Higher BMI linked to decreased breast cancer risk in young women

Higher body mass index (BMI), is associated with a reduced risk of premenopausal breast cancer especially in early adulthood, according to a new study published in the journal JAMA Oncology.

Hazel B. Nichols, assistant professor, epidemiology department, UNC Gillings School of Global Public Health, and colleagues to investigate the association of BMI with premenopausal breast cancer risk, in particular by age at BMI, attained age, risk factors for breast cancer, and tumor characteristics.

Breast cancer is the most commonly diagnosed cancer among women. Its origin is complex and it includes a wide range of factors, among them how much body fat a woman has, a measure often assessed by BMI. Previous research suggests increasing BMI may be associated with reduced risk for premenopausal breast cancer but increased risk after menopause.

For the study, the researchers pooled data from 19 different studies to investigate breast cancer risk for a group of 758,592 women who were younger than 55 years. There were 13,082 new cases of breast cancer over roughly nine years of follow-up per participant.

"The drivers of breast cancer risk can be different for young women compared to older women, so we need to do a better job of understanding what contributes specifically to breast cancer risk in younger women so we can make appropriate recommendations for them," said Nichols. "This study is not a reason to try to gain weight to prevent breast cancer. Heavier women have a lower overall risk of breast cancer before menopause, but there are a lot of other benefits to managing a healthy weight that should be considered. What it does do is help us to try to understand what contributes to breast cancer risk in younger women."

"Studies often have smaller numbers of premenopausal breast cancers since breast cancer is less common at younger ages, and the evidence was not as strong as for postmenopausal breast cancer," Nichols said.

Key Findings:

• Higher BMI was linked to lower cancer risk.


• The largest reductions in risk were for BMI between the ages of 18 and 24, with a 23 percent lower breast cancer risk linked to each five-unit increase in BMI during this time period.


• At ages 25 to 34, each five-unit increase in BMI was linked to 15 percent lower risk.


• There was a 13 percent lower risk for BMI at ages 35 to 44, and a 12 percent lower risk for BMI at ages 45 to 54 years.

"We saw a trend where, as BMI went up, cancer risk went down," Nichols said. "There was no threshold at which having a higher BMI was linked to lower cancer risk."

They also saw the risk decreases linked to higher body mass index for estrogen- or progesterone-receptor positive breast cancer, but they did not see a consistent relationship for BMI and triple negative breast cancer, or hormone-receptor-negative breast cancer.

Nichols said multiple factors could be contributing to the link between higher BMI and lower breast cancer risk in younger women, such as differences in hormones, including estrogen, growth factors, or breast density. Estrogen can be a driver of breast cancer, but there are different levels and sources of estrogen before and after menopause. Before menopause onset, the primary source of estrogen comes from the ovaries, and estrogen produced by fatty tissue may help to downregulate the amount of estrogen produced by the ovaries.

"The amount of estrogen produced by your ovaries is driven by feedback loops in your body," Nichols said. "The small amount of estrogen produced by fat tissue before menopause may help tell the ovaries that they can produce less estrogen and also regulate other hormones or growth factors," Nichols said that after menopause, women with higher adipose tissue have higher estrogen levels.

"After menopause, the ovaries are no longer the primary source of estrogen," she said. "Instead, most estrogens come from adipose, or fat, tissue," she said. "Women who have more adipose tissue after menopause usually have higher levels of estrogen which can contribute to higher breast cancer risk. In young women, estrogen is one factor that contributes, but it's not the whole story."

Based on the study, the authors concluded that increased BMI is inversely associated with the risk of breast cancer diagnosis before menopause, to a greater magnitude than suggested in previous analyses, and with the strongest associations for BMI at young ages. The association with BMI in early adulthood is universal across strata of other risk factors and across breast cancer subtypes. Understanding the biological mechanism underlying this association could have important implications for breast cancer prevention.

For more information click on the link: 10.1001/jamaoncol.2018.1771