Obesity in Postmenopausal Breast Cancer Patients: It Is Time to Improve Actions for a Healthier Lifestyle. The Results of a Comparison Between Two Italian Regions With Different "Presumed" Lifestyles

Laura Cortesi; Giulia Raffaella Galli; Federica Domati; Luana Conte; Luigi Manca; Maria Antonietta Berio; Angela Toss; Anna Iannone; Massimo Federico

doi:10.3389/fonc.2021.769683

Obesity in Postmenopausal Breast Cancer Patients: It Is Time to Improve Actions for a Healthier Lifestyle. The Results of a Comparison Between Two Italian Regions With Different "Presumed" Lifestyles

Front Oncol. 2021 Nov 18:11:769683. doi: 10.3389/fonc.2021.769683. eCollection 2021.

Authors

Affiliations

¹ Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy.
² Breast Unit City of Lecce Hospital, Gruppo Villa Maria (GVM) Care & Research, Lecce, Italy.
³ Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
⁴ Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics, University of Salento, Lecce, Italy.
⁵ Laboratory of Interdisciplinary Research Applied to Medicine, University of Salento and Azienda Sanitaria Locale (ASL), Lecce, Italy.
⁶ Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy.

Abstract

Background: Adult body fatness is a convincing risk factor for postmenopausal breast cancer. With the aim to compare the different breast cancer (BC) features in Northern and Southern Italy, we investigated the relationship between BMI and BC characteristic in two groups of patients referred in the Modena and Lecce breast units.

Materials and methods: A retrospective analysis of a continuous series of BC patients referred to the Città di Lecce Hospital and the Modena Cancer Center, from January 2019 to December 2020 was performed. We identified four groups of BMI at BC diagnosis: underweight, BMI <18.5 kg/m²; normal weight, BMI ≥ 18.5-24.9 kg/m²; overweight, BMI ≥ 25.0-29.9 kg/m²; obese, BMI ≥30.0 kg/m². BC characteristics and clinical outcomes were analyzed by the Kolmogorov-Smirnov test and Mann-Whitney U test; categorical data were compared using Pearson's chi-square test, and dicotomic data were compared by odds ratio.

Results: Nine hundred seventy-seven BC patients were included in the analysis. Overall, 470 were from Modena and 507 from Lecce. No differences were observed in the mean age of BC patients of Modena (61,42) and Lecce (62,08). No statistical differences between the two populations were shown in terms of tumor characteristics and pathological stage. Conversely, a statistical difference of BMI between the BC patients coming from Modena and Lecce (25.87 and 27.81, respectively; p = 0.000001) was found. BC patients diagnosed in Lecce at age ≥70 years had higher median BMI compared with the ones from Modena (p = 0.000002). The increased BMI in this aged population was also associated to larger tumor size (p = 0.040).

Conclusion: The rate of overweight and obesity was higher in BC women living in Southern Italy, despite the presumed nutrition according to the so-called Mediterranean type dietary pattern. Unexpectedly, an increased BMI rate and a relationship with larger tumor size were found in Southern BC patients aged ≥70 years. Our findings strongly support the need for promoting a healthier lifestyle model in Italy, with the aim of reducing the rate of the obesity and, consequently, the increased risk of BC.

Keywords: Mediterranean diet; body mass index; breast cancer; obesity; overweight.