Concurrent Overweight, Obesity, and Related Comorbidities with Advanced Breast Cancer in a Safety Net Hospital: Opportunity for Improvement

Abstract

Introduction: Social determinants of health affect both obesity and breast cancer outcomes. We sought to evaluate overweight, obesity, obesity-related comorbidities, and stage at diagnosis in breast cancer patients at a safety net hospital. Methods: A retrospective review was conducted of new breast cancer surgical referrals at a safety net hospital from 2016 to 2018 for sociodemographic, tumor, and obesity-related characteristics. Results: Overall, 95 patients had a median age of 55 years (range 33–92 years). Hispanic patients comprised 57.9%; 55.8% required language interpretation services. Medicaid covered 52.6%, with charity/state low-income coverage in 33.7%. Breast cancer was diagnosed at stage 0 in 11.6%; stage I, 26.3%; stage II, 31.6%; stage III, 14.7%; and stage IV, 4.2%. Median BMI was 30.1 kg/m2 (range 17.6–50.5 kg/m2). Overall, 16.8% of patients had a BMI 18.5–25 kg/m2, 31.6% had a BMI 25.0–30 kg/m2, and 50.5% had a BMI > 30.0 kg/m2, including 20.0% with class 1 obesity (BMI 30-35 kg/m2); 22.1%, class 2 (BMI 35–40 kg/m2); and 8.4%, class 3 (BMI > 40 kg/m2). Obesity-related comorbidities included hypertension (46.3%), diabetes (27.4%), hyperlipidemia (23.2%), osteoarthritis (5.3%), obstructive sleep apnea (2.1%), transient ischemic attack/stroke (2.1%), and nonalcoholic fatty liver disease (1.1%). Criteria for bariatric surgery (BMI 35–39.9 kg/m2 with > 1 obesity-related comorbidity or BMI > 40.0 kg/m2) were met in 24.2% of patients. Conclusion: While surgeons can successfully treat obesity and breast cancer, with overmore than 80% of new breast cancer patients overweight or obese and half stage II or higher, a combined weight reduction and breast cancer screening intervention may improve breast cancer outcomes, especially in a medically underserved population.