Impact of breast cancer risk factors on clinically relevant prognostic biomarkers for primary breast cancer
Mustapha AbubakarChangyuan GuoHela KokaBin ZhuJoseph DengNan HuBin ZhouMontserrat García‐ClosasNing LüXiaohong R. Yang
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Abstract Purpose In addition to impacting incidence, risk factors for breast cancer may also influence recurrence and survival from the disease. However, it is unclear how these factors affect combinatorial biomarkers for aiding treatment decision-making in breast cancer. Methods Patients were 8179 women with histologically confirmed invasive breast cancer, diagnosed and treated in a large cancer hospital in Beijing, China. Individual clinicopathological (tumor size, grade, lymph nodes) and immunohistochemical (IHC: ER, PR, HER2, KI67) markers were used to define clinically relevant combinatorial prognostic biomarkers, including the Nottingham Prognostic Index (NPI: combining size, grade, nodes) and IHC4 score (combining ER, PR, HER2, KI67). Odds ratios (ORs) and 95% confidence intervals (CIs) for associations between breast cancer risk factors and quartiles (Q1–Q4) of NPI and IHC4 were assessed in multivariable polytomous logistic regression models. Results Overall, increasing parity (OR trend (95% CI) = 1.20(1.05–1.37); P trend = 0.007), overweight (OR(95% CI) vs normal = 1.60(1.29–1.98)), and obesity (OR(95% CI) vs normal = 2.12(1.43–3.14)) were associated with higher likelihood of developing tumors with high (Q4) versus low (Q1) NPI score. Conversely, increasing age (OR trend (95% CI) = 0.75(0.66–0.84); P trend < 0.001) and positive family history of breast cancer (FHBC) (OR(95% CI) = 0.66(0.45–0.95)) were inversely associated with NPI. Only body mass index (BMI) was associated with IHC4, with overweight (OR(95% CI) vs normal = 0.82(0.66–1.02)) and obese (OR(95% CI) vs normal = 0.52(0.36–0.76)) women less likely to develop high IHC4 tumors. Notably, elevated BMI was associated with higher NPI irrespective of hormone receptor-expression status. Conclusions Our findings indicate that factors affecting breast cancer incidence, particularly age, parity, FHBC, and BMI, may impact clinically relevant prognostic biomarkers with implications for surveillance, prognostication, and counseling.Keywords:
Nottingham Prognostic Index
Quartile
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Overweight and obesity as well as associated metabolic disorders belong to the most important risk factors. During the exhibition 'Heureka' in Zurich data on body weight and size as well as on other clinical and biochemical parameters were collected by a questionnaire. Age- and gender-specific prevalence rates were calculated. Between 10 and 41% of the visitors showed a body-mass index of > or = 25 kg/m2, as a function of age and gender -0.7 to 6.2% showed a body-mass index of > or = 30 kg/m2. The most important increase in body weight was found in the age groups between 20 and 40 years. The presented epidemiologic data show that overweight is common in Switzerland, too. Prevention of overweight is still one of the most rational medical strategies and should be intensified in the age group between 20 and 40.
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This study determined the sensitivity and specificity of parental overweight from self-reported height and weight to identify families with overweight school age children. A cross sectional study was conducted among 3059 parents and their children (1558 boys and 1501 girls) aged 7-12 years in five primary schools of Busan, Korea. BMI was calculated from parental reported height and weight and from children's measured height and weight. Parents were considered overweight when their BMI was >25 kg/m2 (WHO, 2000). Children were considered overweight when their BMI was >95th percentile (CDC, 2000). Prevalence of overweight was calculated and logistic regressions were performed. The sensitivity and specificity of parental overweight were calculated. A total of 26% (805/3059) parents were overweight. Of the families with one overweight parent, 15% (N = 109) had an overweight child. When both parents were overweight, 17% (N = 9) had an overweight child. After adjusting for child's age and gender, parental education, family income, and spouse's BMI as required, the odds of having an overweight child were 2.5 [1.8, 3.3] for one overweight parent, and 3.2 [1.4, 7.1] for both overweight parents. While the sensitivity of one overweight parent to identify families with overweight school age children was 44%, specificity was 75%. The presence of both overweight parents provided a 3% sensitivity and 98% specificity for the identification of an overweight school age child. Although parental overweight was obtained from self-reported weight and height in Busan (Korea), it is a practical indicator to identify families with an overweight school age child, it has poor sensitivity.
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The purpose of the study was to find out differences in moderate to vigorous physical activity among non-overweight, overweight and obese children, and between boys and girls. The sample included 364 children (179 boys and 185 girls), aged 6.4 years (+/- 0.3 SD). Physical activity was assessed by 7-day questionnaire. Age adapted BMI was used as overweight and obesity indicator. The children were divided into non-overweight, overweight and obese groups. It was found out, that there are significant differences in non-overweight, overweight and obese children (p < 0.05). Boys were significantly (p < 0.05) less moderate to vigorous physical active than girls, especially in indoor activities. There were also significant differences (p < 0.05) in moderate to vigorous physical activity among non-overweight and obese boys and among overweight and obese boys in weekends and total weekly activity. In girls there are significant differences (p < 0.05) in non-overweight, overweight and groups in weekends and total weekly activity. It is possible to conclude, that obese boys and overweight and obese girls, are prone to less physical activity.
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Based on cross sectional data from a general population of 5,817 people aged 14 to 61, objective overweight is compared with perceived overweight, and information is provided on morbidity due to being overweight, and on what people are doing to try to lose weight. We found that 10 percent of this population are moderately overweight and 12 per cent are severely overweight (although 41 per cent perceive they are overweight). Being overweight is associated with poorer functional status (e.g., overweight is given as the main reason for functional limitations by 13 per cent of people with such limitations) and with considerable pain, worry, and restricted activity because of this condition (e.g., 88 per cent of people who believe they are overweight worry at least a little about it). Only about 7 per cent of those who perceive they are overweight are under a doctor's care to lose weight. If physicians wish to assume a larger role in caring for overweight people, the nature of their role must be carefully evaluated.
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Childhood overweight is rapidly on the rise and underlies the younger presentation of diabetes. The aim of this study was to determine the association between overweight and age, sex, and the perception of the overweight children by their mothers. Three hundred and twenty-one (160 males) children (mean age 4.39 +/- SD 0.83 yr) [body mass index (BMI) 16.6 +/- 2.11] from schools at the kindergarten level were evaluated. Data on age, sex, weight, and height were recorded. At risk for overweight and overweight were defined as a BMI of > or = 85th or > or = 95th percentile, respectively. Written questionnaires for mothers' perceptions about their children's eating habits (a lot, right, little, or very little) and shape (very fat, fat, normal, and thin) were performed. The prevalence of at risk of overweight and overweight was 19 and 18.4%, respectively. There was a significant difference in the proportion of distorted perception of shape between mothers of normal-weight children vs. those of at risk of overweight and overweight children (17 vs. 87.5%, p < 0.001). Seventy-six and 98% of mothers of overweight and at risk of overweight children, respectively, rated them as normal or thin. Mothers exhibited poor overall ability to estimate the way at risk of overweight and overweight children ate. There was a significant difference in the proportion of distorted perception of eating habits between mothers of normal-weight children vs. those of at risk of overweight and overweight children (36.3 vs. 90.8%, p < 0.001). Eighty-four and 96% of mothers of obese and overweight children, respectively, thought that their children ate right or little. A multiple regression analysis using BMI > 95th percentile as the dependent variable showed that the mothers' perceptions of shape and eating habits [odds ratio 4.5; 95% confidence interval (CI) 2.5-7.8; p < 0.0001] were both significant independent risk factors for overweight, adjusted for age and sex. The agreement between the perception of shape and eating habits vs. the medical records BMI > 95th percentile was poor; for shape: kappa 0.31 + 0.07; 95% CI 0.17-0.44, and for nutrition: 0.14 + 0.06; 95% CI 0.02-0.27. This suggests that the mothers' perceptions of shape and eating behavior is a predictor of obesity and could be used in clinical practice as a simple tool to identify children at high risk for overweight.
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