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Comment & Response
May 30, 2019

Accounting for Height in an Analysis of Body Fat and Breast Cancer Risk—In Reply

Author Affiliations
  • 1Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Weill Cornell Medical College, New York, New York
  • 3Albert Einstein College of Medicine, Bronx, New York
JAMA Oncol. 2019;5(7):1068. doi:10.1001/jamaoncol.2019.1103

In Reply The observation that height is positively correlated with breast cancer risk has been raised by Dr Lee, who suggests that this association confounds our finding that higher body fat levels are associated with elevated breast cancer risk in postmenopausal women with normal body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared). We agree that epidemiologic data support an association between increased height and elevated breast cancer risk. As described in our original report, after further adjustment of the multivariable model for BMI, positive associations persisted between both whole-body fat mass and fat mass of the trunk and the risk of overall and estrogen receptor-positive breast cancer.1 Body mass index is a measure of body fat based on height and weight. A potential confounding effect of height was thus limited by the adjustment for BMI. It is therefore not surprising that after additionally adjusting our original analyses for height, the hazard ratios for the association of body fat parameters with incident invasive breast cancer in this cohort of postmenopausal women with normal BMI remain essentially unchanged: 1.81; 95% CI, 1.14-2.89 for whole body fat mass and 1.80; 95% CI, 1.12-2.88 for fat mass of the trunk.

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