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We analyzed data for 20,090 female invasive breast cancer patients who had been followed\u2010up for a median period of 6.7\u00a0years entered in the National Clinical Database\u2013Breast Cancer Registry between 2004 and 2006. We used mainly the<jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content>criteria for<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>\u00a0(kg\/m<jats:sup>2<\/jats:sup>) categories; &lt;18.5 (underweight), \u226518.5\u2013&lt;21.8 (reference), \u226521.8\u2013&lt;25, \u226525\u2013&lt;30 (overweight), and \u226530 (obese). We divided normal weight patients into two subgroups because this category includes many patients compared to others. The timing of<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>measurement was not specified. The Cox proportional hazards model and cubic spline regression were used to estimate hazard ratios (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>s) and 95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>s). Smoking, alcohol, and physical activity were not controlled. A total of 1418 all\u2010cause, 937 breast cancer\u2013specific deaths, and 2433 recurrences were observed. Obesity was associated with an increased risk of all\u2010cause (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 1.46; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.16\u20131.83) and breast cancer\u2013specific death (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 1.47; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.11\u20131.93) for all patients, and with all\u2010cause (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 1.47; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.13\u20131.92) and breast cancer\u2013specific death (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 1.58; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.13\u20132.20) for postmenopausal patients. Being underweight was associated with an increased risk of all\u2010cause death for all (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 1.41; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.16\u20131.71) and for postmenopausal patients (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 1.45; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.15\u20131.84). With regard to subtype and menopausal status, obesity was associated with an increased risk of breast cancer\u2013specific death for all cases of luminal B tumor (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 2.59; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.51\u20134.43; P<jats:sub>heterogeneity<\/jats:sub>of Luminal B vs. Triple negative\u00a0=\u00a00.016) and for postmenopausal patients with luminal B tumor (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 3.24; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.71\u20136.17). Being obese or underweight is associated with a higher risk of death among female breast cancer patients in Japan.<\/jats:p>","DOI":"10.1002\/cam4.678","type":"journal-article","created":{"date-parts":[[2016,2,29]],"date-time":"2016-02-29T10:31:57Z","timestamp":1456741917000},"page":"1328-1340","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Body mass index and survival after diagnosis of invasive breast cancer: a study based on the Japanese National Clinical Database\u2014Breast Cancer Registry"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1383-0487","authenticated-orcid":false,"given":"Masaaki","family":"Kawai","sequence":"first","affiliation":[{"name":"Department of Breast Oncology Miyagi Cancer Center Natori Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Tomotaki","sequence":"additional","affiliation":[{"name":"Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Miyata","sequence":"additional","affiliation":[{"name":"Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Departments of Breast and Endocrine Surgery Okayama University Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Niikura","sequence":"additional","affiliation":[{"name":"Departments of Breast and Endocrine Surgery Tokai University School of Medicine Isehara Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisei","family":"Anan","sequence":"additional","affiliation":[{"name":"Department of Surgery Kitakyushu Municipal Medical Center Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery St. Luke's International Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenjiro","family":"Aogi","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery Shikoku Cancer Center Matsuyama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Ishida","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Graduate School of Medicine Tohoku University Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideji","family":"Masuoka","sequence":"additional","affiliation":[{"name":"Sapporo\u2010kotoni Breast Clinic Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kotaro","family":"Iijima","sequence":"additional","affiliation":[{"name":"Department of Breast Oncology Cancer Institute Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinobu","family":"Masuda","sequence":"additional","affiliation":[{"name":"Department of Pathology Nihon University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Tsugawa","sequence":"additional","affiliation":[{"name":"Division of Breast and Endocrine Surgery Department of Surgery \u00a0St. Marianna University School of Medicine Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery National Cancer Center Hospital Tokyo 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