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50 Obesity and Cancer with Emphasis on Bariatric Surgery

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Minimally Invasive Bariatric Surgery

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Abstract

The aim of this chapter is to identify cancers that to date have been associated with obesity and to highlight the leading physiologic theories linking obesity and cancer. The chapter will then explore the validity of national and international recommendations to reduce adiposity, when appropriate, for the purpose of lowering cancer incidence as well as risk for cancer recurrence. Finally, as a result of bariatric surgery the opportunity has been advanced to investigate whether or not long-term voluntary weight loss for overweight or obesity is associated with reduced cancer risk and lower cancer-related mortality. Finally, the chapter will review cancer risk and cancer mortality subsequent to bariatric surgery, with brief mention of cancer diagnosis incidental to weight loss surgery.

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Acknowledgments

We wish to thank Maureen Rice of the McMaster University Evidence-based Practice Center (MU-EPC), McMaster University, Hamilton, Ontario, for conducting a medical literature review. We also express appreciation to Kenneth Adams, Ph.D.; the late Eugenia Calle, Ph.D.; Paul Hopkins, M.D.; Richard Gress, M.S.; Nan Stroup, Ph.D.; Sherman Smith, M.D.; Steven Simper, M.D.; and Rodrick McKinlay, M.D.

T.D.A. receives partial funding through the Huntsman Fellowship—Advancing Community Cancer Prevention, Intermountain Research and Medical Foundation, Intermountain Healthcare Corporation, SLC, UT. T.D.A., S.C.H., and L.E.D. are supported by grant DK-55006 from the National Institutes of Health/the National Institute of Diabetes and Digestive and Kidney Diseases.

Author information

Authors and Affiliations

  1. Health & Fitness Institute, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, UT, USA

    Ted D. Adams Ph.D., M.P.H.

  2. Division of Cardiovascular Genetics,, University of Utah School of Medicine, Salt Lake City, UT, USA

    Ted D. Adams Ph.D., M.P.H., Steven C. Hunt Ph.D. & Lance E. Davidson Ph.D.

  3. Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Mia Hashibe Ph.D., M.P.H.

Authors
  1. Ted D. Adams Ph.D., M.P.H.
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  2. Steven C. Hunt Ph.D.
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  3. Lance E. Davidson Ph.D.
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  4. Mia Hashibe Ph.D., M.P.H.
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Corresponding author

Correspondence to Ted D. Adams Ph.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA

    Stacy A. Brethauer

  2. Cleveland Clinic Lerner College of Medicine, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA

    Philip R. Schauer

  3. Department of Surgery, Health Sciences Center, University of Virginia Health System, Charlottesville, Virginia, USA

    Bruce D. Schirmer

Review Questions and Answers

Review Questions and Answers

  1. a.

    Question 1: Do pre-menopausal obese women have a greater risk for incidence of breast cancer compared to pre-menopausal normal weight women?

  2. Answer 1:

    No, population-based research suggests that pre-menopausal obese women are at lower risk for developing breast cancer compared to pre-menopausal normal weight women. However, post-menopausal obese women are at a greater risk for breast cancer compared to post-menopausal normal weight women.

  3. b.

    Question 2: What are considered to be the primary mechanistic links between obesity and specific cancer types?

  4. Answer 2:

    Generally, three major categories have been identified as mechanisms associating obesity and obesity-related cancers. These include chronic inflammation, over-release of steroid-related hormones and tumor growth promotion (secondary to hyperinsulinemia.

  5. c.

    Question 3: How strongly does the evidence support the recommendation that traditional weight loss reducesincident risk of cancer as well as cancer recurrence?

  6. Answer 3:

    The evidence relating weight loss from traditional therapies (i.e. diet, physical activity and behavioral modification) and reduced cancer risk are limited primarily because of the difficulty achieving significant and sustained weight loss among overweight and obese population groups.

  7. d.

    Question 4: What is the evidence for reduced cancer incidence and cancer mortality among patients who have had bariatric surgery compared to obese, non-bariatric surgical subjects?

  8. Answer 4:

    Because patients who have undergone bariatric surgery generally lose a large amount of weight (i.e. greater than 20% of initial weight) and maintain significant weight loss for an extended period of time (i.e. years), these patients are ideal to study weight loss and subsequent cancer risk. There are multiple studies that have shown when bariatric cancer patients are compared to severely obese non-surgical subjects, the bariatric surgical patients demonstrate lower cancer mortality and cancer incidence when compared to severely obese non-operated controls.

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Adams, T.D., Hunt, S.C., Davidson, L.E., Hashibe, M. (2015). 50 Obesity and Cancer with Emphasis on Bariatric Surgery. In: Brethauer, S., Schauer, P., Schirmer, B. (eds) Minimally Invasive Bariatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1637-5_50

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