Obesity and risk for relapse of breast cancer in women of low socioeconomic status Free

A34

Background:
 U.S. Census statistics indicated that the rate of poverty in Lousiana is 20.3%, the third highest level in the U.S. The Feist-Weiller Cancer Center (FWCC) provides medical care to a significant portion of Lousiana Low Socioeconomic Status (LSES) patients. Poverty is an important marker for limited access to healthcare, late stage disease, and poor outcomes. Poor adults are more likely to be obese. Obesity has been reported as a risk factor for outcome in breast cancer and hence is a potentially modifiable risk factor. The objective of this study was to describe the incidence of obesity in breast cancer patients of LSES treated at FWCC and to determine if there was a correlation of obesity and LSES with breast cancer recurrence.
 Study Design:
 The medical records of patients with histologically proven breast cancer diagnosed between 1990-2004 at FWCC were reviewed. Patients with Stage IV disease at diagnosis were excluded. Data on insurance, race, body mass index at diagnosis (BMI), stage and zip code of residence was analyzed. Patients with free care or Medicaid were classified as LSES. National Institutes of Health criteria were used to stratify the patients into normal weight (NW, BMI <25 kg/m²), overweight (OW, BMI 25-29.9 kg/m²) and obese (OB, BMI >=30 kg/m²).
 Results:
 Of the 349 patients analyzed, 45% were African American, and 55% were Caucasian with a mean age of 53.6 years (SD ±11.9) and with 25% residing in counties of high poverty. The obesity rate was 51.5% and overweight rate was 29.3%. The rate of LSES was 45% (20% free care and 35% had Medicaid). LSES patients, were more likely to be African Americans (62%, p < 0.001), overweight and obese (88%, p=0.003) and pre-menopausal (46%, p<0.001). 69/349 patients had recurrence. In multivariate analysis by Cox proportional regression model, after adjustment for LSES, race, menopausal status, age at diagnosis and stage, BMI at diagnosis remained a statistically significant predictor (HR=1.042) of time to relapse (p=0.008). In multivariate analysis by Cox proportional regression model, after adjustment for BMI at diagnosis, race, menopausal status, age at diagnosis and stage, LSES is marginal significant predictor (HR = 1.66) of time to relapse (p=0.06)
 Conclusions:
 Our results suggest that obesity contributes to the increase risk of relapse in breast cancer patients. Given the high prevalence of obesity and overweight in our population of African-Americans with LSES, prospective studies on intervention targeting diet and weight control could potentially improve outcomes in breast cancer.