Body Mass Index and Clinical Outcomes in Egyptian Women with Breast Cancer: A Multi-institutional Study

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Amrou Mamdouh Abdeen Shaaban
Ahmed Hassan Abd Aziz
Nada Sholkamy
Hoda Mokhtar
Shimaa Anwer Emam
Abeer Hussien Anter


Purpose: The aim of this work was to evaluate the association between body mass index (BMI) and clinical outcomes among Egyptian female breast cancer patients.

Methods: We reviewed the file registry of 629 patients with operable breast cancer regarding age, sex, height, weight, menopausal status, family history of breast cancer, tumor features, TNM arrangement and treatment during the period from January 2006 to December 2012. In our studies, obesity was defined as a BMI of ≥30 kg/m2. The primary objective was to estimate the effect of body mass index on the clinical outcomes of breast cancer patients including DFS and OAS.

Results: A total of 629 patients with a mean age of 51.1 years. Stage III and Stage II presented 52% and 46.6% respectively. Overweight and obese patients represent 60.5% of all patient population. There was no association between tumor stage, grade or menopausal status and BMI. Patients with normal BMI showed a median survival of 95.3 months [CI: 54.6,136.06]. This was significantly higher than overweight and obese patients (p = 0.001). Nearly one-third of patients (29.1%) with normal BMI experienced disease relapse compared to 32.8% for overweight and obese patients, however, this was statistically not significant (0.097).

Conclusion: According to the results of this retrospective study, increased BMI may be associated with less favorable prognosis of breast cancer patients.

Breast cancer, body mass, outcome

Article Details

How to Cite
Shaaban, A. M. A., Aziz, A. H. A., Sholkamy, N., Mokhtar, H., Emam, S. A., & Anter, A. H. (2020). Body Mass Index and Clinical Outcomes in Egyptian Women with Breast Cancer: A Multi-institutional Study. Journal of Cancer and Tumor International, 10(3), 10-17.
Original Research Article


Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics. CA: A Cancer Journal for Clinicians. 2015;65(2):87-108.

Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in Egypt: Results of the national population-based cancer registry program. Journal of Cancer Epidemiology. 2014;437971.

Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: Cohort study. BMJ. 2007;335(7630):1134.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014;384(9945): 766-81.

Bianchini F, Kaaks R, Vainio H. Overweight, obesity and cancer risk. The Lancet Oncology. 2002;3(9):565-74.

Ursin G, Longnecker MP, Haile RW, Greenland S. A meta-analysis of body mass index and risk of premenopausal breast cancer; 1995.

Van den Brandt PA, Spiegelman D, Yaun SS, Adami H-O, Beeson L, Folsom AR, et al. Pooled analysis of prospective cohort studies on height, weight and breast cancer risk. American Journal of Epidemiology. 2000;152(6):514-27.

MacInnis RJ, English DR. Body size and composition and prostate cancer risk: A systematic review and meta-regression analysis. Cancer Causes & Control. 2006;17(8):989-1003.

Larsson SC, Wolk A. Obesity and colon and rectal cancer risk: A meta-analysis of prospective studies. The American Journal of Clinical Nutrition. 2007;86(3):556-65.

De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. Journal of Obesity; 2013.

Louie SM, Roberts LS, Nomura DK. Mechanisms linking obesity and cancer. Biochimica Et Biophysica Acta (BBA)-Molecular and Cell Biology of Lipids. 2013;1831(10):1499-508.

Vitolins MZ, Kimmick GG, Case LD. BMI influences prognosis following surgery and adjuvant chemotherapy for lymph node-positive breast cancer. The Breast Journal. 2008;14(4):357-65.

Dignam JJ, Wieand K, Johnson KA, Raich P, Anderson SJ, Smokin C, et al. Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Research and Treatment. 2006;97(3):245-54.

Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. Journal of Clinical Oncology. 2002;20(4):1128-43.

Ryu SY, Kim CB, Nam CM, Park JK, Kim KS, Park J, et al. Is body mass index the prognostic factor in breast cancer? A meta-analysis. Journal of Korean Medical Science. 2001;16(5):610.

Chan D, Vieira A, Aune D, Bandera E, Greenwood D, McTiernan A, et al. Body mass index and survival in women with breast cancer—systematic literature review and meta-analysis of 82 follow-up studies. Annals of Oncology. 2014;25(10):1901-14.

Greene F, Page D, Fleming I, Cancer AJCo. Cancer staging manual. American Joint Committee on Cancer (AJCC); Digestive System; Lippincott Raven Publishers: Philadelphia, PA, USA. 2002;113-24.

Organization WH. Tumors of the breast and female genital organs. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Breast and Female Genital Organs Lyon: International Agency for Research in Cancer; 2003.

Organization WH, Ageing WHO, Unit LC. WHO global report on falls prevention in older age: World Health Organization; 2008.

Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Madarnas Y, et al. Fasting insulin and outcome in early-stage breast cancer: Results of a prospective cohort study. Journal of Clinical Oncology. 2002;20(1):42-51.

Group EHBCC. Body mass index, serum sex hormones and breast cancer risk in postmenopausal women. Journal of the National Cancer Institute. 2003;95(16): 1218-26.

Berclaz G, li S, Price KN, Coates AS, Castiglione-Gertsch M, rudenstam CM, et al. Body mass index as a prognostic feature in operable breast cancer: The International Breast Cancer Study Group Experience Ann Oncol. 2004;15:875-84.

Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain and survival after a breast cancer diagnosis. Journal of Clinical Oncology. 2005;23(7):1370-8.

Caan BJ, Kwan ML, Hartzell G, Castillo A, Slattery ML, Sternfeld B, et al. Pre-diagnosis body mass index, post-diagnosis weight change and prognosis among women with early-stage breast cancer. Cancer Causes & Control. 2008;19(10): 1319-28.

Majed B, Moreau T, Senouci K, Salmon RJ, Fourquet A, Asselain B. Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Research and Treatment. 2008;111(2):329-42.

Ewertz M, Jensen M-B, Gunnarsdóttir KÁ, Højris I, Jakobsen EH, Nielsen D, et al. Effect of obesity on prognosis after early-stage breast cancer. Journal of Clinical Oncology. 2010;29(1):25-31.

Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: Systematic review and meta-analysis. Breast Cancer Research and Treatment. 2010;123(3):627-35.

Ligibel JA, Goodwin PJ. New and Renew: Building the case for weight loss in breast cancer. American Society of Clinical Oncology; 2012.

Huang Z, Hankinson SE, Colditz GA, Stampfer MJ, Hunter DJ, Manson JE, et al. Dual effects of weight and weight gain on breast cancer risk. Jama. 1997;278(17): 1407-11.

Lahmann PH, Hoffmann K, Allen N, Van Gils CH, Khaw KT, Tehard B, et al. Body size and breast cancer risk: Findings from the European Prospective Investigation into Cancer and Nutrition (EPIC). International Journal of Cancer. 2004;111(5):762-71.

Moon HG, Han W, Noh DY. Underweight and breast cancer recurrence and death: A report from the Korean Breast Cancer Society. Journal of Clinical Oncology. 2009;27(35):5899-905.

Chen S, Chen CM, Zhou Y, Zhou RJ, Yu KD, Shao ZM. Obesity or overweight is associated with worse pathological response to neoadjuvant chemotherapy among Chinese women with breast cancer. PLoS One. 2012;7(7):41380.

Suzuki R, Saji S, Toi M. Impact of body mass index on breast cancer in accordance with the life-stage of women. Frontiers in Oncology. 2012;2:123.

Mæhle BO, Tretli S. Pre-morbid body-mass-index in breast cancer: Reversed effect on survival in hormone receptor negative patients. Breast Cancer Research and Treatment. 1996;41(2):123-30.

Tretli S, Haldorsen T, Ottestad L. The effect of pre-morbid height and weight on the survival of breast cancer patients. British Journal of Cancer. 1990;62(2):299.

Senie RT, Rosen PP, Rhodes P, Lesser ML, Kinne DW. Obesity at diagnosis of breast carcinoma influences the duration of disease-free survival. Annals of Internal Medicine. 1992;116(1):26-32.

Katoh A, Watzlaf V, D'Amico F. An examination of obesity and breast cancer survival in postmenopausal women. British Journal of Cancer. 1994;70(5):928.

De Azambuja E, McCaskill-Stevens W, Francis P, Quinaux E, Crown JP, Vicente M, et al. The effect of body mass index on overall and disease-free survival in node-positive breast cancer patients treated with docetaxel and doxorubicin-containing adjuvant chemotherapy: The experience of the BIG 02-98 trial. Breast Cancer Research and Treatment. 2010;119(1): 145-53.

Bastarrachea J, Hortobagyi GN, Smith TL, Kau S-WC, Buzdar AU. Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer. Annals of Internal Medicine. 1994;120(1):18-25.

Daling JR, Malone KE, Doody DR, Johnson LG, Gralow JR, Porter PL. Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma. Cancer. 2001;92(4):720-9.