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Original Investigation
June 4, 2021

Association of Body Mass Index, Central Obesity, and Body Composition With Mortality Among Black Breast Cancer Survivors

Author Affiliations
  • 1Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
  • 2Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
  • 3Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick
  • 4Cancer Epidemiology Services, New Jersey State Cancer Registry, Trenton
  • 5Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
  • 6Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, New York
JAMA Oncol. Published online June 4, 2021. doi:10.1001/jamaoncol.2021.1499
Key Points

Question  Are general and central obesity and body composition associated with mortality after diagnosis among Black breast cancer survivors?

Findings  In this cohort study of 1891 Black breast cancer survivors, higher waist-to-hip ratio and body adiposity at approximately 10 months after diagnosis were associated with significantly worse overall and breast cancer–specific survival.

Meaning  This study’s findings suggest that simple measures of body fat distribution and body composition can be useful clinical tools to identify Black breast cancer survivors who have a higher risk of death.


Importance  Obesity disproportionately affects Black women, who also have a higher risk of death after a breast cancer diagnosis compared with women of other racial/ethnic groups. However, few studies have evaluated the association of measures of adiposity with mortality among Black breast cancer survivors.

Objective  To assess the association of measures of adiposity with survival after a breast cancer diagnosis among Black women.

Design, Setting, and Participants  This prospective population-based cohort study comprised 1891 women with stage 0 to IV breast cancer who self-identified as African American or Black and were ages 20 to 75 years. The New Jersey State Cancer Registry was used to identify women living in 10 counties in New Jersey who were recruited from March 1, 2006, to February 29, 2020, and followed up until September 2, 2020.

Exposures  Measures of adiposity, including body mass index, body fat distribution (waist circumference and waist-to-hip ratio), and body composition (percent body fat and fat mass index), were collected during in-person interviews at approximately 10 months after breast cancer diagnosis.

Main Outcomes and Measures  All-cause and breast cancer–specific mortality.

Results  Among 1891 women, the mean (SD) age at breast cancer diagnosis was 54.5 (10.8) years. During a median follow-up of 5.9 years (range, 0.5-14.8 years), 286 deaths were identified; of those, 175 deaths (61.2%) were associated with breast cancer. A total of 1060 women (56.1%) had obesity, and 1291 women (68.3%) had central obesity. Higher adiposity, particularly higher waist-to-hip ratio, was associated with worse survival. Women in the highest quartile of waist-to-hip ratio had a 61% increased risk of dying from any cause (hazard ratio [HR], 1.61; 95% CI, 1.12-2.33) and a 68% increased risk of breast cancer death (HR, 1.68; 95% CI, 1.04-2.71) compared with women in the lowest quartile. The risks of all-cause and breast cancer–specific death were similarly high among women in the highest quartile for waist circumference (HR, 1.74 [95% CI, 1.26-2.41] and 1.64 [95% CI, 1.08-2.48], respectively), percent body fat (HR, 1.53 [95% CI, 1.09-2.15] and 1.81 [95% CI, 1.17-2.80]), and fat mass index (HR, 1.57 [95% CI, 1.11-2.22] and 1.74 [95% CI, 1.10-2.75]); however, the risk was less substantial for body mass index (HR, 1.26 [95% CI, 0.89-1.79] and 1.33 [95% CI, 0.84-2.10]). In analyses stratified by estrogen receptor status, menopausal status, and age, a higher waist-to-hip ratio was associated with a higher risk of all-cause death among women who had estrogen receptor–negative tumors (HR, 2.24; 95% CI, 1.14-4.41), women who were postmenopausal (HR, 2.15; 95% CI, 1.28-3.61), and women who were 60 years or older at diagnosis (HR per 0.10-U increase, 1.76; 95% CI, 1.37-2.26).

Conclusions and Relevance  In this population-based cohort study, central obesity and higher adiposity were associated with higher all-cause and breast cancer–specific mortality among Black breast cancer survivors. Simple measures of body fat distribution and body composition were found to be useful tools for identifying Black women with a higher risk of death after a breast cancer diagnosis.

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