Strong evidence supports the association between obesity and some major types of cancer, consisting mainly of those related to digestive organs and hormone-related malignancies, according to a large-scale review published recently by The British Medical Journal (BMJ).
Strong associations were found in studies that examined body mass index (BMI) with risk of oesophageal (gullet), bone marrow, biliary tract system (which links the liver, gallbladder and pancreas), pancreatic and kidney cancers.
Additionally, for men, there was an additional link with colon and rectal cancers, while for premenopausal women it was with endometrial (womb) cancer.
The international team of researchers, led by Maria Kyrgiou and Kostas Tsilidis from Imperial College London, said there could be associations between obesity and other cancers, but they cautioned that ‘substantial uncertainty’ remained because the quality of evidence was not strong.
They have called for more research because “evidence of the strength of the associations between obesity and cancer may allow finer selection of people at high risk, who could be selected for personalised primary and secondary prevention strategies”.
However, Yikyung Park and Graham Colditz from Washington University School of Medicine are more positive about the findings.
“Though some specifics remain to be worked out, the unavoidable conclusion from this data is that preventing excess adult weight gain can reduce the risk of cancer,” they conclude.
“Given the critical role of healthcare providers in obesity screening and prevention, clinicians, particularly primary care clinicians, can be a powerful force to lower the burden of obesity related cancers as along with the many other chronic diseases linked to obesity such as diabetes, heart disease and stroke.”
Cancer is a leading cause of death worldwide, and the prevalence of obesity has more than doubled over the past 40 years.
Previously published evidence supports the association between obesity and some cancers, but some may be flawed or biased due to weak study design and conduct, according to the researchers.
The team, led by Imperial College, decided to look at the quality of evidence and the strength of the associations by reviewing studies on obesity and the risk of developing cancer.
They identified 204 studies from 49 publications that analysed the obesity measurements, such as body mass index (BMI), weight gain, and waist circumference, and 36 cancers and their subtypes.
Of the 95 studies that included continuous obesity measures, only 13% of associations were supported by strong evidence, meaning the studies had statistically significant results and no suggestion of bias.
Risk of developing cancer for every 5kg increase in BMI ranged from 9% for colorectal cancer among men, to 56% for biliary tract system cancer.
The risk of postmenopausal breast cancer among women who never used hormone replacement therapy increased by 11% for each 5kg of weight gain. The risk of endometrial cancer increased by 21% for each 0.1 increase in waist to hip ratio.
Five additional associations were supported by strong evidence when categorical measures of obesity were used. These included weight gain with risk of colorectal cancer and BMI with risk of gallbladder, gastric cardia and ovarian cancers, and mortality from multiple myeloma.
The researchers say: “This analysis involved an umbrella review of studies that used observational data, which is useful for bringing together evidence.
“However, no firm conclusions can be drawn about cause and effect when analysing observational studies.”