Weight gain of 10% or more common among breast cancer survivors
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Key takeaways:
- Nearly 20% of breast cancer survivors experienced more than 10% weight gain during follow-up.
- Younger age and lower weight at diagnosis were the biggest predictors of weight gain.
BOSTON — Breast cancer survivors are more likely to have weight gain of 10% or more during follow-up compared with healthy controls, with the strongest predictors younger age at diagnosis and lower weight at baseline, data show.
Weight gain after breast cancer diagnosis and treatment is common, yet the incidence of weight gain in the literature varies widely from 10% to 100%, Maria Daniela Hurtado Andrade, MD, PhD, assistant professor of medicine in the division of endocrinology, diabetes and metabolism at Mayo Clinic in Jacksonville, Florida, said during a press conference at ENDO 2024. Additionally, studies have failed to conclusively identify risk factors for weight gain among breast cancer survivors, Hurtado Andrade said.
“In breast cancer survivors, weight gain during the survivorship is associated with increased risk of breast recurrence,” Hurtado Andrade told Healio. “Similarly, weight gain increases breast cancer-specific mortality and cardiovascular mortality, the two leading causes of death among breast cancer survivors. Even though a considerable proportion of breast cancer survivors gain weight during their survivorship, there are significant gaps in the provision of advice or guidelines on weight-gain prevention and weight management. Most patients do not receive advice on this topic at the time of breast cancer diagnosis or during their survivorship.”
For the retrospective study, researchers analyzed data from 4,575 breast cancer survivors using the Mayo Clinic Breast Cancer Registry and 4,575 women without a history of breast cancer or bariatric surgery (controls), selected from the Rochester Epidemiology Project that links medical records of residents from 27 counties in Minnesota and Wisconsin. At the time of breast cancer diagnosis, the mean age was 58 years and mean weight was 76 kg; controls had similar characteristics. Most patients with breast cancer were clinical stage 1, and most had estrogen and progesterone receptor-positive disease. Both groups were primarily non-Hispanic white.
Researchers assessed weight data at baseline and years 1, 4 and 6 after breast cancer diagnosis to generate longitudinal weight trajectory curves on change from baseline.
Within the breast cancer survivor group, half underwent breast-preserving surgery; most received systemic therapy (61% receiving endocrine therapy) and less than one-third received radiation therapy.
On average, weight gain was modest at 4 and 6 years among breast cancer survivors, Hurtado Andrade said, with a mean 1.2% change from baseline to year 4 and a 1.6% change from baseline to year 6. However, when compared with controls, who saw a mean 0.7% change in weight from baseline to 6 years, weight gain was statistically higher (P = .004).
The proportion of survivors gaining 10% or more from baseline weight at years 1, 4 and 6 was higher compared with controls, and at year 6, 18% of breast cancer survivors gained 10% of their baseline weight compared with 8% of controls, Hurtado Andrade said. Researchers observed the same trend with respect to weight gain of 15% or more and 20% or more from baseline.
Hurtado Andrade said variables associated with 10% or greater weight gain at 4 and 6 years included lower baseline weight, younger age at breast cancer diagnosis, more advanced clinical breast cancer stage, receiving systemic therapy and having a BRCA gene mutation. After adjusting for baseline age and weight, age and weight remained the strongest predictors of weight gain.
“Compared to a control group of women matched by age and race, breast cancer survivors on average gain more weight in the long term,” Hurtado Andrade told Healio. “Remarkably, 18% of breast cancer survivors gain at least 10% of their weight during the first 6 years of survivorship. While we identified several risk factors, the ones that carry the highest risk include a younger age at the time of breast cancer diagnosis, lower weight at the time of breast cancer diagnosis, having a BRCA2 mutation, and receiving systemic therapy such as chemotherapy, immunotherapy and/or endocrine therapy.”
Hurtado Andrade said the findings offer valuable insights on which patients are prone to weight gain or increased adiposity after breast cancer diagnosis and treatment.
“The next step for this research is to investigate the effect of weight gain on cardiometabolic risk factors that lead to cardiovascular disease and mortality in breast cancer survivors,” Hurtado Andrade told Healio. “The goal is to develop strategic weight management interventions that can be individualized to patients with breast cancer to prevent cardiovascular disease and mortality. These strategic interventions need to be seamlessly included in the management of breast cancer to provide a holistic, yet individualized, approach to improve health and survival in this population, without increasing the burden of medical care to the patient.”
Perspective
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Reena Bose, MD
I agree with the premise of the study, whereby there is a strong association between obesity and breast cancer risk, and there is a strong association between obesity causation after breast cancer chemotherapy. Many of my female patients in my obesity practice have had a history of breast cancer and are now developing obesity for which they are seeking treatment. So, I am glad we are looking into this demographic of patients and delving deeper into the causation of obesity in patients who are breast cancer survivors.
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Hurtado Andrade MD, et al. MON-024. Presented at: ENDO annual meeting; June 1-4, 2024; Boston.
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