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Obesity and metabolic syndrome influence breast cancer subtypes and mortality rates
Last reviewed: 02.07.2025
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In the Women’s Health Initiative (WHI) randomized trial, a low-fat diet reduced breast cancer mortality, especially in women with more components of metabolic syndrome (MetS) (obesity, high blood pressure, elevated blood sugar, and abnormal cholesterol). A recent analysis of WHI data shows that MetS and obesity have different associations with breast cancer subtypes and mortality risk. The findings are published in CANCER, a peer-reviewed journal of the American Cancer Society.
The analysis included 63,330 postmenopausal participants in the WHI clinical trial without a history of breast cancer, with normal baseline mammograms and MetS scores (0–4). After a median follow-up of 23.2 years, there were 4,562 incident breast cancer cases and 659 breast cancer deaths (breast cancer mortality).
A higher MetS score (3–4), independent of obesity, was associated with poorer prognostic, estrogen receptor (ER)-positive, progesterone receptor (PR)-negative breast cancer cases and a 44% higher risk of breast cancer mortality. Obesity, independent of MetS score, was associated with more favorable prognostic, ER-positive, PR-positive cancer cases. Only women with severe obesity (eg, a postmenopausal woman 5 feet 6 inches (168 cm) tall, weighing more than 218 pounds (99 kg)) had a higher risk of breast cancer mortality.
"Postmenopausal women with higher MetS scores represent a previously unrecognized group with a higher risk of breast cancer mortality. Determining MetS scores in the clinic requires only three questions about cholesterol, diabetes, and hypertension history, as well as waist circumference and blood pressure measurements, which are typically obtained during routine visits." - Rowan T. Chlebowski, MD, PhD, lead author from the Lundquist Institute.