Abstract
Objectives
Several studies suggest that overall and central-obesity are associated with increased breast cancer (BC) risk in postmenopausal-women. However, there are no studies investigating changes of central obesity and BC. We report on the association of BC risk with self-reported skirt size (SS; waist-circumference proxy) changes between 20s and postmenopausal-age.
Design
Prospective cohort-study.
Setting
UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) involving the nine trial centres in England.
Participants
Postmenopausal-women aged >50 with no known history of BC prior to or on the day of completion of the study-entry questionnaire.
Interventions
At recruitment and at study entry, women were asked to complete a questionnaire. Women were followed-up via ‘flagging’ at the NHS Information Centre in England and the Hospital Episode Statistics.
Main outcome-measure
Time to initial BC diagnosis.
Results
Between 2 January 2005 and 1 July 2010, 92 834 UKCTOCS participants (median age 64.0) completed the study-entry questionnaire. During median follow-up of 3.19 years (25th–75th centile: 2.46–3.78), 1090 women developed BC. Model adjusted analysis for potential confounders showed body mass index (BMI) at recruitment to UKCTOCS (HR for a 5 unit change=1.076, 95% CI 1.012 to 1.136), current SS at study entry (HR=1.051; 95% CI 1.014 to 1.089) and change in SS per 10 years (CSS) (HR=1.330; 95% CI 1.121 to 1.579) were associated with increased BC risk but not SS at 25 (HR=1.006; 95% CI 0.958 to 1.056). CSS was the most predictive singe adiposity measure and further analysis including both CSS and BMI in the model revealed CSS remained significant (HR=1.266; 95% CI 1.041 to 1.538) but not BMI (HR=1.037; 95% CI 0.970 to 1.109).
Conclusions
CSS is associated with BC risk independent of BMI. A unit increase in UK SS (eg, 12–14) every 10-years between 25 and postmenopausal-age is associated with postmenopausal BC risk by 33%. Validation of these results could provide women with a simple and easy to understand message.
Strengths and limitations of this study
- To the best of our knowledge, this is the first study investigating the association between central obesity using skirt size (SS) as a proxy and breast cancer risk. Between 25 and postmenopausal age, an increase in SS by one unit every decade increased the risk of postmenopausal breast cancer by 33% while decrease in SS was associated with lowering of risk.
- Our prospective cohort-study includes 94 000 women with comprehensive follow-up through data linkage to multiple national databases.
- There is a possibility of underestimation of self-reported SS. However, if current SS at study entry is uniformly underestimated then there is merely rescaling of CSS so that the strength of the association is unaffected. Furthermore, recall bias of the SS at 25 maybe a limitation but unless this inability in reporting is systematically related to future breast cancer, measurement error can only result in underestimating the strength of the true association between CSS and breast cancer risk.
- Given that obesity is now emerging as a global epidemic, from a public health prospective these findings are significant as they provide women with a simple and easy to understand message.
Sources and More Information:
- Association of skirt size and postmenopausal breast cancer risk in older women: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), BMJ Open 2014;4:e005400 doi:10.1136/bmjopen-2014-005400, 24.09.2014.
- Skirt size increase ups breast cancer risk, NHS Choices, Cancer, September 25 2014.