GYN ONCOLOGY OBesity Project

“Obesity is linked as a cause of 20% of cancer deaths in women.”

Obesity and Cancer Obesity is a risk factor for numerous cancers Esophageal Pancreatic Colorectal Postmenopausal breast Endometrial Ovarian Renal

Mechanisms of Increased Cancer Risk Increased female hormone exposure Excess Insulin Induction of inflammation Turning on of Onco-genes

Relationship Between Insulin Sensitivity and Cytokines Insulin Sensitivity TNF Alpha (pg/ml) r = -0.67, p < Kirwan, Diabetes; 2002

Incidence of Cancer Related to Obesity Breast Cancer (230,480 female US cases yearly) Increase circulating estradiol level is a risk factor for the development of postmenopausal breast cancer Estrogen modulating hormones (SERMs) have been shown to decrease the development of breast cancer

Obesity and Cancer Endometrial Adenocarcinoma (46,470 US cases yearly) Increase in unopposed Estrogen Increase in Endometrial Hyperplasia Approx. 25% of Complex Atypical Hyperplasia (CAH) becomes Invasive AdenoCA, the most prevalent form of Endometrial CA

Obesity and Cancer Overweight and obese women have a 3.5x risk for development of Endometrial Cancer relative to normal weight controls Other risk factors for Endometrial Cancer are HTN and DM, which are associated with obesity

Obesity and Cancer Ovarian Cancer (21,990 US cases yearly) Two-fold increase in risk in obese older women who have never taken postmenopausal hormones

Obesity and Cancer Colon Cancer (52,400 female US cases yearly) Higher amounts of glucose have been associated with subsequent risk of colon cancer Increased hyperinsulinemia and production of insulin-like growth factor are possible agents leading to the increased risk of colon cancer

Obesity and Cancer Esophageal Cancer (3,530 female US cases yearly) Recent evidence suggests a shift to increased rates of adenocarcinoma compared to squamous cancers Increased esophageal reflux with increased inflammation as the possible pathway

Obesity and Cancer Weight loss can reduce the incidence of cancer Two large cohort studies from Sweden and the U.S. suggest a lower cancer incidence as well as decreased risk of death in women undergoing bariatric surgery compared to BMI-matched controls Observational data also has demonstrated that weight loss is associated with reduction of risk for certain cancers including breast cancer

Obesity and Cancer Studies evaluating weight loss and weight gain and survival following a diagnosis of cancer Survival after Endometrial CA reduced in Obese women Physical activity after diagnosis may reduce the risk of breast cancer recurrence Trial for women diagnosed with breast cancer showed longer disease-free survival times for those who lost more weight through intervention with diet and physical activity than the control group

Diagnosis and Treatment of Cancer with Obesity Obesity affects the detection and treatment of cancer Obese less likely to receive routine cancer screening tests More likely to postpone preventive examinations Impacts treatment planning Surgery Radiation therapy Chemotherapy

Diagnosis and Treatment of Cancer with Obesity Risks of surgery are increased by obesity Operative time Blood loss Thromboembolic complications Pneumonia Wound infection Operative site infection

Diagnosis and Treatment of Cancer with Obesity Optimal delivery of radiation and chemotherapy are affected by obesity Chemotherapy : Dosing of therapy may be affected by weight in heavier cancer patients Concerns about high doses of chemotherapy leading to greater toxicity Obese patients may not receive optimal dose intensities compared to nonobese patients Radiation therapy : Target location may be altered and hamper receiving full doses

Diagnosis and Treatment of Cancer with Obesity Many women are unaware of the link of obesity and increased cancer risk Burden of obesity demands increased attention in order to improve cancer prevention and treatment