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Excess body weight and second primary cancer risk after breast cancer: a systematic review and meta-analysis of prospective studies

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Abstract

Several observational studies have investigated the role of body mass index (BMI) in second primary cancer incidence in women with breast cancer. We conducted a systematic review and meta-analysis of the evidence to assess the strength of this association. PubMed and Embase were searched for observational studies up to May 2012, and the reference lists of studies included in the analysis were examined. Random effects models were used to estimate summary relative risks (RRs) and 95 % confidence intervals (CIs). Thirteen prospective studies, five cohort and eight nested case–control studies, were included. In categorical meta-analyses of BMI, obesity was associated to significantly increased risks of contralateral breast (RR = 1.37, 95 % CI: 1.20–1.57), breast (RR = 1.40, 95 % CI: 1.24–1.58), endometrial (RR = 1.96, 95 % CI: 1.43–2.70), and colorectal (RR = 1.89, 95 % CI: 1.28–2.79) second primary cancers. For a BMI increase of 5 kg/m2, dose–response meta-analyses resulted in significantly increased RRs of 1.12 (95 % CI: 1.06–1.20) and 1.14 (95 % CI: 1.07–1.21) for contralateral breast and breast second primary cancers, respectively. The summary RR for endometrial second primary cancers was 1.46 (95 % CI: 1.17–1.83) for a 5-unit increment. This result emphasizes the importance of prevention policies aiming to reduce overweight and obesity prevalence. Clinical trials in breast cancer patients with excess body weight evaluating the effect of normal weight restoration on second primary cancer incidence are needed.

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Acknowledgments

We thank the following authors for sharing complementary data and information: Franco Berrino and Patrizia Pasanisi, Department of Preventive and Predictive Medicine, Istituto Nazionale Tumori, Milan, Italy; Linda S Cook, Department of Internal Medicine, University of New Mexico, Albuquerque, USA; Jim Dignam, Department of Health Studies, University of Chicago, USA; Marianne Ewertz, Department of Oncology, University of Southern Denmark, Odense, Denmark; Pentti Kyyrönen and Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Christopher I Li, Divisions of Public Health Sciences and Human Biology, Fred Hutchinson Cancer Research Center, Seattle, USA; Maria Luisa López González, Department of Medicine, University of Oviedo, Oviedo, Spain; Bilal Majed, Biostatistics Department, Curie Institute, Paris, France; Hans H Storm and Maria Blettner, Danish Cancer Registry, Institute of Cancer Epidemiology, Copenhagen, Denmark. This work was supported by a grant from the French National Cancer Institute. Norat T and Chan DSM are supported by the World Cancer Research Fund (Continuous Update Project grant number 2007/SP01).

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Authors and Affiliations

  1. INRA, UMR1125 Unité de Recherche en Epidémiologie Nutritionnelle, 93017, Bobigny, France

    Nathalie Druesne-Pecollo, Mathilde Touvier, Emilie Barrandon, Laurent Zelek, Serge Hercberg & Paule Latino-Martel

  2. Inserm, UMR557 Unité de Recherche en Epidémiologie Nutritionnelle, 93017, Bobigny, France

    Nathalie Druesne-Pecollo, Mathilde Touvier, Emilie Barrandon, Laurent Zelek, Serge Hercberg & Paule Latino-Martel

  3. CNAM, Unité de Recherche en Epidémiologie Nutritionnelle, 93017, Bobigny, France

    Nathalie Druesne-Pecollo, Mathilde Touvier, Emilie Barrandon, Laurent Zelek, Serge Hercberg & Paule Latino-Martel

  4. Université Paris 13, Sorbonne Paris Cité, Unité de Recherche en Epidémiologie Nutritionnelle, 93017, Bobigny, France

    Nathalie Druesne-Pecollo, Mathilde Touvier, Emilie Barrandon, Laurent Zelek, Serge Hercberg & Paule Latino-Martel

  5. Department of Epidemiology and Public Health, Imperial College, London, UK

    Doris S. M. Chan & Teresa Norat

  6. Department of Medical Oncology, Avicenne Hospital, Bobigny, France

    Laurent Zelek

  7. Department of Public Health, Avicenne Hospital, Bobigny, France

    Serge Hercberg

  8. INRA, Bâtiment 400, 78352, Jouy-en-Josas cedex, France

    Nathalie Druesne-Pecollo

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  1. Nathalie Druesne-Pecollo
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Correspondence to Nathalie Druesne-Pecollo.

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Druesne-Pecollo, N., Touvier, M., Barrandon, E. et al. Excess body weight and second primary cancer risk after breast cancer: a systematic review and meta-analysis of prospective studies. Breast Cancer Res Treat 135, 647–654 (2012). https://doi.org/10.1007/s10549-012-2187-1

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