Body composition changes in women with early breast cancer after adjuvant treatment: a systematic review
DOI:
https://doi.org/10.2340/1651-226X.2025.44707Keywords:
endocrine therapy, Adjuvant Chemotherapy, Early Breast Cancer, body composition, Fat mass, lean body massAbstract
Background and purpose: The objective of this systematic review was to establish an overview of changes in body composition as a result of early breast cancer treatment.
Patient/material and methods: Five databases (PubMed, CINAHL, Embase, Web of Science and Cochrane Library) were used for identifying studies and papers. Selection criteria included: > 18 years, early breast cancer stage 0–III and measurement of body composition with either dual X-ray absorptiometry (DXA), magnetic resonance imaging (MRI) or computed tomography (CT). Studies using only bioelectrical impedance were excluded.
Results: A total of 734 studies were screened; 29 studies were full-text reviewed, and 10 studies were included in this systematic review, with a total of n = 1,062. Included studies were published from 2018 to 2024. This review found consistent increases in fat mass between 3.3 and 9.2% across the studies. Results for lean body mass were less consistent. Two studies examined visceral fat mass, yet both found statistically significant increases.
Interpretation: This systematic review identified consistent increases in total fat mass and visceral fat across the included studies, regardless of whether the treatment involved chemotherapy, endocrine therapy or a combination of both. In contrast, findings related to lean body mass were considerably less consistent. The results highlight the potential implications following breast cancer treatment and emphasise the importance of metabolic monitoring, diet and exercise to increase quality of life and prevent recurrence. This review also highlights the need for more research on the topic, as the included studies exhibit substantial heterogeneity, making it difficult to draw definitive conclusions.
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References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May 4;74(3):229–63.
https://doi.org/10.3322/caac.21834 DOI: https://doi.org/10.3322/caac.21834
Berg T, Jensen MB, Rossing M, Axelsen CT, Kümler I, Søndergaard L, et al. Incidence and survival of primary metastatic breast cancer in Denmark; implication of breast cancer screening, classification, and staging practice. Acta Oncol. 2024 May 6;63:277–87.
https://doi.org/10.2340/1651-226X.2023.37270 DOI: https://doi.org/10.2340/1651-226X.2023.37270
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials. Lancet. 2012 Feb;379(9814):432–44.
https://doi.org/10.1016/S0140-6736(11)61625-5 DOI: https://doi.org/10.1016/S0140-6736(11)61625-5
Harbeck N, Gnant M. Breast cancer. Lancet. 2017 Mar;389(10074):1134–50.
https://doi.org/10.1016/S0140-6736(16)31891-8 DOI: https://doi.org/10.1016/S0140-6736(16)31891-8
Cucciniello L, Garufi G, Di Rienzo R, Martinelli C, Pavone G, Giuliano M, et al. Estrogen deprivation effects of endocrine therapy in breast cancer patients: incidence, management and outcome. Cancer Treat Rev. 2023 Nov;120:102624.
https://doi.org/10.1016/j.ctrv.2023.102624 DOI: https://doi.org/10.1016/j.ctrv.2023.102624
Takahashi S. Management of cancer treatment-induced bone loss (CTIBL) in patients with breast cancer or prostate cancer. J Bone Miner Metab. 2023 May 10;41(3):307–16.
https://doi.org/10.1007/s00774-023-01414-1 DOI: https://doi.org/10.1007/s00774-023-01414-1
Buch K, Gunmalm V, Andersson M, Schwarz P, Brøns C. Effect of chemotherapy and aromatase inhibitors in the adjuvant treatment of breast cancer on glucose and insulin metabolism – a systematic review. Cancer Med. 2019 Jan 18;8(1):238–45.
https://doi.org/10.1002/cam4.1911 DOI: https://doi.org/10.1002/cam4.1911
Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Diabetes after hormone therapy in breast cancer survivors: a case-cohort study. J Clin Oncol. 2018 Jul 10;36(20):2061–9. DOI: https://doi.org/10.1200/JCO.2017.76.3524
Vance V, Mourtzakis M, Mccargar L, Hanning R. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011 Apr;12(4):282–94.
https://doi.org/10.1111/j.1467-789X.2010.00805.x DOI: https://doi.org/10.1111/j.1467-789X.2010.00805.x
Kruse FL, Bille MB, Lendorf ME, Vaabengaard S, Birk S. Coasting related to taxane-induced peripheral neuropathy in patients with breast cancer: a systematic review. Acta Oncol. 2025 Jan 15;64:78–86.
https://doi.org/10.2340/1651-226X.2025.42109 DOI: https://doi.org/10.2340/1651-226X.2025.42109
Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019 Mar 7;4(5):e124865.
https://doi.org/10.1172/jci.insight.124865 DOI: https://doi.org/10.1172/jci.insight.124865
Wang W, Gao Y, Cui J. High visceral fat in female breast cancer patients correlates with the risk of progression after adjuvant chemotherapy. Nutr Cancer. 2022 Jul 3;74(6):2038–48.
https://doi.org/10.1080/01635581.2021.1988993 DOI: https://doi.org/10.1080/01635581.2021.1988993
Fraser SF, Gardner JR, Dalla Via J, Daly RM. The effect of exercise training on lean body mass in breast cancer patients: a systematic review and meta-analysis. Med Sci Sports Exerc. 2022 Feb 1;54(2):211–9.
https://doi.org/10.1249/MSS.0000000000002792 DOI: https://doi.org/10.1249/MSS.0000000000002792
Mazzuca F, Onesti CE, Roberto M, Girolamo M Di, Botticelli A, Begini P, et al. Lean body mass wasting and toxicity in early breast cancer patients receiving anthracyclines. Oncotarget. 2018;9(39):25714-22 DOI: https://doi.org/10.18632/oncotarget.25394
Pedersini R, Schivardi G, Laini L, Zamparini M, Bonalumi A, di Mauro P, et al. Changes in body composition in early breast cancer patients treated with aromatase inhibitors. J Endocrinol Invest. 2024;47(12):3119-3128 https://doi.org/10.1016/j.breast.2024.103794 DOI: https://doi.org/10.1007/s40618-024-02401-7
Kirkham AA, Pituskin E, MacKey JR, Grenier JG, Ian Paterson D, Haykowsky MJ, et al. Longitudinal changes in skeletal muscle metabolism, oxygen uptake, and myosteatosis during cardiotoxic treatment for early-stage breast cancer. Oncologist. 2022 Sep 1;27(9):e748–54.
https://doi.org/10.1093/oncolo/oyac092 DOI: https://doi.org/10.1093/oncolo/oyac092
Kirkham AA, Pituskin E, Thompson RB, MacKey JR, Koshman SL, Jassal D, et al. Cardiac and cardiometabolic phenotyping of trastuzumab-mediated cardiotoxicity: a secondary analysis of the MANTICORE trial. Eur Heart J Cardiovasc Pharmacother. 2022 Mar 1;8(2):130–9.
https://doi.org/10.1093/ehjcvp/pvab016 DOI: https://doi.org/10.1093/ehjcvp/pvab016
van den Berg MMGA, Kok DE, Visser M, de Vries JHM, de Kruif JTCM, de Vries Y, et al. Changes in body composition during and after adjuvant or neo-adjuvant chemotherapy in women with breast cancer stage I–IIIB compared with changes over a similar timeframe in women without cancer. Support Care Cancer. 2020 Apr 1;28(4):1685–93.
https://doi.org/10.1007/s00520-019-04951-6 DOI: https://doi.org/10.1007/s00520-019-04951-6
Burt MG, Mangelsdorf BL, Drake SM, Swan M, Padman S, Vatandoust S, et al. Insulin sensitivity, cardiovascular function and bone health in women with early stage breast cancer before and after cancer treatment. Intern Med J. 2022 Nov 1;52(11):1917–24.
https://doi.org/10.1111/imj.15469 DOI: https://doi.org/10.1111/imj.15469
Ginzac A, Thivat É, Mouret-Reynier MA, Dubray-Longeras P, Van Praagh I, Passildas J, et al. Weight evolution during endocrine therapy for breast cancer in postmenopausal patients: effect of initial fat mass percentage and previous adjuvant treatments. Clin Breast Cancer. 2018 Oct 1;18(5):e1093–102.
https://doi.org/10.1016/j.clbc.2018.06.010 DOI: https://doi.org/10.1016/j.clbc.2018.06.010
Zhang Y, Kang H, Zhao J, Wang Y, Cai W, Zhang X, et al. Neoadjuvant therapy increases the risk of metabolic disorders and osteosarcopenia in patients with early breast cancer. Jpn J Clin Oncol. 2024 Sep 1;54(9):959–66.
https://doi.org/10.1093/jjco/hyae070 DOI: https://doi.org/10.1093/jjco/hyae070
Ballinger TJ, Reddy A, Althouse SK, Nelson EM, Miller KD, Sledge JS. Impact of primary breast cancer therapy on energetic capacity and body composition. Breast Cancer Res Treat. 2018 Nov 1;172(2):445–52.
https://doi.org/10.1007/s10549-018-4924-6 DOI: https://doi.org/10.1007/s10549-018-4924-6
Fredslund SO, Gravholt CH, Laursen BE, Jensen AB. Key metabolic parameters change significantly in early breast cancer survivors: an explorative PILOT study. J Transl Med. 2019 Apr 1;17(1), 105.
https://doi.org/10.1186/s12967-019-1850-2 DOI: https://doi.org/10.1186/s12967-019-1850-2
Rissling MB, Liu L, Natarajan L, He F, Ancoli-Israel S. Relationship of menopausal status and climacteric symptoms to sleep in women undergoing chemotherapy. Support Care Cancer. 2011 Aug;19(8):1107–15.
https://doi.org/10.1007/s00520-010-0914-x DOI: https://doi.org/10.1007/s00520-010-0914-x
Berger AM, Treat Marunda HA, Agrawal S. Influence of menopausal status on sleep and hot flashes throughout breast cancer adjuvant chemotherapy. J Obstet Gynecol Neonatal Nurs. 2009;38(3):353–66.
https://doi.org/10.1111/j.1552-6909.2009.01030.x DOI: https://doi.org/10.1111/j.1552-6909.2009.01030.x
Tolstrup LK, Dieperink KB, Van Leeuwen M, Möller S, Fechner L, Clausen LH, et al. Health-related quality of life in Danish cancer survivors referred to a late effects clinic: a prospective cohort study. Acta Oncol. 2024 Jun 16;63:426–32.
https://doi.org/10.2340/1651-226X.2024.39937 DOI: https://doi.org/10.2340/1651-226X.2024.39937
Kudiarasu C, Lopez P, Galvão DA, Newton RU, Taaffe DR, Mansell L, et al. What are the most effective exercise, physical activity and dietary interventions to improve body composition in women diagnosed with or at high‐risk of breast cancer? A systematic review and network meta‐analysis. Cancer. 2023 Dec 3;129(23):3697–712.
https://doi.org/10.1002/cncr.35043 DOI: https://doi.org/10.1002/cncr.35043
Ho MY, Mackey JR. Presentation and management of docetaxel-related adverse effects in patients with breast cancer. In: Cancer management and research. Vol. 6. Dove Medical Press Ltd; 2014. p. 253–9. London, United Kingdom. DOI: https://doi.org/10.2147/CMAR.S40601
Tavoian D, Ampomah K, Amano S, Law TD, Clark BC. Changes in DXA-derived lean mass and MRI-derived cross-sectional area of the thigh are modestly associated. Sci Rep. 2019 Dec 1;9(1), 10028.
https://doi.org/10.1038/s41598-019-46428-w DOI: https://doi.org/10.1038/s41598-019-46428-w
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Copyright (c) 2025 Valdemar Mendez, Simone Diedrichsen Marstrand , August Nielsen, Trine Lund-Jacobsen, Caroline Kistorp, Peter Schwarz, Kristian Buch-Larsen
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