Journal Club Presentation

1. ASSOCIATION OF OVERWEIGHT AND
OBESITY WITH BREAST CANCER IN INDIA
Presenter: Dr Fredrick Stephen
PG in Community Medicine
MGMCRI
Pondicherry
P Singh, Umesh Kapil, NK Shukla, SVS Deo, SN Dwivedi
Indian Journal of Community Medicine/vol36/issue4/oct2011

2. INTRODUCTION
 Breast cancer is one of the most common incident cancer
and cause of death.
 Body fat is an important locus of endogenous estrogen
production hence could increase the risk of breast cancer.
 Obesity leads to increased levels of fat tissue in the body that
can store toxins and serve as a continuous source of
carcinogens.
 Free estrogen levels are raised in obese women especially in
those with abdominal obesity.
.

3. AIMS AND OBJECTIVES
To study the association of overweight
and obesity with breast cancer in India

4. Study design
Hospital Based Matched Case Control Study
Cases
N=320
Controls
N=320
Matching

5. MATERIALS AND METHODOLOGY
 Place of Study: All India Institute of Medical Sciences New
Delhi
 Type of Study : Hospital Based Matched Case control Study
 Study Period : 2001-2003 (Three years)
 Place of Recruitment
Cases Controls
320 Newly Diagnosed Breast
Cancer patients from the OPD,
hospital admissions of the dept of
Surgery/ Surgical oncology at AIIMS
320 normal healthy individuals
accompanying the patients in the Dept of
Medicine, Surgery and Gastroenterology
at AIIMS and comprehensive Rural Health
Services project at Ballabgarh Hospital,
Faridabad, Haryana

6. Inclusion Criteria
Cases Controls
Proven cases of breast Cancer by
Histopathology/ Cytopathology
The attendants of patients who did
not suffer from any major illness in
the past
Not undergone any treatment
specific for breast cancer
No long course of vitamin or mineral
supplementation during the last one
year
Not suffered from any major chronic
illness in the past before the
diagnosis of breast cancer
Not under Corticosteroid therapy or
suffering from hepatic disorders or
severe malnutrition
No long course of vitamin or mineral
supplementation during the last one
year
Not under Corticosteroid therapy or
suffering from hepatic disorders or
severe malnutrition.

7. Exclusion Criteria
Cases Controls
Subjects who are already on
treatment for Breast Cancer or
corticosteroid therapy.
Subjects who couldn’t be
matched with the cases as per
the criteria ( 2 years and
socioeconomic factors)
Severely ill, malnourished
subjects
Who had taken vitamins and
mineral supplementation during
the past 1 year.
Not given consent for the
investigative procedures.
Not given consent for the
investigative procedures.

8. RESULTS
 Socio Demographic Factors
Sl no. Factors Cases Controls
1. Age (Mean) 45.5 40.98
2. Area of Residence Urban Area (61.9%) -
3. Occupation Housewives (95.9%) Housewives (95.6%)
4. literacy Illiterates (37.2%) Illiterates (35.9%)
5. Socioeconomic Status Lower Middle (46%) Lower Middle
(36.3%)

9. Table 1: Mean anthropometric measurements of the
breast cancer patients (cases) and controls
Sl no. Measurements Breast cancer
Patients
(n=320)
Mean ± SD
Controls
(n=320)
Mean ± SD
P
1 Weight (kg) 59.75 ± 10.92 56.44 ± 11.24 0.000
2 Height (cm) 153.54 ± 4.83 153.14 ± 3.70 0.24
3 BMI (kg/m2) 25.35 ± 4.54 24.03 ± 4.57 0.000
4 MUAC (cm) 26.04 ± 3.41 24.48 ± 2.85 0.000

10. Table 2: Unadjusted relative risk for breast cancer
patients(cases) according to body mass index
Sl no Body Mass
Index
(kg/m2)
Cases
(n=320)
Controls
n=320
Odds
ratio
95% CI
1 <25 145 (45.3%) 161 (50.3%) 1.00 0.76-1.47
2 25-29.9 132 (41.3%) 138 (43.1%) 1.06 1.28-4.01
3 ≥30 43 (13.4%) 21 (6.6%) 2.27

11. CONCLUSION
• The breast cancer patients had a statistically higher mean weight,
BMI, and MUAC as compared to the controls.
• Obesity and weight gain are positively associated with serum
concentrations of endogenous estrogens thus affecting breast
cancer growth and metastasis.
• The results of the study revealed a strong association of
overweight and obesity with breast cancer in the Indian population.
• Weight control may be a modifiable risk factor for breast cancer
prevention and so has significant public health impact in women.

12. LIMITATIONS
 The socio demographic profile provided by the study is
insufficient and not presented in tables.
 Matching between cases and controls was not followed as
per the criteria ( socioeconomic status ).
 Majority of the cases were from urban areas (61.9%)
 In spite of high Illiteracy rates, a semi structured
questionnaire was administered to the subjects

13. LEARNING
 Association of anthropometric factors of weight,
height, and BMI with Breast cancer.
 Hospital based matched case control study.
 Univariate Logistic regression analysis.
 Matching.

14. THANK YOU