Effect of BMI and Waist Hip Ratio on Risk of Breast Cancer and Its Implications on Post Operative Period

INTRODUCTION: Carcinoma Breast is the most common cancer in Indian female.30% of all female cancer. 20% of cancer related deaths in females.Body size is an important modifiable risk factor for breast cancer.But the effect of BMI and Waist-Hip Ratio is less studied in our population. AIM OF THE STUDY: To study the effect of BMI and Waist-Hip Ratio on risk of breast cancer. STUDY POPULATION: Patients admitted in the Department of General Surgery of Tirunelveli Medical College Hospital. Sample Size: 80 cases in two-year duration. Study Design: Descriptive study design. Study Setting: Tirunelveli Medical College Hospital. Sampling Method: Purposive sampling. Procedure: After getting clearance from the Ethical committee and Informed consent in the native language of the patient, details of the patients will be entered in the questionnaire. BMI and WAIST-HIP RATIO will be calculated for each patient. RESULT: 80 patients who were affected by Carcinoma Breast were observed in my study. The parameters which were observed 1. Age, 2. Menstrual status, 3. Presentation, 4. Quadrant of presentation, 5. Pathological grade, 6. TNM stage, 7. BMI, 8. Waist-Hip Ratio. Common age group was 41-50 years & 51-60 years with 28 patients from each group out of 80 patients, 6 patients belong to 31-40 year group and 18 patients belong to 61-70 years age group. Many studies, including Momenimovahed Z, Salehiniya H. [et al.], suggest that peri-menopausal age group is the most common age group, my studies also suggests the same When the menstrual status and the hormonal receptor results were compared we have observed that post-menopausal women have higher incidence of hormone receptor positivity – 48/63 cases (76%) ER +ve, 36/63 cases (57%) PR +ve and the menstruating women have higher incidence of hormone receptor negativity – 9/14 cases (64%) ER -ve, 12/14 cases (85%) PR -ve . Studies by, Huang WY [et al.], Pichon MF [et al.], Enger SM [et al.] has supported this correlation between ER/PR expression and menstrual status of the patient. Most common presentation was Lump (53.8%) then Lump with pain (21.3%), Lump with ulcer (18%), lump with nipple discharge (5%), ulcer (1.2%). Most common side of presentation was left (55%) where as right was (45%), upper outer quadrant is the most commonly involved quadrant (23.8%), Upper outer with lower outer and upper inner quadrant involvement is respectively in next places (11.3%) and (10%). Invasive Ductal Carcinoma is the single most common pathological type seen in my study, a staggering (82.5%), followed by Ductal carcinoma in situ (6.25%). Jaafar Makki [et al.] supported this claim. Mean BMI of my patients observed in my study is 25.05 Below 18.5 – Under weight, 18.5 – 24.9 – Normal, 25.0 – 29.9 – Overweight, 30 & Above – Obese. Where as mean Waist-Hip Ratio of my patients observed in my study is 1.00, 0.80 or below – Low health risk, 0.81-0.85 - Moderate health risk, >0.85 – High risk. When the BMI and Hormonal receptor status were compared we have observed that there is positive correlation between BMI and ER & PR status with the significant P value (0.0001) irrelevant to their menstrual status. Nicoletta Biglia [et al.] observed that elevated BMI correlated with hormonal receptor status of post menopausal women whereas no relation between BMI and Hormonal status in premenopausal women. Fei Wang, Xiang wang,liyuan liu, Shu Wang et al observed positive correlation between BMI and Hormonal Receptor status only in premenopausal status women. When the Waist Hip Ratio and Hormonal receptor status were compared we observed a negative correlation between Waist Hip Ratio and ER & PR status with significant P value (0.0001). This was supported by Fei Wang, Xiang wang, liyuan liu, Shu Wang et al which has also stated that Waist Hip Ratio is positively correlated with ER & PR negative Breast cancer. CONCLUSION: In my study a total of 80 female patients with breast cancer in my institute were studied. The distinct effect of BMI and waist Hip ratio on risk of breast cancer and its implications on hormonal receptors were established. The association of ER, PR receptors with BMI, Waist Hip Ratio and Menstrual status were evaluated.55 patients (59%) were positive for estrogen receptor and 25 (31%) were negative. 41 patients (51.3%) were progesterone receptor positive and 39 (48.7%) were progesterone receptor negative. Most of the tumours in postmenopausal women were hormone receptor positive. In premenopausal women the percentage of Hormonal receptors were negative. BMI is positively correlated with Hormonal receptors whereas Waist Hip ratio is negatively correlated. These results were comparable with the previous studies and thus reinforce the usefulness of estimation of the receptor status for treatment purpose in breast carcinoma