11
Obesity and cancer – The update 2013

https://doi.org/10.1016/j.beem.2013.04.005Get rights and content

Progress of the last five years regarding “Obesity and Cancer” with preference to cohort studies was reviewed for cancer of the colorectum, breast, endometrium, renal cell, and adenocarcinomas of the esophagus and compared to the knowledge reviewed in the year 2008. The new studies are mostly confirming what has been known also 5 years ago. Gender seems to play a role in colorectal cancer in that risk due to body fatness is much lower in women than in men. Body fatness at young adulthood is particularly related to risk of renal cancer whereas attained body fatness at a later stage of adulthood is driving the risk for postmenopausal breast and endometrial cancer. Fat distribution is playing a strong role for risk of adenocarcinoma of the esophagus and to a lesser extent also for colon cancer. Prediagnostic body fatness plays also a role in cancer recurrence and survival.

Introduction

Obesity as a modifiable life style factor is directly linked with several unfavorable metabolic and bone related health conditions. Further, obesity is also linked with increased risk of diseases forming the majority of cause of death and mortality itself.1 The expert report of the International Agency for Research on Cancer (IARC) from 2002/2003 entitled “Weight control and physical activity” can be considered as a mile stone of making aware the link between obesity and cancer to a wider audience.2 In the report it was concluded that sufficient evidence exists for a link between obesity and increased risk of colon cancer, postmenopausal breast cancer, endometrial cancer, renal cell cancer, and adenocarcinoma of the esophagus. At that time, results from only a few cohort studies were available and most of the evidence came from case–control studies. In respect to methodology, case–control studies have the disadvantage that they can only retrospectively assess anthropometric status. Thus, case–control studies rely on self-reported previous weight. This information is usually more distorted by measurement error than direct measurements of anthropometric parameters by trained interviewer. The direct measurement of anthropometric parameters is possible in prospective research settings. Thus, this update concentrates on results from prospective studies.

In 2008, the status of results from prospective studies since the report of IARC was reviewed by the author together with other authors using the literature until 2007.3 Since than, additional prospective study results were becoming available that have examined not only the relation between general obesity and cancer but also investigated other anthropometric parameters to describe excess body fat such as fat distribution, recalled weight during life course, and weight gain. Research interest also focused on subtypes of a cancer defined by histology, genetics, or other measures and on the modifying effects of other exposures such as smoking, menopause status, and hormone use. Additionally, high interest also emerged to the question about the role of obesity for cancer survival and recurrence.

Therefore, the present article provides an updated overview of results from recent prospective studies of the association of measures of excess body fat with the cancer sites already labeled to be related to obesity by IARC. The review also included the recent studies on survival and particular address the question whether the recent studies allow a more refined view of the link between measures of excess fatness and these cancer sites. Cancer sites that emerged also to be linked to obesity such as cancer of the pancreas, ovary, gallbladder, thyroid and lung were not considered in this review.4

Section snippets

Measures of excess of body fat

Most of the prospective cohorts on cancer risk based their measurements of body fatness on anthropometry. There is also the possibility that fat and its distribution is directly determined by techniques such as ultrasound, bioelectrical impedance analysis (BIA), densitometry, or imaging procedures (CT, NMR) or by the measurement of (subcutaneous) skin folds. However, such techniques are only rarely used in cohort studies that need to be large due to the low incidence of cancer.

Anthropometric

Obesity and cancer in general

There is growing interest in the relation between life style exposures and cancer in general. The interest is not driven by getting new insights into etiology but into the public health implication. Particular anthropometric parameters such as BMI favor data pooling and meta-analyses since they are easy to conduct and available in most cohort studies. The largest initiatives of this type often focus on mortality and cause of death. The study with 57 cohorts and about 900,000 study participants

Obesity and cancers of the colon and rectum

In the review from 2008,3 the following conclusions have been drawn from the study results so far: 1) Obesity is not related to rectal cancer; 2) BMI is related to colon cancer but much weaker in women than in men; 3) body fat distribution is related to colon cancer with a similar strength in men as in women; 4) body fat distribution adjusted for BMI is still a risk factor. The overall conclusion was that visceral fatness is driving the risk for colon cancer. This view was supported by studies

Obesity and breast cancer

In the review from 2008,3 the following conclusion were drawn regarding breast cancer: 1) BMI and body weight have been found to be positively related to risk of breast cancer among postmenopausal women and inverse associations among premenopausal women; 2) the association between BMI and risk of postmenopausal breast cancer was found to be stronger among women who did not use hormone replacement therapy (HRT) compared to women who did use hormones. 3) most studies found waist circumference not

Obesity and endometrial cancer

In the 2008 review, the following conclusions were drawn regarding endometrial cancer3: 1) It is still unclear whether the association between body weight and risk of endometrial cancer is linear; 2) This opens up an independent role for measures of fat distribution particularly among women with low BMI; 3) Adult weight gain has been shown to be associated with increases in risk for endometrial cancer in a dose-dependent manner; 4) Evidence exists for an interaction of adiposity with HRT use in

Obesity and renal cell cancer

Renal cell carcinoma is the major type (80–90%) of kidney cancer. In the review from 2008, the following conclusions were drawn3: 1) In most of the cohort studies BMI was identified as a risk factor for renal cell cancer, 2) it is still uncertain whether there is a gender difference in the strength of estimates since some studies observed higher risk estimates in women; 3) study results so far suggest that fat distribution does not play a role in renal cell cancer risk beyond adiposity in

Obesity and oesophageal cancer

Oesophageal cancer is subdivided into two main histological types, the squamous cell carcinoma and adenocarcinoma. Oesophageal squamous cell carcinoma is the predominant type of cancer and occurs mostly in the upper and middle part of the esophagus while adenocarcinoma of the esophagus occurs most frequently in the lower part. The adenocarcinoma of the esophagus often develops on the basis of Barrett's esophagus, a premalignant condition characterized by replacement of squamous epithelium with

Summary

In this article, progress of the last years with preference to cohort studies were reviewed regarding the five cancer sites that had been identified by IARC to be related to measures of body fatness in 2002: Cancer of the colorectum, (postmenopausal) breast, endometrium, renal cell, and adenocarcinomas of the esophagus. The previous status of insight into the relation between measures of body fatness and cancer risk was taken from a review published in the year 2008. The new studies are mostly

References (61)

  • D.A. Revicki et al.

    Relationship between body mass indices and measures of body adiposity

    American Journal of Public Health

    (1986)
  • G.C. Kabat et al.

    Scaling of weight for height in relation to risk of cancer at different sites in a cohort of Canadian women

    American Journal of Epidemiology

    (2013)
  • D.O. Okorodudu et al.

    Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis

    International Journal of Obesity (London)

    (2010)
  • B.L. Wajchenberg

    Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome

    Endocrine Reviews

    (2000)
  • A. Burton et al.

    Young adulthood body mass index and risk of cancer in later adulthood: historical cohort study

    Cancer Causes and Control

    (2010)
  • T. Byers et al.

    Does intentional weight loss reduce cancer risk?

    Diabetes, Obesity and Metabolism

    (2011)
  • I. Gribovskaja-Rupp et al.

    Obesity and colorectal cancer

    Clinics in Colon and Rectal Surgery

    (2011)
  • K. Whitlock et al.

    The association between obesity and colorectal cancer

    Gastroenterology Research Practices

    (2012)
  • K. Aleksandrova et al.

    Obesity and colorectal cancer

    Frontiers in Bioscience

    (2013)
  • Y. Ma et al.

    Obesity and risk of colorectal cancer: a systematic review of prospective studies

    PLoS One

    (2013)
  • J. Brändstedt et al.

    Gender, anthropometric factors and risk of colorectal cancer with particular reference to tumour location and TNM stage: a cohort study

    Biology of Sex Differences

    (2012)
  • H. Li et al.

    Body weight, fat distribution and colorectal cancer risk: a report from cohort studies of 134255 Chinese men and women

    International Journal of Obesity (London)

    (2012)
  • Y.J. Lee et al.

    Adiposity and the risk of colorectal adenomatous polyps: a meta-analysis

    Cancer Causes and Control

    (2011)
  • S. Hong et al.

    Abdominal obesity and the risk of colorectal adenoma: a meta-analysis of observational studies

    European Journal of Cancer Prevention

    (2012)
  • K. Nimptsch et al.

    Body fatness during childhood and adolescence, adult height, and risk of colorectal adenoma in women

    Cancer Prevention Research

    (2011)
  • A.E. Prizment et al.

    Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa Women's Health Study

    Cancer Epidemiology, Biomarkers & Prevention

    (2010)
  • J.A. Meyerhardt et al.

    Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from Cancer and Leukemia Group B 89803s

    Journal of Clinical Oncology

    (2011)
  • S. Alipour et al.

    Body mass index and body surface area and their associations with outcomes in stage II and III colon cancer

    Journal of Gastrointestinal Cancer

    (2012)
  • Z. Cheraghi et al.

    Effect of body mass index on breast cancer during premenopausal and postmenopausal periods: a meta-analysis

    PLoS One

    (2012)
  • H.R. Harris et al.

    Body size across the life course, mammographic density, and risk of breast cancer

    American Journal of Epidemiology

    (2011)
  • Cited by (54)

    • Impact of neighborhoods and body size on survival after breast cancer diagnosis

      2015, Health and Place
      Citation Excerpt :

      A large number of prognostic factors from both interview and clinical sources were considered and bias due to differential follow-up was minimized by linkage to population-based cancer registries and death registry records. Our findings indicate that future research on modifiable prognostic factors after breast cancer diagnosis should consider body size measures beyond BMI, such as WHR, which may better characterize distribution of adiposity among diverse groups of women (Protani et al., 2010; Kwan et al., 2014; Boeing, 2013). We also found that certain neighborhood characteristics were associated with WHR.

    • Obesity and liver cancer

      2019, Annals of Hepatology
      Citation Excerpt :

      Indeed, the development of cardiovascular diseases and of type 2 diabetes mellitus (T2DM) are the best known obesity-related complications. However, obesity is also an established risk factor for the development of several malignancies, such as breast, colorectal, endometrium, esophagus, gallbladder, kidney and pancreas cancers, as well as bone-marrow malignancies (Fig. 1) [3–6]. Overall, obesity increases mortality rates in all cancers, as showed in a study from the American Cancer Society in which subjects with a body mass index (BMI) greater than 40 had death rates higher than those in normal weight individuals (52% higher in men and 62% higher in women) [7].

    View all citing articles on Scopus
    View full text