Obesity has been found to elevate the risk of breast cancer recurrence in postmenopausal patients with hormone receptor–positive (HR+) early-stage breast cancer who are undergoing treatment with aromatase inhibitors, according to a comprehensive study conducted over an 18-year period using data from the Danish Breast Cancer Group.

Clinical studies have consistently highlighted obesity as a risk factor for recurrence in postmenopausal women with HR+ breast cancer. Notably, evidence suggests that women with obesity may not experience the same protective effects from aromatase inhibitors as those with a healthy weight, although limited data exist on this subject.

The cohort study, involving postmenopausal women diagnosed with stage I to III HR+ breast cancer receiving adjuvant endocrine therapy with aromatase inhibitors, categorized patients based on their body mass index (BMI). The BMI categories included healthy weight (18.5–24.9), overweight (25–29.9), obesity (30–34.9), and severe obesity (≥ 35), with patients of a healthy weight serving as the reference group for statistical analyses.

Key findings from the study include:

1. Patient Enrollment and Follow-Up:
   • A total of 13,230 patients with BMI information participated, with a median age at diagnosis of 64.4 years.
   • Throughout a median follow-up of 6.2 years, 1,587 recurrences were observed.
2. Recurrence Hazards:
   • Multivariable analyses revealed increased recurrence hazards associated with obesity (adjusted HR, 1.18 [95% CI, 1.01–1.37]) and severe obesity (adjusted HR, 1.32 [95% CI, 1.08–1.62]) compared to patients with a healthy weight.
   • Patients with overweight also exhibited a greater risk of recurrence, but the results did not reach statistical significance (adjusted HR, 1.10 [95% CI, 0.97–1.24]).

The study’s conclusion underscores the link between obesity and an elevated risk of breast cancer recurrence in postmenopausal patients with HR+ early-stage breast cancer undergoing aromatase inhibitor therapy. This large, population-based cohort study aligns with prior research, indicating that patients with obesity may derive less benefit from adjuvant endocrine therapy than those with a healthy weight.

The authors advocate for further exploration into whether alternative endocrine therapies, such as tamoxifen, should be considered for postmenopausal women with obesity and early-stage HR+ breast cancer to enhance their prognosis, challenging the current recommendation of aromatase inhibitors for this patient population. However, one thing is certain, weight loss is clearly indicated for postmenopausal women with obesity and early-stage HR+ breast cancer to enhance their prognosis and enhance their general health. 

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