more weight than postmenopausal survivors.

What does this mean for me?  

This study shows that in women with a family history of cancer a breast cancer diagnosis and treatment is linked to weight gain. This study did not look at specific causes of, or ways to manage this weight gain. However, there are expert guidelines and programs available to help cancer survivors control their weight. Knowing your risk for weight gain after diagnosis and treatment may help you and your doctor create a plan for weight management after treatment.  

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Expert Guidelines

The National Comprehensive Cancer Network sets recommendations on weight management and nutrition for cancer survivors.

NCCN Principles of Weight Loss

  • Replace foods that are high in calories with low-calorie, nutritious foods.
  • Practice portion control by using smaller plates and avoiding extra servings.
  • Monitor weight daily.
  • Incorporate physical activity, particularly strength training to improve body mass. 
  • Track diet, calories and physical activity routines. 
  • Consider referral to a registered dietitian.

NCCN General Principles of Nutrition

  • Assess diet for daily intake of fruits, vegetables, and unrefined grains, as well as red and processed meats, alcohol, and processed foods or beverages with added fats and/or sugars.
  • Assess eating habits, including portion size, night grazing, snacking habits, frequency of eating out, and use of added fats and/or sugars to foods or beverages.
  • Encourage informed choices about food to ensure variety and adequate nutrient intake.
  • Recommend plant-based diet with majority of food being vegetables, fruits and whole grains with limited amounts of refined sugars and red or processed meat.

NCCN General Principles of Weight Management

  • Weight loss should be a priority for overweight/obese cancer survivors.
  • Maintenance of weight should be encouraged for normal weight survivors.
  • Weight gain should be a priority for underweight survivors. 
  • Weight gain after a cancer diagnosis is common; discuss strategies to prevent weight gain.

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?
  • What are the current guidelines for weight management for cancer survivors?
  • Can you refer me to a registered dietitian who specializes in oncology nutrition? 

Open Clinical Trials

  • NCT02750826: Breast Cancer WEight Loss Study (BWEL Study) is a phase III trial studying whether weight loss in overweight and obese women may prevent breast cancer from coming back (recurrence). This study aims to test whether overweight or obese women who take part in a weight loss program after being diagnosed with breast cancer have a lower rate of cancer recurrence as compared to women who do not take part in the weight loss program. 
  • NCT03314688: Lifestyle, Exercise, and Nutrition Study Early After Diagnosis will examine, in 250 women newly diagnosed with Stage I-III breast cancer who are not practicing the dietary and lifestyle guidelines, and who are scheduled to receive neoadjuvant or adjuvant chemotherapy,



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 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 did not have a family history of cancer were not included in the comparisons. 


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. 

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posted 8/24/15

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