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Review
. 2010;15(6):556-65.
doi: 10.1634/theoncologist.2009-0285. Epub 2010 May 27.

Obesity and cancer

Kathleen Y Wolin  1 , Kenneth Carson, Graham A Colditz
Affiliations
Review

Obesity and cancer

Kathleen Y Wolin et al. Oncologist. 2010.

Abstract

Weight, weight gain, and obesity account for approximately 20% of all cancer cases. Evidence on the relation of each to cancer is summarized, including esophageal, thyroid, colon, renal, liver, melanoma, multiple myeloma, rectum, gallbladder, leukemia, lymphoma, and prostate in men; and postmenopausal breast and endometrium in women. Different mechanisms drive etiologic pathways for these cancers. Weight loss, particularly among postmenopausal women, reduces risk for breast cancer. Among cancer patients, data are less robust, but we note a long history of poor outcomes after breast cancer among obese women. While evidence on obesity and outcomes for other cancers is mixed, growing evidence points to benefits of physical activity for breast and colon cancers. Dosing of chemotherapy and radiation therapy among obese patients is discussed and the impact on therapy-related toxicity is noted. Guidelines for counseling patients for weight loss and increased physical activity are presented and supported by strong evidence that increased physical activity leads to improved quality of life among cancer survivors. The "Five A's" model guides clinicians through a counseling session: assess, advise, agree, assist, arrange. The burden of obesity on society continues to increase and warrants closer attention by clinicians for both cancer prevention and improved outcomes after diagnosis.

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Conflict of interest statement

Disclosures: Kathleen Y. Wolin: None; Kenneth Carson: None; Graham A. Colditz: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

Figures

Figure 1.
Figure 1.
Trends in obesity, U.S. Abbreviation: BMI, body mass index. Source: NCHS 2008. Available at http://www.cdc.gov/nchs/data/hestat/overweight/overweight_adult.htm.
Figure 2.
Figure 2.
Estimated proportion of cancer in the U.S. that could have been avoided by changes in each category of nongenetic cancer causes.
Figure 3.
Figure 3.
Serum insulin and risk for prostate cancer. p (trend) = .02. Based on Table 3 of Albanes D, Weinstein SJ, Wright ME et al. Serum insulin, glucose, indices of insulin resistance, and risk of prostate cancer. J Natl Cancer Inst 2009;101:1272–1279.
Figure 4.
Figure 4.
Sustained weight loss and breast cancer risk in postmenopausal women who never used postmenopausal hormones. Based on Table 3 of Eliassen AH, Colditz G, Rosner B et al. Adult weight change and risk of postmenopausal breast cancer. JAMA 2006;296:193–201.
Figure 5.
Figure 5.
Physical activity, diet, and behavioral goals for sustained weight loss.
See this image and copyright information in PMC

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