Trends in incidence rates for obesity-associated cancers in the US

Impact of a dietitian-led very low calorie diet clinic on perioperative risk for patients with obesity awaiting elective, non-bariatric surgery: A retrospective cohort study

BACKGROUND

Despite a lack of evidence that intentional weight loss reduces the risk of postoperative complications, adults with obesity are commonly asked to lose weight before elective surgery. We hypothesized that patients undertaking dietitian-led preoperative, very low calorie diet treatment could reduce perioperative surgery risks, as per validated risk scoring systems. The purpose of this study was to measure the impact of a dietitian-led preoperative very low calorie diet clinic on the American Society of Anesthesiologists physical status scores and National Surgical Quality Improvement Program Surgical Risk Calculator scores for patients with obesity awaiting non-bariatric elective surgery.

METHODS

This retrospective cohort study included patients referred to the preoperative dietitian-led very low calorie diet clinic before elective surgical procedures over a 2-year-9-month period. The dietitian prescribed individualized, very low calorie diet-based treatment. Primary outcomes were changes in the American Society of Anesthesiologists and Surgical Risk Calculator scores from pretreatment until surgery.

RESULTS

A total of 141 eligible participants (48 ± 13.4 years, 76% women, body mass index 41.7 ± 6.3 kg/m2) demonstrated clinically significant weight loss (mean 7.1 ± 6.1kg, 5.2% body weight, P < .001). Median treatment duration was 13 weeks (interquartile range 6.2-19.2 weeks). Five participants (3.5%) avoided surgery due to weight loss-related improvements in their condition. American Society of Anesthesiologists scores improved for 16% (n = 22/141) of participants. Overall, the median surgical risk calculator estimated risk of 'serious' and 'any' postoperative complication reduced from 4.8% to 3.9% (P < .001) and 6% to 5.1% (P < .001), respectively. Reduction in all Surgical Risk Calculator scores occurred, including surgical site infection, re-admission, and cardiac events (P < .05).

CONCLUSION

The dietitian-led preoperative, very low calorie diet clinic improved American Society of Anesthesiologists and Surgical Risk Calculator scores for non-bariatric elective surgery patients with obesity. Randomized controlled trials comparing this approach with a control group are warranted.

Elective Surgery in Adult Patients with Excess Weight: Can Preoperative Dietary Interventions Improve Surgical Outcomes? A Systematic Review

This systematic review summarises the literature regarding the impact of preoperative dietary interventions on non-bariatric surgery outcomes for patients with excess weight/obesity, a known risk factor for poor surgical outcomes. Four electronic databases were searched for non-bariatric surgery studies that evaluated the surgical outcomes of a preoperative diet that focused on weight/fat loss or improvement of liver steatosis. Meta-analysis was unfeasible due to the extreme heterogeneity of variables. Fourteen studies, including five randomised controlled trials, were selected. Laparoscopic cholecystectomy, hernia repair, and liver resection were most studied. Diet-induced weight loss ranged from 1.4 kg to 25 kg. Preoperative very low calorie diet (≤800 kcal) or low calorie diet (≤900 kcal) for one to three weeks resulted in: reduction in blood loss for two liver resection and one gastrectomy study (-27 to -411 mL, p < 0.05), and for laparoscopic cholecystectomy, reduction of six minutes in operating time (p < 0.05) and reduced difficulty of aspects of procedure (p < 0.05). There was no difference in length of stay (n = 7 studies). Preoperative ≤ 900 kcal diets for one to three weeks could improve surgical outcomes for laparoscopic cholecystectomy, liver resection, and gastrectomy. Multiple randomised controlled trials with common surgical outcomes are required to establish impact on other surgeries.

Assessing factors related to waist circumference and obesity: application of a latent variable model

BACKGROUND

Because the use of BMI (Body Mass Index) alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome) and obesity (binary outcome) among Iranian adults.

METHODS

Data included 18,990 Iranian individuals aged 20-65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variable model, we estimated the relation of two correlated responses (waist circumference and obesity) with independent variables including age, gender, PR (Place of Residence), PA (physical activity), smoking status, SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), CHOL (cholesterol), FBG (Fasting Blood Glucose), diabetes, and FHD (family history of diabetes).

RESULTS

All variables were related to both obesity and waist circumference (WC). Older age, female sex, being an urban resident, physical inactivity, nonsmoking, hypertension, hypercholesterolemia, hyperglycemia, diabetes, and having family history of diabetes were significant risk factors that increased WC and obesity.

CONCLUSIONS

Findings from this study of Iranian adult settings offer more insights into factors associated with high WC and high prevalence of obesity in this population.

Obesity-related proliferative diseases: the interaction between adipose tissue and estrogens in post-menopausal women

Epidemiological studies have shown that overweight and cancer are closely related, even though obesity alone does not apparently heighten cancer risk by the same amount. Given the low overall risk of all cancers with obesity, it is unlikely that obesity alone causes cancer, but should instead be considered as a tumor promoter. There are three main hypotheses that could explain how obesity might contribute to cancer development and growth: the inflammatory cytokines from adipose tissue hypothesis, the insulin resistance and hyperinsulinemia hypothesis, and the unopposed estrogen cancer hypothesis. The link between obesity and cancer is that adipocytes constitute a major component of the tumor microenvironment for breast and abdominally metastasizing cancers, promoting tumor growth. This review will mainly focus attention on the relationship between adipose tissue, estrogens, and cancer risk.

Endometrial histology in severely obese bariatric surgery candidates: an exploratory analysis

BACKGROUND

Endometrial pathology risk has been linked to obesity; however, little is known of its prevalence in severely obese women not seeking care for endometrial pathology associated symptoms. This pilot study was designed to explore the frequency and risk factors associated with endometrial pathology in cancer-free, severely obese, bariatric surgery candidates using the Pipelle endometrial sampling technique (SureFlex Preferred Curette, Bioteque America, Inc, New Taipei City, Taiwan).

METHODS

Twenty-nine severely obese bariatric surgery candidates with intact uteruses and no history of endometrial cancer or endometrial ablation were included in this subanalysis from a larger cohort of 47. Endometrial samples were obtained using a Pipelle endometrial suction curette at a single time point before surgery. Logistic regression was used to assess the relationship between body mass index and endometrial pathology when adjusting for age and race.

RESULTS

Of the 29 successful biopsies, 8 (27.6%) were classified as abnormal endometrium: 1 was classified as complex atypical hyperplasia, 1 was classified as hyperplasia without atypia, 4 samples were identified with endometrial polyps, and 2 samples were identified with metaplasia. None presented with cancer. Increasing body mass index was significantly associated with higher risk of abnormal endometrium (OR = 1.19, 95% CI [1.03-1.36], P = .01).

CONCLUSIONS

The findings in this sample suggest that obesity may be associated with increased risk of having undiagnosed endometrial pathology. More thorough examination of relationships between levels of obesity and endometrial pathology are needed to better characterize high cancer risk groups who may benefit from introducing new screening measures.

Insulin and IGFs in obesity-related breast cancer

Obesity and the Metabolic Syndrome are associated with multiple factors that may cause an increased risk for cancer and cancer-related mortality. Factors involved include hyperinsulinemia, hyperglycemia, hyperlipidemia and IGFs. Insulin resistance is also associated with alterations in the levels of proinflammatory cytokines, chemokines, adipokines (leptin, adiponectin) that may also be contributing factors. The insulin family of proteins is ubiquitously expressed and has pleiotropic effects on metabolism and growth. However insulin, IGF-1 and particularly IGF-2 have been identified as tumor promoters in multiple studies. Mouse models have focused on insulin and IGF-1 and their receptors as being involved in tumor progression and metastases. The role of the insulin receptor as either mediating the effects on tumors or as compensating for the insulin-like growth factor receptor has arisen. Its role has been supported by preclinical studies and the importance of insulin resistance and hyperinsulinemia in obesity and early diabetes. Since the focus of this review is the insulin-family we will focus on insulin, IGF-1 and IGF-2.

The anti-obesity potential of sigmoidin A

CONTEXT

During the last few decades, the prevalence of obesity in the western world has dramatically increased with epidemic proportions. Hand in hand with this statistic, the incidences of obesity-linked diseases such as diabetes are increasing with pandemic rate. The search for novel drugs and nutritional intervention approaches for obesity is now of significant importance.

OBJECTIVE

The anti-obesity potential of eriodictyol (ERD) and its close structural analogue, sigmoidin A (SGN), were evaluated. SGN was isolated from Erythrina abyssinica Lam. ex DC. (Fabaceae).

MATERIALS AND METHODS

Concentrations between 300 and 0.1 µM of test samples and reference drugs made in three-fold dilutions were tested for enzyme inhibitory effects. The major obesity target, pancreatic lipase, was used to test the anti-obesity potential while the selective effects of the compounds were determined through assessments of effects on α-glucosidase.

RESULTS

The inhibitory effect of SGN on pancreatic lipase (IC₅₀, 4.5 ± 0.87 µM) was 30-times greater than that of ERD (IC₅₀, 134 ± 19.39 µM) while their effect on α-glucosidase enzyme was comparable (IC₅₀ value of 62.5 ± 9.47 and 57.5 ± 13.15 µM). The anti-obesity drug, orlistat, inhibited pancreatic lipase with an IC₅₀ value of 0.3 ± 0.04 µM, while the anti-diabetic drug, acarbose, inhibited α-glucosidase with an IC₅₀ value of 190.6 ± 16.05 µM.

DISCUSSION

Although less active than the standard anti-obesity drug, orlistat, the observed activity indicated that prenylation of the flavonoid skeleton potently enhances anti-lipase activity.

CONCLUSION

Such groups of flavonoids need to be further investigated for their therapeutic and nutritional benefit in combating obesity problems.

Altered Hypothalamic Signaling and Responses to Food Deprivation in Rats Fed a Low-Carbohydrate Diet

OBJECTIVE

To model how consuming a low-carbohydrate (LC) diet influences food intake and body weight.

RESEARCH METHODS AND PROCEDURES

Food intake and body weight were monitored in rats with access to chow (CH), LC-high-fat (HF), or HF diets. After 8 weeks, rats received intracerebroventricular injections of a melanocortin agonist (melanotan-II) and antagonist (SHU9119), and feeding responses were measured. At sacrifice, plasma hormones and hypothalamic expression of mRNA for proopiomelanocortin (POMC), melanocortin-4 receptor, neuropeptide Y (NPY), and agouti related protein (AgRP) were assessed. A second set of rats had access to diet (chow or LC-HF) for 4 weeks followed by 24 h food deprivation on two occasions, after which food intake and hypothalamic POMC, NPY, and AgRP mRNA expression were measured.

RESULTS

HF rats consumed more food and gained more weight than rats on CH or LC-HF diets. Despite similar intakes and weight gains, LC-HF rats had increased adiposity relative to CH rats. LC-HF rats were more sensitive to melanotan-II and less sensitive to SHU9119. LC-HF rats had increased plasma leptin and ghrelin levels and decreased insulin levels, and patterns of NPY and POMC mRNA expression were consistent with those of food-deprived rats. LC-HF rats did not show rebound hyperphagia after food deprivation, and levels NPY, POMC, and AgRP mRNA expression were not affected by deprivation.

DISCUSSION

Our results demonstrate that an LC diet influences multiple systems involved in the controls of food intake and body weight. These data also suggest that maintenance on an LC-HF diet affects food intake by reducing compensatory responses to food deprivation.

Features of cancer management in obese patients

There is worldwide increased in obesity prevalence and statistical almost half of United-States, including children, could be obese by 2050. Obesity in cancer patients is a major issue in oncology because weight gain and obesity account for approximately 20% of all cancer cases. Indeed, increased obesity is linked with higher risk of various types of cancer and a poorer survival. Although biological mechanisms underlying how obesity causes an increased risk of cancer are suggested, overweight as a putative direct cause of death is still debated. Numerous confounding factors may impact on survival, including comorbidities and imaging limitations. Moreover, difficulties to achieve the standard oncologic care with surgery, chemotherapy and/or radiation may also be concerned. Herein, we examined the specific features and potential adaptation of the cancer management in overweighed patients. Then, we reviewed how implicated molecular pathways may provide new strategies to decrease cancer risk and predict toxicities in an increasingly obese population.

Type 2 diabetes and cancer: what is the connection?

Epidemiological studies have demonstrated an association between type 2 diabetes and cancer. Type 2 diabetes is characterized by insulin resistance and hyperinsulinemia. Hyperinsulinemia may lead to cancer through insulin's effect on its cognate receptor and the insulin-like growth factor system. The effects of insulin and insulin-like growth factor I on cancer development and progression have been demonstrated in animal and human studies. Type 2 diabetes has been positively associated with cancers of the breast, colon, and pancreas. An inverse relationship has been observed between type 2 diabetes and prostate cancer, and this may be due to lower testosterone levels in men with type 2 diabetes. Medications used to treat type 2 diabetes may affect cancer cells directly or indirectly by affecting serum insulin levels. Hyperinsulinemia may be an important risk factor for cancer as well as a target for cancer therapy.

Dominant and diet-responsive groups of bacteria within the human colonic microbiota

The populations of dominant species within the human colonic microbiota can potentially be modified by dietary intake with consequences for health. Here we examined the influence of precisely controlled diets in 14 overweight men. Volunteers were provided successively with a control diet, diets high in resistant starch (RS) or non-starch polysaccharides (NSPs) and a reduced carbohydrate weight loss (WL) diet, over 10 weeks. Analysis of 16S rRNA sequences in stool samples of six volunteers detected 320 phylotypes (defined at >98% identity) of which 26, including 19 cultured species, each accounted for >1% of sequences. Although samples clustered more strongly by individual than by diet, time courses obtained by targeted qPCR revealed that 'blooms' in specific bacterial groups occurred rapidly after a dietary change. These were rapidly reversed by the subsequent diet. Relatives of Ruminococcus bromii (R-ruminococci) increased in most volunteers on the RS diet, accounting for a mean of 17% of total bacteria compared with 3.8% on the NSP diet, whereas the uncultured Oscillibacter group increased on the RS and WL diets. Relatives of Eubacterium rectale increased on RS (to mean 10.1%) but decreased, along with Collinsella aerofaciens, on WL. Inter-individual variation was marked, however, with >60% of RS remaining unfermented in two volunteers on the RS diet, compared to <4% in the other 12 volunteers; these two individuals also showed low numbers of R-ruminococci (<1%). Dietary non-digestible carbohydrate can produce marked changes in the gut microbiota, but these depend on the initial composition of an individual's gut microbiota.

Estimating the number of U.S. incident cancers attributable to obesity and the impact on temporal trends in incidence rates for obesity-related cancers

BACKGROUND

Reaching the American Cancer Society challenge goal for the nation to reduce cancer incidence by 25% by 2015 will be influenced in part by the epidemic of obesity. The purpose of this study was to estimate the impact of obesity on the number obesity-attributable incident cancers in the U.S. in 2007 and on trends on cancer incidence rates.

METHODS

Using estimated relative risks (RRs) for obesity vs. normal weight/height from published meta-analyses and/or large cohort studies, and the prevalence of obese adults from the latest national surveys, attributable risk percent (ARP) and numbers of obesity-attributed incident cancers in 2007 were estimated. Using the ARPs, the impact of obesity trends on trends in incidence rates for certain obesity-related cancers was estimated for the calendar years (1976-1980 through 2001-2004) for which cancer rates and obesity prevalence rates were available.

RESULTS

An estimated 33,966 new cancers (4% of all estimated cancers) in males and 50,535 (7% of all estimated cancers) in females diagnosed in 2007, or 6% of all cancers, may be potentially attributable to obesity. Without the impact of rising obesity rates, incidence rates might have declined (instead of remaining stable) from 1988-1994 to 2001-2004 for uterus, breast and certain other cancers.

CONCLUSIONS

Obesity may contribute to about 6% of U.S. incident cancers, apparently has affected recent trends in incidence rates for certain cancers, and is important because of increasing prevalence in the U.S. population.

State ranks of incident cancer burden due to overweight and obesity in the United States, 2003

OBJECTIVE

Given links between obesity and cancer, we estimated incident cancer burden due to overweight and obesity at the state level in the United States.

METHODS AND PROCEDURES

Using state rankings by per capita burden of incident cancer cases diagnosed in 2003 that were related to overweight and obesity, we examined the frequency with which states ranked in the highest and lowest quintiles of weight-related burden for cancers of the postmenopausal breast, endometrium, kidney, colon, and prostate. In this study, data from the Behavioral Risk Factor Surveillance System (BRFSS), US Census, US Mortality Public Use Data Tapes, and National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program were used.

RESULTS

Western states had the lowest weight-related cancer burden for both sexes. Iowa, South Dakota, and West Virginia had the highest burden for all three types of male cancers. West Virginia is the only state that ranked in the quintile of highest weight-related burden for all four cancers considered in women.

DISCUSSION

For certain cancers, including endometrial, postmenopausal breast, and colon cancers, states with high burdens clustered in geographic regions, warranting further inquiry. Although state ranks for the total cancer burden and the prevalence of overweight and obesity correlated with state ranks for weight-related incident cancer burden, they often served poorly as its proxy. Such a finding cautions against simply targeting states with high overweight and obesity or high total burdens of cancers for which overweight and obesity are risk factors, as this approach may not reach areas of unrecognized burden.

Prevalence of obesity among children in six Chicago communities: findings from a health survey

OBJECTIVES

We analyzed data from a community health survey to assess levels of obesity and overweight among children in some Chicago communities compared with national U.S. estimates.

METHODS

Data came from the Sinai Improving Community Health Survey, which was conducted via face-to-face interviews with people living in six racially and ethnically diverse Chicago communities during 2002 and 2003. A stratified, three-stage probability study design was employed to obtain a representative sample from each community. Height and weight data reported by the primary caretakers of 501 randomly selected children aged 2-12 years were used to determine age- and gender-specific body mass index (BMI), which was then used to classify weight status (obese > or =95th percentile for age and gender).

RESULTS

Compared with 16.8% for the U.S., the prevalence of obesity was 11.8% in a non-Hispanic white community on Chicago's north side, 34.0% in a Mexican American community on the west side, and 56.4% in a non-Hispanic black community on the south side.

CONCLUSIONS

Surveillance of the childhood obesity epidemic at the local level is limited. Findings describe the extent of disparities in childhood overweight and obesity within one city and how local-level data can shape new initiatives for improved health, one community at a time.

Endoscopic and ultrasonographic evaluation before and after Roux-en-Y gastric bypass for morbid obesity

BACKGROUND

Esophagogastric abnormalities are recognized prior and after bariatric procedures, but frequency and severity are debated. Liver and biliary tract findings are also of clinical importance, especially gallstones and liver steatosis.

AIM

To compare pre-operative findings of hepatobiliary ultrasound and upper digestive endoscopy with post-operative results in patients submitted to open Roux-en-Y gastric bypass for morbid obesity.

METHODS

A total of 80 patients were enrolled 16.8 +/- 12.1 months after operation, all of them on routine follow-up program, and 8 were excluded. Retrospective analysis aimed at pre-operative clinical, endoscopic and ultrasonographic examinations and were prospectively repeated.

RESULTS

Pre-operative endoscopical report was available in 42 cases, and 52 examinations were performed post-operatively. Frequency of esophagitis changed from 16.7% (7/42) to 15.4% (8/52), and of gastritis from 45.2% (19/42) to 21.2% (11/52). Gastric or gastrojejunal ulcers were initially present in 4.8% (2/42) and increased to 9.6% (5/52). Post-operatively, an unusual abnormality was silastic band erosion: 7.7% (4/52). Helicobacter pylori was present in 50.0% (21/42) before and 3.5% (2/52) after operation. Ultrasonographic study had been done before intervention in 63 subjects, and 57 were executed on follow-up. Liver steatosis occurred previously in 58.7% (37/63) and in 43.9% (25/57) later on. Only 12.7% (8/63) of the patients had undergone cholecystectomy before bariatric operation, 29.1%(16/55) suffered simultaneous resection of gallbladder because of stones during Roux-en-Y gastric bypass, and an additional 26.8% (10/36) developed gallstones post-operatively.

CONCLUSIONS

Liver steatosis did not statistically improve, nor did inflammatory conditions of the upper digestive tube, despite reduction of H. pylori infections; gallbladder stones requiring intervention were common.

Evaluation of Alternate Size Descriptors for Dose Calculation of Anticancer Drugs in the Obese

Purpose

Despite the rising prevalence of obesity, there is paucity of information describing how doses of anticancer drugs should be adjusted in clinical practice. Here, we assessed the pharmacokinetics of eight anticancer drugs in adults and evaluated the potential utility of alternative weight descriptors in dose calculation for the obese.

Patients and Methods

A total of 1,206 adult cancer patients were studied, of whom 162 (13.4%) were obese (body mass index ≥ 30). Pharmacokinetic parameters were calculated using noncompartmental analysis, and compared between lean (body mass index ≤ 25) and obese patients.

Results

The absolute clearance of cisplatin, paclitaxel, and troxacitabine was significantly increased in the obese (P < .023), but this was not observed for carboplatin, docetaxel, irinotecan, or topotecan (P < .17). For doxorubicin, the systemic clearance was statistically significantly reduced in obese women (P = .013), but not in obese men (P = .52). Evaluation of alternate weight descriptors for dose calculation in the obese, including predicted normal weight, lean body mass, (adjusted) ideal body weight, and the mean of ideal and actual body weight, indicated that, for most of the evaluated drugs, weight scalars used to calculate body-surface area should consider actual body weight regardless of size.

Conclusion

The results suggest that a number of widely used empiric strategies for dose adjustments in obese patients, including a priori dose reduction or dose capping, should be discouraged.

Meta-analysis of mixed treatment comparisons at multiple follow-up times

Mixed treatment comparisons (MTC) meta-analysis is a methodology for making inferences on relative treatment effects based on a synthesis of both direct and indirect evidence on multiple treatment contrasts. This is particularly useful in the context of cost-effectiveness analysis and medical decision making. Here, we extend these methods to a more complex situation where trials report results at one or more, different yet fixed, follow-up times. These methods are applied to an illustrative data set combining evidence on healing rates under six different treatments for gastro-esophageal reflux disease (GERD). A series of Bayesian hierarchical models based on piece-wise exponential hazards is developed that borrow strength across the MTC networks and also across time points. These include models for absolute and relative treatment effects, models with fixed or random effects over time, random walk models, and models with homogeneous or heterogeneous between-trials variation. The deviance information criterion (DIC) is used to guide model development and selection. Models for absolute treatment effects generate materially different rankings of the treatments than models that separate the trial-specific baselines from the relative treatment effects. The extent of between-trials heterogeneity in treatment effects depends on treatment contrast. In discussion we note that models of this type have a very wide potential application.

Diabetes mellitus and risk of endometrial cancer: a meta-analysis

AIMS/HYPOTHESIS

Diabetes has been associated with a statistically significantly increased risk of endometrial cancer in most, but not all studies. To provide a quantitative assessment of the association between diabetes and risk of endometrial cancer, we conducted a meta-analysis of case-control studies and cohort studies.

SUBJECTS AND METHODS

We identified studies by a literature search of PubMed and Embase through to January 2007 and by searching the reference lists of relevant articles. Summary relative risks (RRs) with 95% CIs were calculated using random-effects model.

RESULTS

The analysis of diabetes (largely type 2) and endometrial cancer is based on 16 studies (three cohort and 13 case-control studies), including 96,003 participants and 7,596 cases of endometrial cancer. Twelve of the studies showed a statistically significantly increased risk and four a non-significant increased risk of endometrial cancer. In our meta-analysis we found that diabetes was statistically significantly associated with an increased risk of endometrial cancer (summary RR 2.10, 95% CI 1.75-2.53). The risk estimates were somewhat stronger among case-control (RR 2.22, 95% CI 1.80-2.74) than among cohort studies (RR 1.62, 95% CI 1.21-2.16), stronger among studies adjusting only for age (RR 2.74, 95% CI 1.87-4.00) compared with multivariate adjustment (RR 1.92, 95% CI 1.58-2.33) and slightly lower in studies performed in the USA than in those performed Europe. The analysis of type 1 diabetes and endometrial cancer was based on three studies and found a statistically significant positive association (summary RR 3.15, 95%CI 1.07-9.29).

CONCLUSIONS/INTERPRETATION

Results from the meta-analysis support a relationship between diabetes and increased risk of endometrial cancer.

Racial differences in breast cancer survival in women under age 60

INTRODUCTION

There is a known difference in breast cancer survival between races in the US for which several factors such as social, lifestyle and genetic factors may be relevant.

METHOD

This is a retrospective study among women entitled to free treatment in the US department of defense health care system. Within this group, we investigated the temporal trend of absolute survival of 13,793 of White and African American aged 20-59 years and diagnosed between 1980 and 1999 with breast cancer.

RESULT

There is a 3% overall improvement in survival in whites which can be explained by an earlier detection, and a two percent decrease in AA with a distinct pattern by age group. In the 40-49 year age group, the survival in white increases from 84.5% in the year 1980-1984 to 87.4 % in the year 1995-1999, in AA we estimate a decrease from 79.7% to 78.5%. When accounting for stage at diagnosis a slight reduction in survival in whites and a strong reduction in AA indicates a significant interaction between race and calendar period. The differences in survival patterns between blacks and whites are mainly caused by breast cancer and not by other causes.

CONCLUSION

The gap in survival which strongly increased with calendar period cannot be explained by unequal access to health care. Possible explanations include a lower participation of early detection programs for breast cancer in AA and an increasing prevalence of obesity over time which is more pronounced in AA than in whites.

Impact of overweight and obesity on medical care costs, all-cause mortality, and the risk of cancer in Japan

We conducted three prospective cohort studies that examined the association between body mass index (BMI) and health outcomes in Japan. Our studies found statistically significant relationships between excess body weight and increased medical costs, all-cause mortality, and risk of cancer incidence. There was a U-shaped association between BMI and mean total costs. The estimated excess costs attributable to overweight and obesity was 3.2% of the total costs. This 3.2% is within the range reported in studies in Western countries (0.7%-6.8%). We observed statistically significant elevations in mortality risk in obese (BMI> or = 30.0 kg/m(2)) women and lean (BMI<18.5 kg/m(2)) men and women. Our prospective cohort study found statistically significant relationships between excess weight and increased risk in women of all cancers. The population attributable fraction (PAF) of all incident cancers in this population that were attributable to overweight and obesity were 4.5% in women, which were within the range reported from Western populations, from 3.2% for US women to 8.8% for Spanish women. Our data suggests that excess body weight is a problem not only in Western countries but also in Japan.

Correlation and Comparison of Body Mass Index on Hemodynamics in Hypertensive and Normotensive Patients Undergoing Intravenous Sedation

PURPOSE

The purpose of this project was to retrospectively compare and correlate body mass index (BMI) and hemodynamics in hypertensive and normotensive patients undergoing intravenous sedation for dentoalveolar surgery.

PATIENTS AND METHODS

A retrospective chart analysis of 263 consecutive male patients undergoing intravenous (IV) sedation for dentoalveolar surgery was divided into 5 BMI groups: underweight, normal weight, overweight, obese, extremely obese. Data recorded were noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and pulse (P). Statistical analysis of mean values between groups was carried out using multivariate linear regression analysis, Pearson's correlation coefficient, and Student's t test and found significant for P < .05.

RESULTS

Average hemodynamic values for normotensive patients were significantly lower for all groups except for pulse in the normal group, pulse in the obese group, and DBP in the extremely obese group. For normotensive patients, there were statistically significant strong positive correlation for elevated BMI and increased baseline changes in SBP and PP. For the hypertensive group, there was a statistically significant moderate positive correlation for elevated BMI and increased baseline changes in PP and statistically significant strong positive correlation for baseline changes in MAP. Baseline changes were significant for greater increases in SBP and decreases in DBP and MAP in the underweight hypertensive group. Significant increases from baseline in the normotensive group were for PP in the normal BMI group and for pulse in the obese group. All baseline changes, with the exception of normotensive underweight SBP (+26.7%) and hypertensive PP (+23.9%), were within +/-20% of baseline (range, -12.2% to +17.4%).

CONCLUSION

In general, normotensive patients in this study had lower average hemodynamic values than hypertensive patients in all BMI groups. Great variability was seen in baseline changes for all BMI groups, but a substantial majority of changes were within +/-20% of baseline. There were statistically significant moderate and positive correlations in BMI for changes from baseline for several hemodynamic measurements. Intravenous sedation for oral and maxillofacial surgery procedures maintains a stable hemodynamic state in hypertensive and normotensive patients regardless of BMI.

Bariatric surgery in the field of gynecological oncology

Obesity has become a foremost health problem. More than half of US adults are overweight or obese. This has been due to sedentary lifestyles, increased intake of refined carbohydrates, and fat-rich diets. Obese women are particularly susceptible to a variety of health risks including cancer, especially cancers of the breast, endometrium, and colon. Bariatric surgery appears to be a viable option for the treatment of severe obesity. As the role of surgery in the management of this condition becomes increasingly frequent, it is important for gynecological oncologists to recognize the potential for gynecological malignancies in this patient population.

Epidemiology - identifying the causes and preventability of cancer?

It has been almost 25 years since Doll and Peto performed their landmark analysis of epidemiological data to identify the causes of cancers and possible modes of cancer prevention. Since then, there have been many additional studies of cancer incidence using various epidemiological techniques. These studies revealed expanded opportunities for cancer prevention through approaches that include vaccination, increased physical activity, weight control and avoidance of post-menopausal hormone therapy.

Endometrial Cancer Incidence Trends in Europe: Underlying Determinants and Prospects for Prevention

More than one in 20 female cancers in Europe are of the endometrium. Surveillance of incidence rates is imperative given the rapidly changing profile in the prevalence and distribution of the underlying determinants. This study presents an analysis of observed and age-period-cohort-modeled trends in 13 European countries. There were increasing trends among postmenopausal women in many Northern and Western countries. Denmark and possibly France and Switzerland were exceptions, with decreasing trends in postmenopausal women. In premenopausal and perimenopausal women, declines were observed in Northern and Western Europe, most evidently in Denmark, Sweden, and the United Kingdom, affecting consecutive generations born after 1925. These contrast with the increasing trends regardless of menopausal age in some Southern and Eastern European countries, particularly Slovakia and Slovenia. These observations provide evidence of changes in several established risk factors over time and have implications for possible primary prevention strategies. In postmenopausal women, changes in reproductive behavior and prevalence of overweight and obesity may partially account for the observed increases, as well as hormone replacement therapy use in certain countries. Combined oral contraceptive use may be responsible for the declines observed among women aged <55 years. Whereas there are some prospects for chemoprevention in premenopausal women as oral contraceptive use becomes more widespread in Europe, increases in obesity and decreases in fertility imply that endometrial cancer in postmenopausal women will become a more substantial public health problem in the future.

ADVANCES IN CANCER EPIDEMIOLOGY: Understanding Causal Mechanisms and the Evidence for Implementing Interventions

In a worldwide population of 6 billion, in the year 2000, approximately 10 million cancers were diagnosed, and there were an estimated 6.2 million cancer deaths. Whereas the universality of cancer incidence and mortality is established, the burden of cancer by type or organ site is distributed unequally between developing and industrialized nations. Populations in developing countries are disproportionately affected by cancers in which infectious agents are causal. Our review of advances in cancer epidemiology underscores the complexity of pathogenic mechanisms mediated by chronic inflammation, obesity, and gene-environment interactions as in tobacco and alcohol carcinogenesis. Ultimately, the implementation of effective cancer control interventions that will serve to alleviate the cancer burden must integrate basic and applied research in the behavioral, social, biomedical, and population sciences.

Impact of obesity on clinical outcomes in robotic prostatectomy

OBJECTIVES

To assess the preoperative parameters and clinical outcomes of patients undergoing robotic laparoscopic radical prostatectomy with specific attention to the body mass index (BMI). Little is known about the impact of obesity (BMI greater than 30) on the clinical outcomes of patients undergoing radical prostatectomy.

METHODS

The data of 100 men undergoing robotic laparoscopic radical prostatectomy between June 2002 and October 2003 were prospectively entered into a database. The standard clinical characteristics (eg, prostate-specific antigen, Gleason score) and perioperative and postoperative parameters were evaluated. Additionally, all were assessed preoperatively and postoperatively for American Urological Association symptom and bother scores, uroflowmetry, postvoid residual urine volume, and sexual function.

RESULTS

Nineteen men were obese (BMI greater than 30) and 81 were not (BMI less than 30). The two groups had a similar need for transfusion, length of stay, and pathologic outcome. However, the obese men had poorer baseline urinary function (peak flow rate 13.9 versus 18.3 mL/s; voided volume 306 versus 454 mL; P < or =0.05) and sexual function (Sexual Health Inventory of Men score 14.1 versus 18.2; P < or =0.05). Obese men had significantly more complications (26.3% versus 4.9%; P = 0.01) and required more time to return to baseline activities (7 versus 4.3 weeks; P = 0.09) and urinary function. Finally, at 6 months, only 47% of obese patients versus 91.4% of nonobese patients had achieved pad-free urinary continence (P < or =0.001).

CONCLUSIONS

In this study, obese patients had significantly worse baseline urinary and sexual function, had complications, and did not recover urinary function as quickly or as well as nonobese patients. Obese patients also demonstrated a strong trend toward a delay in recovery time.

Transferrin saturation, dietary iron intake, and risk of cancer

PURPOSE

Transferrin saturation of more than 60% has been identified as a cancer risk factor. It is unclear whether dietary iron intake increases the risk of cancer among individuals with transferrin saturation of less than 60%. The purpose of this study was to examine the association of dietary iron intake and the risk of cancer among adults with increased transferrin saturation.

METHODS

Analysis of a cohort study, the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study, was performed. US adults (aged 25 to 74 years at baseline) were followed up from baseline in 1971-1974 to 1992 (N = 6,309).

RESULTS

A total of 7.3% of the US population had a serum transferrin saturation of more than 45% at baseline. Intake of dietary iron was essentially uncorrelated with transferrin saturation (r = 0.04). Compared with individuals who had normal serum transferrin saturation and low dietary iron intake, individuals whose serum transferrin saturation was more than 45% and who had high dietary iron intake also had an increased adjusted relative risk of cancer (2.24; 95% confidence interval [CI], 1.02-4.89). Increased risk was not found for individuals with a transferrin saturation of more than 45% but a normal dietary iron intake (hazard ratio, 1.02; 95% CI, 0.69-1.49). Transferrin saturation levels could be set as low as 41%, and the individuals with high transferrin saturation and high dietary iron intake would still have an increased adjusted relative risk of cancer (hazard ratio, 2.00; 95% CI, 1.04-3.82).

CONCLUSIONS

Among persons with increased transferrin saturation, a daily intake of dietary iron more than 18 mg is associated with an increased risk of cancer. Future research might focus on the benefits of dietary changes in those individuals with increased serum transferrin saturation.

Obesity and risk of cancer in Japan

We conducted a population-based prospective cohort study in Japan to examine the relationship between body mass index (BMI) and the risk of incidence of any cancer and of cancer at individual sites. Body mass index was calculated from self-administered body weight and height at baseline. Relative risks (RR) and 95% confidence intervals (CI) were calculated in multivariate proportional-hazards models. Among 27,539 persons (15,054 women and 12,485 men) aged 40 years or older who were free of cancer at enrollment in 1984, 1,672 (668 women and 1,004 men) developed cancer during 9 years of follow-up. In women, after adjustment for potential confounders, the RR of all cancers associated with different BMI, relative to a BMI of 18.5-24.9, were 1.04 (95% CI = 0.85-1.27) for BMI = 25.0-27.4, 1.29 (1.00-1.68) for BMI = 27.5-29.9 and 1.47 (1.06-2.05) for BMI >/=30.0 (p for trend = 0.007). Higher BMI was also significantly associated with higher risk of cancers of the colorectum, breast (postmenopausal), endometrium and gallbladder in women. In men, we observed significantly increased all-cancer risk among only never-smokers. Overweight and obesity could account for 4.5% (all subjects) or 6.2% (never-smokers) of the risk of any cancer in women and -0.2% (all subjects) or 3.7% (never-smokers) in men. The value for women was within the range among women reported from Western populations (3.2%-8.8%). Our data demonstrate that excess weight is a major cancer risk among Japanese women.

Racial disparities in female breast cancer in South Carolina: clinical evidence for a biological basis

OBJECTIVE

Racial disparities in breast cancer outcomes are well documented: African-American (AA) women have markedly poorer survival than do European-American (EA) women. A growing literature suggests that AA women have, on average, tumors of more aggressive histopathology, even if discovered early. We investigated this in our South Carolina population.

METHODS

Tumor registry data for 1687 AA and EA women with breast cancers newly diagnosed during 2000-2002 at the two Palmetto Health hospitals in Columbia, SC, were reviewed.

RESULTS

Corresponding to our regional population, 31% of cancers were in AA women. In both racial groups, 19% were in situ. Among women with invasive cancers, AA women had significantly earlier age at diagnosis than did EA women. Fewer AA women had lobular carcinoma (p = 0.001) or Her-2 over-expressing disease (7 versus 19%, p = 0.001). Significantly more AA women had high-grade cancer, larger tumors, axillary metastases and ER negative/PR negative tumors. After controlling for T-stage, AA women were significantly more likely to have high-grade and/or ER negative disease. Detection of invasive cancers by screening mammogram was less frequent in AA women (40 versus 53%, p < 0.000), and in small ER negative cancers.

CONCLUSIONS

At diagnosis, breast cancers in AA women tend to have the hallmarks of more aggressive and less treatable disease, even in small tumors, a pattern resembling that of breast cancers in younger EA women. Whatever the causes, these observations suggest breast cancer is biologically different in AA women. This may contribute substantially to the poorer outcomes in African-American women.