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Epidemiology and Population Health

Consecutive gain and loss in body weight and waist circumference with risk of subsequent breast cancer in Korean women

Abstract

Background

This study investigated the association between longitudinal changes in weight and waist circumference and breast cancer risk according to menopausal status.

Methods

This retrospective cohort study used data from the population-based Korean National Health Insurance Service (NHI) database. The study population included women aged ≥40 years who consecutively underwent three biennial breast cancer screenings between 2009–2014 and were followed up until 2020. The percentage changes in weight and waist circumference during the three screenings were calculated and categorized into five groups based on the level of increase or decrease in these two factors. Hazard ratios (HRs) and 95% confidence intervals (95% CI) for breast cancer risk were calculated and adjusted for other factors.

Results

Of 691,253 premenopausal and 1,519,211 postmenopausal women, 9485 and 12,553 breast cancer cases were identified, respectively, during a median 6.9 follow-up years. Postmenopausal women with two consecutive weight gains had an increased risk of breast cancer risk (HR = 1.11, 95% CI = 1.01 to 1.22); meanwhile, consecutive weight loss was associated with a decreased risk (HR = 0.84, 95% CI = 0.76 to 0.93). Single time and continuous decreases in waist circumference were associated with a decreased risk (HR = 0.91, 95% CI = 0.85 to 0.98, and HR = 0.84, 95% CI = 0.76–0.93), while single time and continuous increases were associated with an increased risk (HR = 1.08, 95% CI = 1.01 to 1.15, and HR = 1.13, 95% CI = 1.04 to 1.22). Single weight gain was associated with the increased breast cancer risk in premenopausal women (HR = 1.07, 95% CI = 1.01 1.13).

Conclusions

Our findings suggest a dose-response relationship between weight, waist circumference change, and the risk of future breast cancer.

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Fig. 1: Our initial database included women aged ≥40 years who underwent all three breast cancer screenings during the three periods.
Fig. 2: Changes in body weight and waist circumference between the 1st and 2nd period, and between 2nd and 3rd period were assessed.
Fig. 3: Multivariable cox regression models for association of change in body weight and waist circumference with breast cancer using restricted cubic splines.

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Data availability

Data are available through the Korean National Health Insurance Sharing Service (NHISS).

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.

    Article  Google Scholar 

  2. Neuhouser ML, Aragaki AK, Prentice RL, Manson JE, Chlebowski R, Carty CL, et al. Overweight, obesity, and postmenopausal invasive breast cancer risk: a secondary analysis of the women’s health initiative randomized clinical trials. JAMA Oncol. 2015;1:611–21.

    Article  Google Scholar 

  3. Eliassen AH, Colditz GA, Rosner B, Willett WC, Hankinson SE. Adult weight change and risk of postmenopausal breast cancer. JAMA. 2006;296:193–201.

    Article  CAS  Google Scholar 

  4. Harvie M, Howell A, Vierkant RA, Kumar N, Cerhan JR, Kelemen LE, et al. Association of gain and loss of weight before and after menopause with risk of postmenopausal breast cancer in the Iowa women’s health study. Cancer Epidemiol Biomarkers Prev. 2005;14:656–61.

    Article  Google Scholar 

  5. Morimoto LM, White E, Chen Z, Chlebowski RT, Hays J, Kuller L, et al. Obesity, body size, and risk of postmenopausal breast cancer: the Women’s Health Initiative (United States). Cancer Causes Control. 2002;13:741–51.

    Article  Google Scholar 

  6. 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). Int J Cancer. 2004;111:762–71.

    Article  CAS  Google Scholar 

  7. Neuhouser ML, Aragaki AK, Prentice RL, Manson JE, Chlebowski R, Carty CL, et al. Overweight, obesity, and postmenopausal invasive breast cancer risk: a secondary analysis of the women’s health initiative randomized clinical trials. JAMA Oncol. 2015;1:611–21.

    Article  Google Scholar 

  8. Hardefeldt PJ, Penninkilampi R, Edirimanne S, Eslick GD. Physical activity and weight loss reduce the risk of breast cancer: a meta-analysis of 139 prospective and retrospective studies. Clin Breast Cancer. 2018;18:e601–12.

    Article  Google Scholar 

  9. Teras LR, Patel AV, Wang M, Yaun SS, Anderson K, Brathwaite R, et al. Sustained weight loss and risk of breast cancer in women 50 years and older: a pooled analysis of prospective data. J Natl Cancer Inst. 2020;112:929–37.

    Article  Google Scholar 

  10. Parker ED, Folsom AR. Intentional weight loss and incidence of obesity-related cancers: the Iowa Women’s Health Study. Int J Obes Relat Metab Disord. 2003;27:1447–52.

    Article  CAS  Google Scholar 

  11. Michels KB, Terry KL, Eliassen AH, Hankinson SE, Willett WC. Adult weight change and incidence of premenopausal breast cancer. Int J Cancer. 2012;130:902–9.

    Article  CAS  Google Scholar 

  12. Lee KR, Hwang IC, Han KD, Jung J, Seo MH. Waist circumference and risk of breast cancer in Korean women: A nationwide cohort study. Int J Cancer. 2018;142:1554–9.

    Article  CAS  Google Scholar 

  13. Park JW, Han K, Shin DW, Yeo Y, Chang JW, Yoo JE, et al. Obesity and breast cancer risk for pre- and postmenopausal women among over 6 million Korean women. Breast Cancer Res Treat. 2021;185:495–506.

    Article  Google Scholar 

  14. White AJ, Nichols HB, Bradshaw PT, Sandler DP. Overall and central adiposity and breast cancer risk in the Sister Study. Cancer. 2015;121:3700–8.

    Article  Google Scholar 

  15. Houghton SC, Eliassen H, Tamimi RM, Willett WC, Rosner BA, Hankinson SE. Central adiposity and subsequent risk of breast cancer by menopause status. J Natl Cancer Inst. 2021;113:900–8.

    Article  Google Scholar 

  16. Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort profile: the national health insurance service-national sample cohort (NHIS-NSC), South Korea. Int J Epidemiol. 2017;46:e15.

    PubMed  Google Scholar 

  17. Bahk J, Kim YY, Kang HY, Lee J, Kim I, Lee J, et al. Using the national health information database of the national health insurance service in korea for monitoring mortality and life expectancy at national and local levels. J Korean Med Sci. 2017;32:1764–70.

    Article  Google Scholar 

  18. Cheol Seong S, Kim YY, Khang YH, Heon Park J, Kang HJ, Lee H, et al. Data resource profile: the national health information database of the national health insurance service in South Korea. Int J Epidemiol. 2017;46:799–800.

    PubMed  Google Scholar 

  19. Chlebowski RT, Luo J, Anderson GL, Barrington W, Reding K, Simon MS, et al. Weight loss and breast cancer incidence in postmenopausal women. Cancer. 2019;125:205–12.

    Article  Google Scholar 

  20. Kim S, Kwon S. Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea. Soc Sci Med. 2015;138:241–7.

    Article  Google Scholar 

  21. Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863.

  22. Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med. 1989;8:551–61.

    Article  CAS  Google Scholar 

  23. World Health Organization. Regional Office for the Western P. The Asia-Pacific perspective: redefining obesity and its treatment, Sydney: Health Communications Australia, 2000.

  24. Catsburg C, Kirsh VA, Soskolne CL, Kreiger N, Bruce E, Ho T, et al. Associations between anthropometric characteristics, physical activity, and breast cancer risk in a Canadian cohort. Breast Cancer Res Treat. 2014;145:545–52.

    Article  Google Scholar 

  25. Teras LR, Goodman M, Patel AV, Diver WR, Flanders WD, Feigelson HS. Weight loss and postmenopausal breast cancer in a prospective cohort of overweight and obese US women. Cancer Causes Control. 2011;22:573–9.

    Article  Google Scholar 

  26. Welti LM, Beavers DP, Caan BJ, Sangi-Haghpeykar H, Vitolins MZ, Beavers KM. Weight fluctuation and cancer risk in postmenopausal women: the women’s health initiative. Cancer Epidemiol Biomarkers Prev. 2017;26:779–86.

    Article  Google Scholar 

  27. Moy FM, Greenwood DC, Cade JE. Associations of clothing size, adiposity and weight change with risk of postmenopausal breast cancer in the UK Women’s Cohort Study (UKWCS). BMJ Open. 2018;8:e022599.

    Article  Google Scholar 

  28. Premenopausal Breast Cancer Collaborative G, Schoemaker MJ, Nichols HB, Wright LB, Brook MN, Jones ME, et al. Association of body mass index and age with subsequent breast cancer risk in premenopausal women. JAMA Oncol. 2018;4:e181771.

    Article  Google Scholar 

  29. Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4:579–91.

    Article  CAS  Google Scholar 

  30. Amadou A, Hainaut P, Romieu I. Role of obesity in the risk of breast cancer: lessons from anthropometry. J Oncol. 2013;2013:906495.

    Article  Google Scholar 

  31. Macinnis RJ, English DR, Gertig DM, Hopper JL, Giles GG. Body size and composition and risk of postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev. 2004;13:2117–25.

    Article  CAS  Google Scholar 

  32. Guo W, Key TJ, Reeves GK. Adiposity and breast cancer risk in postmenopausal women: Results from the UK Biobank prospective cohort. Int J Cancer. 2018;143:1037–46.

    Article  CAS  Google Scholar 

  33. Burger HG, Hale GE, Dennerstein L, Robertson DM. Cycle and hormone changes during perimenopause: the key role of ovarian function. Menopause. 2008;15:603–12.

    Article  Google Scholar 

  34. Wacholder S, Hartge P, Lubin JH, Dosemeci M. Non-differential misclassification and bias towards the null: a clarification. Occup Environ Med. 1995;52:557–8.

    Article  CAS  Google Scholar 

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Funding

This work was supported by a National Research Foundation of Korea grant funded by the Korean government (MSIT) (grant no. 2021R1A2C1011958). This work was partly supported by Institute of Information & communications Technology Planning & Evaluation (IITP) grant funded by the Korea government (MSIT) (No. 2020-0-01373, Artificial Intelligence Graduate School Program (Hanyang University)) and the research fund of Hanyang University (HY-202100000670036).

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Contributions

TXMT was responsible for designing the study, extracting and analyzing data, interpreting results, creating tables, and writing the original draft of the manuscript. HS and SK were responsible for data analysis and reviewing and revising the manuscript. SR, YC, and BP contributed to the design of the study, supervised the research, and reviewed and revised the manuscript.

Corresponding author

Correspondence to Boyoung Park.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The Institutional Review Board of the Hanyang University College of Medicine (approval no. HYUIRB-202106-003-1), approved this study.

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Tran, T.X.M., Kim, S., Song, H. et al. Consecutive gain and loss in body weight and waist circumference with risk of subsequent breast cancer in Korean women. Int J Obes 46, 1742–1748 (2022). https://doi.org/10.1038/s41366-022-01173-5

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