WHS PR Symposium: Obesity and Cancer The Next Frontier

8/10/2019 WHS PR Symposium: Obesity and Cancer The Next Frontier

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Edna M. Mora, MD,Professor, Department of Surgery, School of Medici

Medical Sciences Campus, University of Puerto Rico Investigator UPR Comprehensive Cancer C


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I, or my immediate family member includingspouse/partner, have at present and/or havehad within the last 12 months, or anticipateNO financial interest/arrangement oraffiliation with one or more organizationsthat could perceived as a real or apparentconflict of interest in context to the design,implementation, presentation, evaluationetc. of this presentation .


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True or False

______ 1. Obesity is not a disease, but a judgement of weight bysociety.

______ 2. Obesity promotes cancer.

______ 3. Obesity induces cancer.


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Is obesity important in the cancer field?

Obesity and its relationship to cancer physiology and biologyDoes obesity promote a cancer-promoting environment(carcinogenesis)?Does obesity increase the growth and metastatic potential oftumors? (tumorogenesis)How to manage obesity in the cancer patient receivingtreatment or after treatment?Obesity definitionConclusions


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In the US, 33% of adults and 17% of children and adolescents

are categorized as obese.In Puerto Rico, 32% overweight, 17% obese (children) 2012

66% overweight, 25-30% obese (adult)2011Body mass index (BMI)- WHO categories25-29.9 kg/m2- overweight30 kg/m2- obesityObesity contributes to several major illnesses: cardiovascular,diabetes, cancer. It increases the risk and mortality for all ofthem.

Ligibel, JA, et al. Journal of Clinical Oncology 32


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Obesity increased cancer risk, recurrence and cancer-related

mortality in patients with early-stage cancer.Breast cancer- obese at the time of diagnosis

75% increased in mortality in pre-menopausal women34% increased in mortality in post-menopausal women

Prostate cancer- obese menincrease risk of developing biologically aggressive prostatecancer and more likely to have advanced disease at the timeof diagnosis

Ligibel, JA, et al. Journal of Clinical Oncology 32: 1Boeing H, et al Best Prac Res Clin Endo Meta 27:21


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A BMI 35 kg/m2 may be associated with an increased risk of colocancer recurrence and mortality, but data is less consistent.Endometrial cancer- risk increased linearly with increasing BMI. It mainly driven by general fatness attained at late adulthood.Evidence for a relationship of fatness at diagnosis and survival isweak.Renal cell cancer- there are uncertainties regarding gender andobesity effect on survival.Esophageal cancer- risk driven by abdominal fat. No relationshipwith survival.



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Other cancers related to obesity:

uterinepancreaticthyroidgallbladder

ovarian Non-Hodking lymphomacervical Multiple Myelomaliver



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Cancer survivors are NO more likely to beconsuming a healthy diet, exercising, ormaintaining a healthy weight compared toadults without history of cancer.

Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014


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Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014


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Carcinogenesis Tumorogenesis Metastatses
http://www.google.com.pr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.belleonline.com/newsletters/volume9/vol9-1/n2v91.html&ei=DSJiVMbEEYejgwS204LAAg&bvm=bv.79189006,d.eXY&psig=AFQjCNHSwB1O60b8d66dERacd0KVa4g_7Q&ust=1415803682834623


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Adipose tissue is a very active endocrine and metabolic organ.Cells adipocytes

pre-adipocytesfibroblastsmacrophagesblood vessels

Adipokines (cytokines)leptin

adiponectinplaminogen activator inhibitor (PAI)-1VEGFTNF- IL-6

Inflammatory m

Van Kruijsdijk RCM, et al. Ca Epi Bio Prev 18: 2569-2578


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Immune System

Macrophages- M1 (increased), M2 (deceased)EosinophilsNeutrophilsMast cells

T-lymphocytesB-Lymphocytes

INFLAMMATION

Catalan V et al. Frontiers in Physiology 4(275)


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Catalan V et al. Frontiers in Physiology 4(275): 1


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Perez-Hernandez AI, et al. Frontiers in Endocrinol 5(65): 1


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Van Kruijsdijk RCM, et al. Ca Epi Bio Prev 18: 2569-


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Education

Exercise programHealthy nutrition interventionwith follow-upSet goalsInvolve the relatives


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Oprah Magazine March 2014


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Ligibel, JA, et al. Journal of Clinical Oncology 32


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Ashwell M, et al. BMC Medicine 12:207, 201


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Obesity is an important aspect of cancer.

Obesity increases the risk of several types of cancers andincreases the progression and survival of the disease.Obesity acts as a carcinogenic, tumorogenic and metastaticenvironment. WHt ratio is more practical and functional than BMI in

associating obesity with risk of diseases.We should start implementing educational strategies todecrease obesity and overweight in children and adults.


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True or False

______ 1. Obesity is not a disease, but a judgement of weight bysociety.

______ 2. Obesity promotes cancer.

______ 3. Obesity induces cancer.


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WHS PR Symposium: Obesity and Cancer The Next Frontier

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