Bowen Adam M, Baraka Dania, Ali Bilal, Pierce Shannon, Bayya Maha
Hematology Oncology, Upstate University Hospital, Syracuse, USA.
Internal Medicine, McLaren Greater Lansing, Lansing, USA.
Cureus. 2025 May 26;17(5):e84843. doi: 10.7759/cureus.84843. eCollection 2025 May.
The global rise in obesity has intersected with increasing breast cancer incidence, generating a critical need to understand how excess adiposity affects diagnostic accuracy, treatment delivery, and patient outcomes. Although large epidemiologic studies have established associations between obesity and worse breast cancer prognosis, individual-level clinical nuances remain underrepresented. This review systematically evaluates case-based evidence to identify how obesity contributes to diagnostic delays and treatment complications in breast cancer care. This systematic review was conducted according to PRISMA 2020 guidelines and registered with PROSPERO. Databases searched included PubMed, Embase, Scopus, and Google Scholar through April 2025, using terms related to breast cancer, obesity, and case reports. Eligible studies included English-language case reports or series describing diagnostic or therapeutic complications in obese women with breast cancer. The Joanna Briggs Institute checklist was used to assess methodological quality. Nine patients from eight reports met inclusion criteria. Thematic analysis revealed four key domains in which obesity affected care: delayed or misattributed diagnosis, increased risk of surgical site infections and reconstructive failure, altered metabolism and pharmacokinetics leading to treatment toxicity or underdosing, and compounded clinical complexity due to multimorbidity. Cases included rare infections, malabsorption of endocrine therapy post-bariatric surgery, and fatal toxicities amplified by obesity-related comorbidities. Obesity introduces clinically significant barriers throughout breast cancer diagnosis and treatment. This review emphasizes how real-world patient cases echo trends from population studies while revealing additional mechanistic and procedural challenges. Greater awareness of obesity-specific risks can inform personalized strategies to mitigate diagnostic errors, optimize treatment efficacy, and improve outcomes amid the ongoing obesity epidemic.
全球肥胖率的上升与乳腺癌发病率的增加同时出现，这使得迫切需要了解过多的肥胖是如何影响诊断准确性、治疗实施和患者预后的。尽管大型流行病学研究已经证实了肥胖与更差的乳腺癌预后之间的关联，但个体层面的临床细微差别仍未得到充分体现。本综述系统地评估了基于病例的证据，以确定肥胖是如何导致乳腺癌治疗中的诊断延迟和治疗并发症的。本系统综述是根据PRISMA 2020指南进行的，并在PROSPERO上进行了注册。检索的数据库包括截至2025年4月的PubMed、Embase、Scopus和谷歌学术，使用了与乳腺癌、肥胖和病例报告相关的术语。符合条件的研究包括描述肥胖乳腺癌女性诊断或治疗并发症的英文病例报告或系列研究。使用乔安娜·布里格斯研究所检查表来评估方法学质量。来自8份报告的9名患者符合纳入标准。主题分析揭示了肥胖影响治疗的四个关键领域：诊断延迟或误诊、手术部位感染和重建失败的风险增加、代谢和药代动力学改变导致治疗毒性或剂量不足，以及由于多种疾病导致临床复杂性增加。病例包括罕见感染、减肥手术后内分泌治疗吸收不良以及与肥胖相关的合并症加剧的致命毒性。肥胖在整个乳腺癌诊断和治疗过程中带来了具有临床意义的障碍。本综述强调了真实世界的患者病例如何呼应人群研究的趋势，同时揭示了额外的机制和程序挑战。在持续的肥胖流行中，提高对肥胖特异性风险的认识可以为个性化策略提供信息，以减少诊断错误、优化治疗效果并改善预后。
