The impact of obesity on treatment choices and outcomes in operable breast cancer

https://doi.org/10.1016/j.amjsurg.2018.10.048Get rights and content

Abstract

Introduction

Obesity has been associated with negative oncologic outcomes in breast cancer.

Methods

Retrospective review of patients with operable breast cancer at a single institution from 2009 to 2012. Patients with carcinoma in situ or metastatic disease were excluded. Variables included utilization of MRI, surgical treatment, perioperative, and long-term oncologic outcomes. Primary outcome was rate of breast conserving surgery. Secondary outcomes included MRI utilization, contralateral prophylactic mastectomy, and perioperative outcomes.

Results

There were 1566 patients included for the study, 596 (38%) of whom were obese. MRI was utilized less in obese patients (62.4% vs 51.2%, p < 0.001). Breast conserving surgery was more common in obese patients (53.1% vs 59.7%, p 0.010). There was no difference in performance of contralateral prophylactic mastectomy or post-mastectomy reconstruction. Perioperative outcomes were inferior in obese patients including increased surgical site infections (5.7% vs 11.7%, p < 0.001), return to the emergency department (2.5% vs 5.2%, p 0.004), and hospital readmissions (1.8% vs 3.7%, p 0.017). No difference in survival was observed.

Conclusion

Obese patients with operable breast cancer receive different treatment than non-obese patients, however survival and recurrence outcomes were similar among the two groups.

Section snippets

Background

Breast cancer is the most common cancer in the United States with approximately 12.4% of US women being diagnosed during their lifetime.1 Obesity has been linked to an increased risk of developing hormone-receptor positive breast tumors with some studies demonstrating up to a 52% increase in the risk of developing hormone receptor positive breast cancers in post-menopausal women with obesity. The increased risk in post-menopausal obese women is thought to be due to increased levels of aromatase

Materials and methods

The study was conducted as a retrospective review of consecutive patients with invasive breast cancer diagnosed between 2009 and 2012. This was conducted within a single institution, Spectrum Health, at the Butterworth and Blodgett Campuses. The study obtained approval from the Institutional Review Board with a waiver of informed consent.

Demographics

There were 1566 patients included for study, of which 596 (38%) were obese. The groups were equivalent for nulliparity, tumor histology, grade, nodal disease, lymphovascular invasion, and hormone receptor status. Obese patients were older with a higher incidence of comorbidities including hypertension, DM, hyperlipidemia and hypothyroidism. Obese patients were also more likely to present with stage II breast cancer. Please see Table 1 for further information on demographics and tumor

Discussion

The rate of obesity in the United States has been steadily increasing over the past several decades. In the wake of this epidemic, it is important to understand the impact of obesity on the treatment and outcomes of other diseases. We sought to examine the impact of obesity on a large consecutive cohort of patients with invasive breast cancer.

Obese patients in our study were more likely to undergo breast conserving surgery than non-obese patients. This is important as mastectomy rates increase

Conflict of interest disclosures

The authors have no disclosures.

References (8)

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