The Impact of Obesity on the Incidence and Treatment of Gynecologic Cancers: A Review

Modesitt, Susan C.; Nagell, J.R. van

doi:10.1097/01.ogx.0000180866.62409.01

Cited by 140 publications

(106 citation statements)

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“…29 Obese women may be given lower doses of chemotherapy because the ideal body surface area rather than true body surface area is used to estimate the dose of chemotherapy. [30][31][32] The fact that obese women experienced less toxicity than normal weight women supports that hypothesis, but we did not detect an interaction between obesity and toxicity on breast cancer-specific survival. Other proposed biological mechanisms include higher estrogen levels among obese women that counter the efficacy of tamoxifen and increase cell proliferation, elevated adipokine levels caused by obesity that may accelerate cancer progression, independent effects of insulin, altered immune responses, and oxidative stress.…”

Section: Discussionsupporting

confidence: 59%

Factors Affecting Survival Among Women with Breast Cancer in Hawaii

Maskarinec

Pagano

Lurie

et al. 2011

Journal of Women's Health

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Background: Given previous reports of ethnic differences in breast cancer survival among Hawaii's population, we investigated the role of adherence to treatment standards, treatment toxicity, preexisting chronic conditions, and obesity in the survival of 382 prospectively studied breast cancer patients representing six ethnic groups. Methods: Participants were recruited from several hospitals in Honolulu. Information on tumor characteristics and treatment was abstracted from medical records. Based on the Physicians Data Query (PDQ

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Section: Discussionsupporting

confidence: 59%

Factors Affecting Survival Among Women with Breast Cancer in Hawaii

Maskarinec

Pagano

Lurie

et al. 2011

Journal of Women's Health

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“…Because of concerns of relative overdosing in obese patients with a large body surface area, it is well documented that empiric dose capping of chemotherapeutic drugs (usually at a body surface area of either 1.8 or 2 m 2 ) occurs in some centers (41). Furthermore some, but not all, observational studies have shown that dose intensity (42) and the cumulative dose (20) of chemotherapy may be lower in obese women (compared with normal weight).…”

Section: Discussionmentioning

confidence: 99%

Obesity and Ovarian Cancer Survival: A Systematic Review and Meta-analysis

Protani

Nagle

Webb

2012

Cancer Prevention Research

131

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Studies that have examined the association between obesity and ovarian cancer survival have provided conflicting results. We reviewed and quantitatively summarized existing evidence, exploring potentially important sources of variability, such as the timing of body mass index (BMI) assessment and different cutpoints used to categorize BMI. A systematic search of MEDLINE and EMBASE was conducted to identify original data evaluating the association between obesity and survival in women with ovarian cancer. Adjusted hazard ratios (HR) from studies were pooled using a random-effects model. The meta-analysis of 14 studies showed slightly poorer survival among obese than in non-obese women [pooled HR, 1.17; 95% confidence interval (CI), 1.03-1.34]. This estimate did not vary appreciably when BMI was measured before diagnosis (1.13; 0.95-1.35), at the time of diagnosis (1.13; 0.81-1.57) or at the commencement of chemotherapy (1.12; 0.96-1.31). We found a slightly stronger association in studies that only included women with a BMI 30 in their "obese" group (1.20) than in studies that also included overweight women (BMI 25; 1.14). Women with ovarian cancer who are obese appear to have slightly worse survival than non-obese women. However, there is a large amount of inter-study variation, which means that no solid conclusions can be drawn. Cancer Prev Res; 5(7); 901-10. Ó2012 AACR.

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“…The major modifiable determinants of type 2 diabetes, hyperinsulinaemia and insulin resistance are obesity [4,5] and low physical activity [6], both of which have also been shown to be risk factors for endometrial cancer [6][7][8]. A number of studies have reported a positive association between diabetes and incidence of [9][10][11][12][13][14][15][16][17][18][19][20] or mortality from [21] endometrial cancer.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2007

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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 casecontrol 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.

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The Impact of Obesity on the Incidence and Treatment of Gynecologic Cancers: A Review

Cited by 140 publications

References 100 publications

Factors Affecting Survival Among Women with Breast Cancer in Hawaii

Factors Affecting Survival Among Women with Breast Cancer in Hawaii

Obesity and Ovarian Cancer Survival: A Systematic Review and Meta-analysis

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

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