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Obesity and Cancer

  • Mary MarianEmail author
  • Cynthia A. Thomson
Chapter
Part of the Nutrition and Health book series (NH)

Abstract

Obesity is a global epidemic and a wealth of evidence suggests that obesity in addition to sedentary lifestyle and diet are modifiable risk factors associated with cancer. Several cancers including breast (in postmenopausal women), cervical, colon, endometrial, esophageal, gallbladder, multiple myeloma, non-Hodgkin’s lymphoma, rectal, renal, thyroid cancer, and even pancreatic cancer have been associated with obesity. A variety of biological mechanisms involving the adipocyte has been implicated in tumorigenesis. Moreover, poorer outcomes in terms of worsened disease survival have been reported for obese patients. A number of small, randomized, controlled trials to promote weight loss in cancer survivors have been undertaken and suggest modest results in relation to weight control. This chapter will review the potential mechanisms linking obesity and cancer together with a summary of the available studies of weight control in cancer survivors. Guidelines for cancer survivors regarding diet and physical activity for risk reduction and weight control also will be discussed.

Keywords

Obesity and cancer Adipokines and cancer Weight control and cancer Obesity and cancer survivors 

References

  1. 1.
    American Cancer Society. Cancer Facts and Figures 2012. Available at: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-031941.pdf.
  2. 2.
    The American Institute for Cancer Research and World Cancer Research Fund Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. Available at: http://www.aicr.org/research/research_science_expert_report.html.
  3. 3.
    Aune D, Greenwood DC, Chan DS, Vieira R, Vieira AR, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. 2012;23:843–52.CrossRefPubMedGoogle Scholar
  4. 4.
    Larsson SC, Wolk A. Overweight and obesity and incidence of leukemia: a meta-analysis of cohort studies. Int J Cancer. 2008;122:1418–21.CrossRefPubMedGoogle Scholar
  5. 5.
    National Cancer Institute Fact Sheet. Obesity and Cancer Risk. Available at: http://www.cancer.gov/cancertopics/factsheet/Risk/obesity.
  6. 6.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:243–74.CrossRefPubMedGoogle Scholar
  7. 7.
    Services UDoHaH. 2012. http://HealthyPeople.gov
  8. 8.
    Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, et al. American Cancer Society Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2006;56:254–81. quiz 313-254.CrossRefPubMedGoogle Scholar
  9. 9.
    Harvey AE, Lashinger LM, Hursting SD. The growing challenge of obesity and cancer: an inflammatory issue. Ann N Y Acad Sci. 2011;1229:45–52.CrossRefPubMedGoogle Scholar
  10. 10.
    Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.CrossRefPubMedGoogle Scholar
  11. 11.
    Renehan AG, Roberts DL, Dive C. Obesity and cancer: pathophysiological and biological mechanisms. Arch Physiol Biochem. 2008;114:71–83.CrossRefPubMedGoogle Scholar
  12. 12.
    Haslam D. Obesity: a medical history. Obes Rev. 2007;8 Suppl 1:31–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Khandekar MJ, Cohen P, Spiegelman BM. Molecular mechanisms of cancer development in obesity. Nat Rev Cancer. 2011;11:886–95.CrossRefPubMedGoogle Scholar
  14. 14.
    Hursting SD, Hursting MJ. Growth signals, inflammation, and vascular perturbations: mechanistic links between obesity, metabolic syndrome, and cancer. Arterioscler Thromb Vasc Biol. 2012;32:1766–70.CrossRefPubMedGoogle Scholar
  15. 15.
    Stofkova A. Leptin and adiponectin: from energy and metabolic dysbalance to inflammation and autoimmunity. Endocr Regul. 2009;43:157–68.PubMedGoogle Scholar
  16. 16.
    van Kruijsdijk RC, van der Wall E, Visseren FL. Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev. 2009;18:2569–78.CrossRefPubMedGoogle Scholar
  17. 17.
    Wong KK, Engelman JA, Cantley L. Targeting the PI3K signaling pathway in cancer. Curr Opin Genet Dev. 2010;20:87–90.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Barb D, Williams CJ, Neuwirth AK, Mantzoros CS. Adiponectin in relation to malignancies: a review of existing basic research and clinical evidence. Am J Clin Nutr. 2007;86:858–66.Google Scholar
  19. 19.
    Morris PG, Hudis CA, Giri D, Morrow M, Falcone DJ, et al. Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer. Cancer Prev Res (Phila). 2011;4:1021–9.CrossRefGoogle Scholar
  20. 20.
    Key TJ, Appleby PN, Reeves GK, Roddam A, Dorgan JF, et al. Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst. 2003;95:1218–26.CrossRefPubMedGoogle Scholar
  21. 21.
    Kidd S, Spaeth E, Watson K, Burks J, Lu H, et al. Origins of the tumor microenvironment: quantitative assessment of adipose-derived and bone marrow-derived stroma. PLoS One. 2012;7:e30563.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Suga H, Eto H, Aoi N, Kato H, Araki J, et al. Adipose tissue remodeling under ischemia: death of adipocytes and activation of stem/progenitor cells. Plast Reconstr Surg. 2010;126:1911–23.CrossRefPubMedGoogle Scholar
  23. 23.
    Roberts DL, Dive C, Renehan AG. Biological mechanisms linking obesity and cancer risk: new perspectives. Annu Rev Med. 2010;61:301–16.CrossRefPubMedGoogle Scholar
  24. 24.
    Sirin O, Kolonin MG. Treatment of obesity as a potential complementary approach to cancer therapy. Drug Discov Today. 2013;18:567–73. http://dx.doi.org/ 10.1016/j.drudis.2012.05.008
  25. 25.
    Ramsey AM, Martin RC. Body mass index and outcomes from pancreatic resection: a review and meta-analysis. J Gastrointest Surg. 2011;15:1633–42.CrossRefPubMedGoogle Scholar
  26. 26.
    Fotopoulou C, Richter R, Braicu EI, Kuhberg M, Feldheiser A, et al. Impact of obesity on operative morbidity and clinical outcome in primary epithelial ovarian cancer after optimal primary tumor debulking. Ann Surg Oncol. 2011;18:2629–37.CrossRefPubMedGoogle Scholar
  27. 27.
    Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62:220–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123:627–35.CrossRefPubMedGoogle Scholar
  29. 29.
    Meyerhardt JA, Ma J, Courneya KS. Energetics in colorectal and prostate cancer. J Clin Oncol. 2010;28:4066–73.CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Parekh N, Chandran U, Bandera EV. Obesity in cancer survival. Annu Rev Nutr. 2012;32:311–42.CrossRefPubMedGoogle Scholar
  31. 31.
    Prizment AE, Flood A, Anderson KE, Folsom AR. Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa Women’s Health Study. Cancer Epidemiol Biomarkers Prev. 2010;19:2229–37.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Doria-Rose VP, Newcomb PA, Morimoto LM, Hampton JM, Trentham-Dietz A. Body mass index and the risk of death following the diagnosis of colorectal cancer in postmenopausal women (United States). Cancer Causes Control. 2006;17:63–70.CrossRefPubMedGoogle Scholar
  33. 33.
    Haydon AM, Macinnis RJ, English DR, Giles GG. Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut. 2006;55:62–7.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Gong Z, Agalliu I, Lin DW, Stanford JL, Kristal AR. Obesity is associated with increased risks of prostate cancer metastasis and death after initial cancer diagnosis in middle-aged men. Cancer. 2007;109:1192–202.CrossRefPubMedGoogle Scholar
  35. 35.
    Ma J, Li H, Giovannucci E, Mucci L, Qiu W, et al. Prediagnostic body-mass index, plasma C-peptide concentration, and prostate cancer-specific mortality in men with prostate cancer: a long-term survival analysis. Lancet Oncol. 2008;9:1039–47.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Li D, Morris JS, Liu J, Hassan MM, Day RS, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009;301:2553–62.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Lino-Silva LS, de Leon DC, Salcedo-Hernandez RA, Cavazos-Saman C, Perez-Montiel MD. A high body mass index is not a worse prognostic factor for endometrial carcinoma in a predominantly obese population. Clin Transl Oncol. 2012;15(3):243–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Backes FJ, Nagel CI, Bussewitz E, Donner J, Hade E, et al. The impact of body weight on ovarian cancer outcomes. Int J Gynecol Cancer. 2011;21:1601–5.CrossRefPubMedCentralPubMedGoogle Scholar
  39. 39.
    Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, 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 89803. J Clin Oncol. 2008;26:4109–15.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Rickles AS, Iannuzzi JC, Mironov O, Deeb AP, Sharma A, et al. Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg. 2012;17(1):133–43.CrossRefPubMedGoogle Scholar
  41. 41.
    Fowke JH, Motley SS, Concepcion RS, Penson DF, Barocas DA. Obesity, body composition, and prostate cancer. BMC Cancer. 2012;12:23.CrossRefPubMedCentralPubMedGoogle Scholar
  42. 42.
    Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol. 2005;23:1370–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Healy LA, Ryan AM, Sutton E, Younger K, Mehigan B, et al. Impact of obesity on surgical and oncological outcomes in the management of colorectal cancer. Int J Colorectal Dis. 2010;25:1293–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011;4:486–501.CrossRefGoogle Scholar
  45. 45.
    Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361:664–73.CrossRefPubMedGoogle Scholar
  46. 46.
    Thomson CA, Stopeck AT, Bea JW, Cussler E, Nardi E, et al. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets. Nutr Cancer. 2010;62:1142–52.CrossRefPubMedGoogle Scholar
  47. 47.
    Patterson RE, Flatt SW, Saquib N, Rock CL, Caan BJ, et al. Medical comorbidities predict mortality in women with a history of early stage breast cancer. Breast Cancer Res Treat. 2010;122:859–65.CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.
    Chiou WK, Hwang JS, Hsu KH, Lin JD. Diabetes mellitus increased mortality rates more in gender-specific than in nongender-specific cancer patients: a retrospective study of 149,491 patients. Exp Diabetes Res. 2012;701643.Google Scholar
  49. 49.
    Sedlack SMPM, Wolfe P, et al. Effect of a low fat versus a low carbohydrate weight loss dietary intervention on biomarkers of long term survival in breast cancer patients (‘CHOICE’): study protocol. BMC Cancer. 2011;11:1–10.CrossRefGoogle Scholar
  50. 50.
    Demark-Wahnefried W, Campbell KL, Hayes SC. Weight management and its role in breast cancer rehabilitation. Cancer. 2012;118:2277–87.CrossRefPubMedGoogle Scholar
  51. 51.
    Campbell KL, Van Patten CL, Neil SE, Kirkham AA, Gotay CC, et al. Feasibility of a lifestyle intervention on body weight and serum biomarkers in breast cancer survivors with overweight and obesity. J Acad Nutr Diet. 2012;112:559–67.CrossRefPubMedGoogle Scholar
  52. 52.
    Demark-Wahnefried W, Kenyon AJ, Eberle P, Skye A, Kraus WE. Preventing sarcopenic obesity among breast cancer patients who receive adjuvant chemotherapy: results of a feasibility study. Clin Exerc Physiol. 2002;4:44–9.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Demark-Wahnefried W, Case LD, Blackwell K, Marcom PK, Kraus W, et al. Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. Clin Breast Cancer. 2008;8:70–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Djuric Z, DiLaura NM, Jenkins I, Darga L, Jen CK, et al. Combining weight-loss counseling with the weight watchers plan for obese breast cancer survivors. Obes Res. 2002;10:657–65.CrossRefPubMedGoogle Scholar
  55. 55.
    Djuric Z, Mirasolo J, Kimbrough L, Brown DR, Heilbrun LK, et al. A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. J Natl Med Assoc. 2009;101:552–64.PubMedCentralPubMedGoogle Scholar
  56. 56.
    Goodwin P, Esplen MJ, Butler K, Winocur J, Pritchard K, et al. Multidisciplinary weight management in locoregional breast cancer: results of a phase II study. Breast Cancer Res Treat. 1998;48:53–64.CrossRefPubMedGoogle Scholar
  57. 57.
    Irwin ML, Alvarez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, et al. Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity (Silver Spring). 2009;17:1534–41.CrossRefGoogle Scholar
  58. 58.
    Irwin ML, Varma K, Alvarez-Reeves M, Cadmus L, Wiley A, et al. Randomized controlled trial of aerobic exercise on insulin and insulin-like growth factors in breast cancer survivors: the Yale Exercise and Survivorship study. Cancer Epidemiol Biomarkers Prev. 2009;18:306–13.CrossRefPubMedCentralPubMedGoogle Scholar
  59. 59.
    Pakiz B, Flatt SW, Bardwell WA, Rock CL, Mills PJ. Effects of a weight loss intervention on body mass, fitness, and inflammatory biomarkers in overweight or obese breast cancer survivors. Int J Behav Med. 2011;18:333–41.CrossRefPubMedCentralPubMedGoogle Scholar
  60. 60.
    Sedlacek SM, Playdon MC, Wolfe P, McGinley JN, Wisthoff MR, et al. Effect of a low fat versus a low carbohydrate weight loss dietary intervention on biomarkers of long term survival in breast cancer patients (‘CHOICE’): study protocol. BMC Cancer. 2011;11:287.CrossRefPubMedCentralPubMedGoogle Scholar
  61. 61.
    Ligibel JA, Meyerhardt J, Pierce JP, Najita J, Shockro L, et al. Impact of a telephone-based physical activity intervention upon exercise behaviors and fitness in cancer survivors enrolled in a cooperative group setting. Breast Cancer Res Treat. 2012;132:205–13.CrossRefPubMedCentralPubMedGoogle Scholar
  62. 62.
    Christy SM, Mosher CE, Sloane R, Snyder DC, Lobach DF, et al. Long-term dietary outcomes of the FRESH START intervention for breast and prostate cancer survivors. J Am Diet Assoc. 2011;111:1844–51.CrossRefPubMedCentralPubMedGoogle Scholar
  63. 63.
    Demark-Wahnefried W, Morey MC, Sloane R, Snyder DC, Miller PE, et al. Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol. 2012;30:2354–61.CrossRefPubMedCentralPubMedGoogle Scholar
  64. 64.
    Morey MC, Snyder DC, Sloane R, Cohen HJ, Peterson B, et al. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA. 2009;301:1883–91.CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    von Gruenigen V, Frasure H, Kavanagh MB, Janata J, Waggoner S, et al. Survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED): a randomized controlled trial. Gynecol Oncol. 2012;125:699–704.CrossRefGoogle Scholar
  66. 66.
    Parsons JK, Newman VA, Mohler JL, Pierce JP, Flatt S, et al. Dietary modification in patients with prostate cancer on active surveillance: a randomized, multicentre feasibility study. BJU Int. 2008;101:1227–31.CrossRefPubMedGoogle Scholar
  67. 67.
    Campbell MK, Carr C, Devellis B, Switzer B, Biddle A, et al. A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control. Ann Behav Med. 2009;38:71–85.CrossRefPubMedCentralPubMedGoogle Scholar
  68. 68.
    Bourke L, Thompson G, Gibson DJ, Daley A, Crank H, et al. Pragmatic lifestyle intervention in patients recovering from colon cancer: a randomized controlled pilot study. Arch Phys Med Rehabil. 2011;92:749–55.CrossRefPubMedGoogle Scholar
  69. 69.
    Hewitt ME, Ganz P, Institute of Medicine (U.S.), American Society of Clinical Oncology. From cancer patient to cancer survivor: lost in translation. Washington, DC: National Academies Press; 2006.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Colleges of Medicine & Agriculture/Life SciencesUniversity of ArizonaTucsonUSA
  2. 2.Mel & Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonUSA

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