Physique May Relate to Breast Cancer
Women with pear-shaped figures, who carry more weight in their thighs and buttocks than in their abdomen, may agonize over their appearance. But a new study finds they’re at lower risk for developing breast cancer than their “apple-shaped” sisters, who carry more weight in their abdomen than in their thighs and buttocks.
In fact, an overweight, pear-shaped woman can be at lower risk of breast cancer than a leaner, apple-shaped woman, according to Florida researchers, who published their study in the current Annals of Internal Medicine. They compared 216 breast-cancer patients with 432 control patients, classifying them as apple-shaped or pear-shaped by computing their waist-to-hip ratio.
(Waist-hip ratios are computed by dividing waist measurement by hip measurement. Waist-hip ratios of .77 to .80 are classified as mildly apple-shaped; ratios higher than .80 are termed very apple-shaped. Ratios from .73 to .76 are termed mildly pear-shaped; those below .73 are very pear-shaped.)
Women with mildly apple-shaped figures are three times as likely to develop breast cancer, said Dr. David V. Schapira, a University of South Florida associate professor of medicine and the study’s principal investigator. The risk is about equal to having a sister or mother with breast cancer, he said. Women described as “very apple-shaped” have a six-fold greater risk.
In contrast, women who are mildly pear-shaped or very pear-shaped have a low risk of getting breast cancer, Schapira said.
“Everybody believes diet and (being) fat has something to do with breast cancer,” said Dr. Gary H. Lyman, professor of internal medicine at the University of South Florida and another researcher on the study. “This research takes the study of risks a step further. It’s not just excess weight or total body fat that increases breast cancer risk. It’s where that body fat is distributed,” said Lyman, who noted that the data needs to be confirmed by other studies.
The Florida study isn’t the first to consider the impact of body fat distribution on health. Recently, other researchers reported that people with beer bellies have lower levels of the so-called “good” cholesterol (HDL) than those with trimmer tummies.
The Florida scientists don’t know for sure why apple-shaped women seem to be at greater risk of breast cancer, but suspect a hormonal link. “Apple-shaped women have higher levels of circulating estrogens. We don’t know exactly why,” Schapira said. “But those higher estrogen levels are believed to increase breast cancer risk,” he said.
The good news? Apple-shaped women who lose weight seem to redistribute the weight in a more desirable way, said Lyman, who is studying that possibility further. When an apple-shaped woman loses weight and becomes more pear-shaped, the abdominal fat cells--which are bigger and more metabolically active than fat cells in the buttocks and thighs--shrink proportionately more than those on the thighs or buttocks, Schapira said, thus perhaps reducing the circulating estrogen levels.
The recommendations based on the study? “Mildly apple-shaped women should pay more attention to guidelines about breast cancer prevention, such as mammography,” Schapira said. “Physicians should pay more attention to these women in terms of counseling and encouraging them to follow prevention guidelines and a sound diet.”
But a local cancer prevention expert disagrees. Dr. William Hindle, director of the Breast Diagnostic Center at Los Angeles County/USC Women’s Hospital, said the study should not alter patient management a whit. Every woman--and especially those over 40--needs to be concerned about breast cancer risk, he said. “There’s a long list of risks associated with breast cancer,” said Hindle. “They’re interesting and statistically valid. But the important point is this: Every woman should be concerned about breast cancer. Over 75% of women with breast cancer have no risk factors except being a woman and growing older.”
