Compelling Evidence on Overweight & Cancer Compels Action

An editorial published in today's British Medical Journal (BMJ) by Cancer News in Context's Yikung Park and Graham Colditz makes the strong case that it's time to take action to combat weight-related cancers.  The editorial addresses a new "umbrella review," also published in the BMJ today, that found strong evidence that overweight and obesity increases the risk of 11 types of cancer.

The review, by Maria Kyrgiou and colleagues, collected and analyzed over 200 systemic reviews and meta-analyses that included data on 36 different cancers. Of these, the researchers found strong links between various measures of overweight and an increased risk of cancers of the esophagus (adenocarcinoma), stomach, colon, rectum, biliary tract, pancreas, breast, endometrium, ovary, and kidney, as well as multiple myeloma.

In their editorial, Park and Colditz, point out key differences between the conclusions of the umbrella review and a 2016 International Agency for Research on Cancer (IARC) report, which Colditz headed, and which concluded that there is sufficient evidence that overweight and obesity increased the risk of 13 types of cancer. Differences between the findings of the two papers, Park and Colditz write, could be related to differences in the type of studies included in the analyses and the methods used to assess the studies that were included. Among other things, the:

"IARC report clearly demonstrated the importance of assessing the quality of each meta-analysis, including search strategy, inclusion and exclusion criteria, and data extraction, which is often outside the scope of an umbrella review"

Despite some important differences between the IARC report and umbrella review, the findings of the new review further bolster the evidence that overweight and obesity cause cancer. As Park and Colditz write:

"Though some specifics remain to be worked out, the unavoidable conclusion from these data is that preventing excess adult weight gain can reduce the risk of cancer."

The American Institute for Cancer Research estimates that overweight and obesity cause over 130,000 cancers each year in the United States, and millions annually lose their lives to weigh-related cancers worldwide. As the obesity epidemic continues largely unabated, the tragedy of these numbers will only worsen if we stay on the same course. Among other efforts to address the issue, Park and Colditz conclude, we need to tap the currently unmet potential of the healthcare system:

"Given the critical role of healthcare providers in obesity screening and prevention, clinicians, particularly those in primary care, can be a powerful force to lower the burden of obesity related cancers, as well as the many other chronic diseases linked to obesity such as diabetes, heart disease, and stroke. The data are clear. The time for action is now."

Doubling Down on Prevention: Heart Disease & Cancer's Shared Risk Factors

Even in parts of the country experiencing an early thaw, winter starts to feel a bit long by the end of February.  The days are still short. The temps are still low. And the trees are still mostly bare. 

Yet, even amidst all that, we can still take heart.  Not just because we're about to crest into March, and the first days of spring, but because February is literally "Heart" month.  American Heart Month - A federally designated month focused on raising awareness of the importance of heart disease and the steps that can help prevent and manage it. 

On top of this, February also happens to be Cancer Prevention Month, which is amazingly apt.  Heart disease and cancer are the first and second leading causes of death in the United States (see figure), together accounting for approximately 1.2 million deaths each year.  This takes an incredible toll on individuals and their families, as well as on the nation's health as a whole.  

Yet, at the same time, there's a positive message in the middle of the depressing numbers. Both heart disease and cancer are very preventable, which offers wonderful opportunities to make gains against the diseases. Approximately three quarters of heart disease and half of cancers could be avoided with overall healthy lifestyles. And most of the steps that lower the risk of one, also lower the risk of the other.

Shared health behaviors that can lower the risk of both heart disease and cancer, include:

• Avoiding tobacco (and secondhand smoke)

• Maintaining a healthy weight

• Being physically active

• Eating a healthy diet - rich in fruits, vegetables, and whole grains; and low in unhealthy fats and red/processed meat

• Getting screening tests, for certain cancers and heart disease risk factors - Talk with a doctor about which apply to you

• Considering taking a daily low-dose aspirin, if age 50 - 69 - But talk with a doctor first 

Health recommendations often fall into silos of information.  Breast cancer in this silo.  Heart disease in that one.  And colon cancer over there. This can make it easy to miss how important some basic healthy behaviors can be for preventing many key chronic diseases.  Yet it's hard to overstate the potential impact of a handful of healthy behaviors.

So, while we're getting ready to shed some layers and get outside more often as the calendar moves toward spring, why not use these last, focused days of winter to think about one or two things you can do to give a boost to your health and lower your risk of heart disease and cancer? 

• Add one more piece of fruit to your lunch a few days a week.  

• Buy that cereal that has whole gains as a first ingredient. 

• Search for some new meatless recipes to try.  

• Visit smokefree.gov for information about quitting smoking.  

• Tell yourself you're going to do something physically active every day -- no matter how small.  

• Call your clinic or doctor's office to see if you're up-to-date on recommended health screenings and make an appoint to get caught up if you're not. 

Doing these things is probably easier than you think, and the benefits of doing them probably greater. You've got this.

For more tips on making healthy changes, see 8IGHT WAYS to Stay Healthy and Prevent Cancer.  For personalized prevention plans and estimate of your risk of cancer, heart disease, and other conditions, see Your Disease Risk.

Cancer Missed Factors: Many People Unaware of Key Behaviors That Can Lower Cancer Risk

A new report from the American Institute for Cancer Research (AICR) shows that a large percentage of the United States population remains confused about which lifestyle factors increase the risk of cancer and which do not.

While a large majority of the public knows that smoking and sun exposure increase cancer risk, only 50 percent or fewer know that key risk factors like overweight, physical inactivity, alcohol, and processed meat increase risk.  In addition, many lifestyle factors with unproven or tenuous links to cancer were identified by high percentages as proven cancer risk factors. Between 52 - 60 percent of people incorrectly stated that genetically modified foods (GMOs), artificial sweeteners, hormones in beef, and food additives impact a person's chances of developing cancer. Good evidence does not support these links.

Based on a phone survey of a nationally representative sample of around 1,000 people, the AICR report is the eighth in a series, with the first published in 2001.

Perhaps the most surprising finding in the report is the continued low-level understanding that overweight and obesity increase cancer risk.  While there has been overall improvement since 2001, when just 35 percent of respondents identified the link between weight and cancer, the percentage has bounced around the 50 percent mark since 2009, seemingly stalled. Overweight causes over 130,000 cancers a year and increases the risk of over ten different cancers.

Studies show that half of all cancers could be prevented through healthy behaviors. And the list of key steps that lower cancer risk is generally straightforward and relatively short.  We highlight them in our Eight Ways to Prevent Cancer series (see figure), and AICR, the National Cancer Institute, and other such organizations have similar publications.

As the new report suggests, to help people realize these benefits, we need to continue to get the word out on these important prevention messages.  But our efforts must reach beyond the public and also include institutions throughout society - state/local governments, schools, healthcare systems, insurers, and workplaces.  For knowledge to transform into sustained action, reinforcement is key.  Our friends, our workplaces, our healthcare providers, and our community each play a key role in helping us meet our health goals.

From knowledge, to action, to impact.  Together, we can make this happen.

Large Study Finds Inequality Increases Risk of Premature Death on Par with Unhealthy Behaviors

Suggests focus on inequality should be similar to that on lifestyle risk factors

by Hank Dart

A large, new study has found that income inequality contributes to premature death on a level similar to important lifestyle factors like smoking, physical inactivity, and diabetes.

The study, appearing in The Lancet, combined findings from 48 cohort studies in high-income countries and included over 1.7 million men and women.  Its goal was to assess the impact of socioeconomic status (SES) alongside key lifestyle factors included in the World Health Organization's (WHO) 25 x 25 initiative.

The WHO created the 25 x 25 initiative in 2011, with the goal of reducing premature deaths from non-communicable diseases, like heart disease and cancer, by 25 percent by 2025.  The initiative targets seven major risk lifestyle factors: smoking, diabetes, physical inactivity, excessive drinking, high blood pressure, overweight, and salt intake.

The study included each of these lifestyles factors, except salt intake, which was not measured in enough of the combined studies to be included in the analyses.  Income and socioeconomic status (SES) were estimated through a person's occupation, a measure available across the 48 studies.  The three main occupation levels were:  high (e.g., managers, higher professionals), intermediate (e.g., farmers, lower supervisors), and low (e.g., sales workers, semi-skilled/unskilled workers).

The researchers found that low socioeconomic status (SES) increased the risk of premature death from all causes by 26 percent compared to high SES.  This was greater than the impact of overweight and close to the impact of physical inactivity (28 percent increase), high alcohol intake (36 percent increase), and high blood pressure (31 percent increase).  Diabetes increased the risk of premature mortality 73 percent, and smoking more than doubled risk.  The findings controlled for the potential interrelation of SES with the lifestyle risk factors.

When looking at the potential impact population wide, the rankings of the risk factors included in the study shifted a bit, with inequality coming just after smoking and physical inactivity in importance.  The researchers calculated the percent of premature deaths that could be avoided if everyone in the population had a low-risk level of each factor - for example, if inequality were eliminated and everyone had a high-earning occupation, if everyone exercised, and if everyone avoided smoking.

Doing this, they found that low SES accounted for 15 percent of premature deaths in women and 19 percent in men.  This falls not too far behind smoking (21 percent in women, 29 percent in men) and physical inactivity (23 percent in women, 26 percent in men) and in front of the other lifestyle factors included in the study (see figure).

Too often, factors like inequality and socioeconomic status are left out of prevention planning - viewed as health factors that cannot be modified.  This study, however, adds to the evidence that inequality has an independent and important impact on health and that reducing inequality should be a key goal of efforts to improve individuals', and the nation's, health -- right alongside efforts focused on limiting smoking, increasing physical activity, and controlling weight.  

Photo: Cityscape Reflected by danscape (CC License, CC BY 2.0)

Benefits of the HPV Vaccine for Girls and Boys

Only two doses now needed for most youth, instead of three

By Katy Henke

HPV, or human papillomavirus, is an increasingly popular health topic these days. Not only are there news stories about HPV and the HPV vaccine just about every week, but there's a push across nearly all levels of healthcare -- from federal agencies to local healthcare providers -- to encourage parents to vaccinate their children against the cancer-causing virus. And for good reason. The Centers for Disease Control and Prevention (CDC) estimates that almost all adults in the United States will have an HPV infection at some point in their lives. 

Most of these infections will clear on their own, but some can persist. And the CDC reports that over 90% of cervical cancer and anal cancer cases are caused by HPV, as are 60% of penile cancers and 70% of head and neck cancers.  It is a much broader list than many people may understand (see table).

But it's not all doom and gloom.  In fact, the fight against HPV-related cancers is one of the bright spots in cancer prevention, with huge potential for benefit. Since 2011, both girls and boys have been able to receive the HPV vaccine, which protects against HPV and reduces the risk of developing future cancers. What used to be a three-dose vaccine is now an easier two-dose vaccine. 

Boys and girls ages 11-12 should receive the two doses six months apart to be most effective. HPV is a sexually transmitted disease, and often times doesn’t have any symptoms, so it’s important to take preventative measures before your child becomes sexual active.  

Older teenagers and young adults (up to 26 years of age) can also benefit from the HPV vaccine. Specific recommendations can vary based on age, gender, and other factors. So, it's important to see a healthcare provider for details.

The HPV vaccine is a safe and great way to prevent cancer later in life. And most insurance plans cover it. For more information, visit the CDC’s HPV website.

HPV vaccination is a simple step to help protect our future generations.

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