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Can waist measurements predict breast cancer risk?


Clinical bottom line

This review finds an increased risk of breast cancer associated with abdominal obesity in pre-menopausal women, but no independent effect of abdominal obesity in post-menopausal women.


The link between obesity and breast cancer has long been recognised. This systematic review examines the relationship between abdominal obesity and breast cancer risk and whether any relationship is independent of general obesity.


M Harvie et al. Central obesity and breast cancer risk: a systematic review. Obesity Reviews 2003 4: 157-173.

Systematic review

The literature was searched for cohort and case-control studies using the Cochrane Library (2001); and MEDLINE, Embase and Cancer Lit (until 2002). Bibliographies, abstracts and conference proceedings were also reviewed. There were no language restrictions. Out of 28 papers identified, 14 case-control studies were excluded for not reporting (i) waist or waist-hip ratio data, (ii) separate analyses of pre- and post-menopausal women or (iii) odds ratios; and six case-control studies were excluded as waist was measured after commencing breast cancer treatment. Eight papers were included in the final analysis:

Waist and hip measurements were taken by participants, friends or researchers; the site of measurements varied (e.g. umbilicus, 2.5 cm above umbilicus or narrowest point); neither measurements nor menopausal status were updated in the majority of studies and definitions of menopausal status varied.

Studies adjusted for a variety of lifestyle and reproductive factors (e.g. age, body mass index (BMI), family history of breast cancer, age of menarche, age at first birth).


Post-menopausal women

Pre-menopausal women


This paper aimed to determine whether relationships between breast cancer risk and abdominal obesity are independent of general obesity (by adjusting for BMI). In other words, can measurements of waist and waist-hip ratio be used to predict risk of breast cancer?

Post-menopausal women with smaller waist or waist-hip ratio measurements had a lower breast cancer risk, but this relationship disappeared when results were adjusted for BMI (therefore no independent effect of abdominal obesity). In contrast, adjusting for BMI introduced a lowered breast cancer risk in pre-menopausal women with smaller waist or waist-hip ratio measurements.

To summarise: abdominal obesity was specifically associated with breast cancer risk in pre-menopausal women, but not in post-menopausal women.

Although this was a well-conducted review, inevitably there are limitations associated with the papers included in it:

Further evidence is needed, overcoming these limitations, before waist measurements are used as an index of breast cancer risk in pre-menopausal women.