Oncology Central

ESMO 2017: Central obesity may be a key cancer for postmenopausal women

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According to novel research presented at the ESMO 2017 Congress (8–12th September 2017, Madrid, Spain) body fat distribution in the trunk is more important than body weight when it comes to cancer risk in postmenopausal women.

The findings are part of a Prospective Epidemiologic Risk Factor study, an observational, prospective cohort study which aimed to gain a better understanding of age-related diseases in Danish postmenopausal women.

The study analyzed the body fat and body fat composition of 5855 women, mean age 71 years, over the course of 12 years by utilizing baseline dual-energy X-ray absorptiometry scans. The team then went onto utilize information from national cancer registries to record 811 solid cancers (293 breast and ovarian cancers, 345 lung and gastrointestinal cancers and 173 other cancers) in the study cohort.

From this the team were able to demonstrate that the ratio of abdominal fat to peripheral fat was a significant independent predictor of cancer diagnosis up to 12 years after baseline (hazard ratio [HR] 1.30; 95%, CI: 1.11 to 1.52; p < 0.001). Neither BMI nor fat percentage showed significance.

“When assessing cancer risk, body mass index (BMI) and fat percentage may not be adequate measures as they fail to assess the distribution of fat mass,” commented study investigator Line Mærsk Staunstrup (Nordic Bioscience and ProScion, Herlev, Denmark). “Avoiding central obesity may confer the best protection.”

By investigating the risk factors in specific cancers the investigators determined that only lung and gastrointestinal cancers were associated with high abdominal to peripheral fat ratios. Other risk factors included receipt of hormone replacement therapy, smoking and older age, by controlling for these risk factors the investigators were able to demonstrate that fat ratio is an independent risk factor.

“The average elderly women can very much use this information, as it is known that the menopause transition initiates a shift in body fat towards the central trunk area. Therefore elderly women should be especially aware of their lifestyle when they approach the pre-menopause age,” explained Maersk Staunstrup.

“Clinicians can additionally use the information for a preventive conversation with women who are in higher risk of cancer. While clinicians have access to whole body DXA scanners at most hospitals, portable DXA scanners have become available on the commercial market and this may allow regional bone and fat scanning, however it may not be the most reliable for measuring central obesity,” she concluded.

Andrea De Censi from Galliera Hospital (Genova, Italy) commented on the study: “While obesity has previously been linked to cancer risk, the link to lung cancer is new and intriguing.”

“These data open the door for clinicans to intiate a number of interventions in obese patients. In addition to fat loss with diet and exercise, there may be a potential role for a diabetes drug, such as metformin, which can lower insulin effects and contribute to cancer prevention,” he concluded.

Reference

Stanstrup; A study of body fat composition, derived from DXA-scans, in association with cancer incidence in postmenopausal women’ (2017).

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