Cancer Incidence and Mortality in Relation to Body Mass Index in the Million Women Study: Cohort Study

Overview

Journal BMJ

Specialty General Medicine

Date 2007 Nov 8

PMID 17986716

Citations 576

Authors

Gillian K Reeves

Kirstin Pirie

Valerie Beral

Jane Green

Elizabeth Spencer

Diana Bull

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the relation between body mass index (kg/m2) and cancer incidence and mortality.

Design: Prospective cohort study.

Participants: 1.2 million UK women recruited into the Million Women Study, aged 50-64 during 1996-2001, and followed up, on average, for 5.4 years for cancer incidence and 7.0 years for cancer mortality.

Main Outcome Measures: Relative risks of incidence and mortality for all cancers, and for 17 specific types of cancer, according to body mass index, adjusted for age, geographical region, socioeconomic status, age at first birth, parity, smoking status, alcohol intake, physical activity, years since menopause, and use of hormone replacement therapy.

Results: 45,037 incident cancers and 17 203 deaths from cancer occurred over the follow-up period. Increasing body mass index was associated with an increased incidence of endometrial cancer (trend in relative risk per 10 units=2.89, 95% confidence interval 2.62 to 3.18), adenocarcinoma of the oesophagus (2.38, 1.59 to 3.56), kidney cancer (1.53, 1.27 to 1.84), leukaemia (1.50, 1.23 to 1.83), multiple myeloma (1.31, 1.04 to 1.65), pancreatic cancer (1.24, 1.03 to 1.48), non-Hodgkin's lymphoma (1.17, 1.03 to 1.34), ovarian cancer (1.14, 1.03 to 1.27), all cancers combined (1.12, 1.09 to 1.14), breast cancer in postmenopausal women (1.40, 1.31 to 1.49) and colorectal cancer in premenopausal women (1.61, 1.05 to 2.48). In general, the relation between body mass index and mortality was similar to that for incidence. For colorectal cancer, malignant melanoma, breast cancer, and endometrial cancer, the effect of body mass index on risk differed significantly according to menopausal status.

Conclusions: Increasing body mass index is associated with a significant increase in the risk of cancer for 10 out of 17 specific types examined. Among postmenopausal women in the UK, 5% of all cancers (about 6000 annually) are attributable to being overweight or obese. For endometrial cancer and adenocarcinoma of the oesophagus, body mass index represents a major modifiable risk factor; about half of all cases in postmenopausal women are attributable to overweight or obesity.

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References

Gallus S, Naldi L, Martin L, Martinelli M, La Vecchia C . Anthropometric measures and risk of cutaneous malignant melanoma: a case-control study from Italy. Melanoma Res. 2006; 16(1):83-7. DOI: 10.1097/01.cmr.0000194429.77643.76. View

Veierod M, Thelle D, Laake P . Diet and risk of cutaneous malignant melanoma: a prospective study of 50,757 Norwegian men and women. Int J Cancer. 1997; 71(4):600-4. DOI: 10.1002/(sici)1097-0215(19970516)71:4<600::aid-ijc15>3.0.co;2-f. View

Freedman D, Sigurdson A, Doody M, Rao R, Linet M . Risk of melanoma in relation to smoking, alcohol intake, and other factors in a large occupational cohort. Cancer Causes Control. 2003; 14(9):847-57. DOI: 10.1023/b:caco.0000003839.56954.73. View

Holly E, Lele C, Bracci P, McGrath M . Case-control study of non-Hodgkin's lymphoma among women and heterosexual men in the San Francisco Bay Area, California. Am J Epidemiol. 1999; 150(4):375-89. DOI: 10.1093/oxfordjournals.aje.a010017. View

Terry P, Giovannucci E, Bergkvist L, Holmberg L, Wolk A . Body weight and colorectal cancer risk in a cohort of Swedish women: relation varies by age and cancer site. Br J Cancer. 2001; 85(3):346-9. PMC: 2364077. DOI: 10.1054/bjoc.2001.1894. View

Whitlock G, Clark T, Hoorn S, Rodgers A, Jackson R, Norton R . Random errors in the measurement of 10 cardiovascular risk factors. Eur J Epidemiol. 2002; 17(10):907-9. DOI: 10.1023/a:1016228410194. View

Niedhammer I, Bugel I, Bonenfant S, Goldberg M, Leclerc A . Validity of self-reported weight and height in the French GAZEL cohort. Int J Obes Relat Metab Disord. 2000; 24(9):1111-8. DOI: 10.1038/sj.ijo.0801375. View

Farrow D, Weiss N, Lyon J, Daling J . Association of obesity and ovarian cancer in a case-control study. Am J Epidemiol. 1989; 129(6):1300-4. DOI: 10.1093/oxfordjournals.aje.a115249. View

Wolk A, Gridley G, Svensson M, Nyren O, McLaughlin J, Fraumeni J . A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control. 2001; 12(1):13-21. DOI: 10.1023/a:1008995217664. View

10.

Thune I, Olsen A, Albrektsen G, Tretli S . Cutaneous malignant melanoma: association with height, weight and body-surface area. a prospective study in Norway. Int J Cancer. 1993; 55(4):555-61. DOI: 10.1002/ijc.2910550406. View

11.

Purdie D, Bain C, Webb P, Whiteman D, Pirozzo S, Green A . Body size and ovarian cancer: case-control study and systematic review (Australia). Cancer Causes Control. 2001; 12(9):855-63. DOI: 10.1023/a:1012267619561. View

12.

Moller H, Mellemgaard A, Lindvig K, Olsen J . Obesity and cancer risk: a Danish record-linkage study. Eur J Cancer. 1994; 30A(3):344-50. DOI: 10.1016/0959-8049(94)90254-2. View

13.

Flegal K, Graubard B, Williamson D, Gail M . Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005; 293(15):1861-7. DOI: 10.1001/jama.293.15.1861. View

14.

Samanic C, Chow W, Gridley G, Jarvholm B, Fraumeni Jr J . Relation of body mass index to cancer risk in 362,552 Swedish men. Cancer Causes Control. 2006; 17(7):901-9. DOI: 10.1007/s10552-006-0023-9. View

15.

Patel A, Rodriguez C, Bernstein L, Chao A, Thun M, Calle E . Obesity, recreational physical activity, and risk of pancreatic cancer in a large U.S. Cohort. Cancer Epidemiol Biomarkers Prev. 2005; 14(2):459-66. DOI: 10.1158/1055-9965.EPI-04-0583. View

16.

Chow W, Blot W, Vaughan T, Risch H, Gammon M, Stanford J . Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst. 1998; 90(2):150-5. DOI: 10.1093/jnci/90.2.150. View

17.

. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995; 854:1-452. View

18.

Calle E, Thun M, Petrelli J, Rodriguez C, Heath Jr C . Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999; 341(15):1097-105. DOI: 10.1056/NEJM199910073411501. View

19.

Magnusson C, Roddam A . Breast cancer and childhood anthropometry: emerging hypotheses?. Breast Cancer Res. 2005; 7(3):83. PMC: 1143562. DOI: 10.1186/bcr1014. View

20.

Phillips R, Snowdon D . Dietary relationships with fatal colorectal cancer among Seventh-Day Adventists. J Natl Cancer Inst. 1985; 74(2):307-17. View