Best Practice & Research Clinical Endocrinology & Metabolism
11Obesity and cancer – The update 2013
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
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