Changes in Age Distribution of Obesity-Associated Cancers | Cancer Screening, Prevention, Control | JAMA Network Open | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.153.100.128. Please contact the publisher to request reinstatement.
1.
Lauby-Secretan  B, Scoccianti  C, Loomis  D, Grosse  Y, Bianchini  F, Straif  K; International Agency for Research on Cancer Handbook Working Group.  Body fatness and cancer: viewpoint of the IARC Working Group.  N Engl J Med. 2016;375(8):794-798. doi:10.1056/NEJMsr1606602PubMedGoogle ScholarCrossref
2.
Steele  CB, Thomas  CC, Henley  SJ,  et al.  Vital signs: trends in incidence of cancers associated with overweight and obesity—United States, 2005-2014.  MMWR Morb Mortal Wkly Rep. 2017;66(39):1052-1058. doi:10.15585/mmwr.mm6639e1PubMedGoogle ScholarCrossref
3.
Griffiths  C, Jimenez  E, Chalas  E.  Causal effect of obesity on gynecologic malignancies.  Curr Probl Cancer. 2019;43(2):145-150. doi:10.1016/j.currproblcancer.2018.07.011PubMedGoogle ScholarCrossref
4.
Keum  N, Greenwood  DC, Lee  DH,  et al.  Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies.  J Natl Cancer Inst. 2015;107(2):djv088. doi:10.1093/jnci/djv088PubMedGoogle ScholarCrossref
5.
Gunter  MJ, Riboli  E.  Obesity and gastrointestinal cancers: where do we go from here?  Nat Rev Gastroenterol Hepatol. 2018;15(11):651-652. doi:10.1038/s41575-018-0073-yPubMedGoogle ScholarCrossref
6.
López-Suárez  A.  Burden of cancer attributable to obesity, type 2 diabetes and associated risk factors.  Metabolism. 2019;92:136-146. doi:10.1016/j.metabol.2018.10.013PubMedGoogle ScholarCrossref
7.
NCD Risk Factor Collaboration (NCD-RisC).  Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants.  Lancet. 2016;387(10026):1377-1396. doi:10.1016/S0140-6736(16)30054-XPubMedGoogle ScholarCrossref
8.
Fryar  CD, Carroll  MD, Ogden  C.  Prevalence of Overweight, Obesity, and Severe Obesity Among Adults Age 20 and Over: United States, 1960-1962 Through 2015-2016. Bethesda, MD: National Center for Health Statistics; 2018. https://www.cdc.gov/nchs/data/hestat/obesity_adult_15_16/obesity_adult_15_16.htm. Accessed February 17, 2019.
9.
Zohar  L, Rottenberg  Y, Twig  G,  et al.  Adolescent overweight and obesity and the risk for pancreatic cancer among men and women: a nationwide study of 1.79 million Israeli adolescents.  Cancer. 2019;125(1):118-126. doi:10.1002/cncr.31764PubMedGoogle ScholarCrossref
10.
Arnold  M, Jiang  L, Stefanick  ML,  et al.  Duration of adulthood overweight, obesity, and cancer risk in the women’s health initiative: a longitudinal study from the United States.  PLoS Med. 2016;13(8):e1002081. doi:10.1371/journal.pmed.1002081PubMedGoogle ScholarCrossref
11.
Arnold  M, Freisling  H, Stolzenberg-Solomon  R,  et al; CHANCES Consortium.  Overweight duration in older adults and cancer risk: a study of cohorts in Europe and the United States.  Eur J Epidemiol. 2016;31(9):893-904. doi:10.1007/s10654-016-0169-zPubMedGoogle ScholarCrossref
12.
Berger  NA.  Young adult cancer: influence of the obesity pandemic.  Obesity (Silver Spring). 2018;26(4):641-650. doi:10.1002/oby.22137PubMedGoogle ScholarCrossref
13.
Juo  YY, Gibbons  MAM, Dutson  E,  et al.  Obesity is associated with early onset of gastrointestinal cancers in California.  J Obes. 2018;2018:7014073. doi:10.1155/2018/7014073PubMedGoogle ScholarCrossref
14.
Li  D, Morris  JS, Liu  J,  et al.  Body mass index and risk, age of onset, and survival in patients with pancreatic cancer.  JAMA. 2009;301(24):2553-2562. doi:10.1001/jama.2009.886PubMedGoogle ScholarCrossref
15.
Liu  PH, Wu  K, Ng  K,  et al.  Association of obesity with risk of early-onset colorectal cancer among women.  JAMA Oncol. 2019;5(1):37-44. doi:10.1001/jamaoncol.2018.4280PubMedGoogle ScholarCrossref
16.
McWilliams  RR, Maisonneuve  P, Bamlet  WR,  et al.  Risk factors for early-onset and very-early-onset pancreatic adenocarcinoma: a Pancreatic Cancer Case-Control Consortium (PanC4) analysis.  Pancreas. 2016;45(2):311-316. doi:10.1097/MPA.0000000000000392PubMedGoogle ScholarCrossref
17.
Ellis  L, Abrahão  R, McKinley  M,  et al.  Colorectal cancer incidence trends by age, stage, and racial/ethnic group in California, 1990-2014.  Cancer Epidemiol Biomarkers Prev. 2018;27(9):1011-1018. doi:10.1158/1055-9965.EPI-18-0030PubMedGoogle ScholarCrossref
18.
National Cancer Institute. SEER data & software. https://seer.cancer.gov/data-software/. Accessed July 22, 2019.
19.
Edwards  BK, Howe  HL, Ries  LA,  et al.  Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. cancer burden.  Cancer. 2002;94(10):2766-2792. doi:10.1002/cncr.10593PubMedGoogle ScholarCrossref
20.
Yancik  R.  Population aging and cancer: a cross-national concern.  Cancer J. 2005;11(6):437-441. doi:10.1097/00130404-200511000-00002PubMedGoogle ScholarCrossref
21.
Yancik  R.  Epidemiology of cancer in the elderly: current status and projections for the future.  Rays. 1997;22(1)(suppl):3-9.PubMedGoogle Scholar
22.
Berger  NA, Savvides  P, Koroukian  SM,  et al.  Cancer in the elderly.  Trans Am Clin Climatol Assoc. 2006;117:147-155.PubMedGoogle Scholar
23.
Moore  KJ, Sussman  DA, Koru-Sengul  T.  Age-specific risk factors for advanced stage colorectal cancer, 1981-2013.  Prev Chronic Dis. 2018;15:E106. doi:10.5888/pcd15.170274PubMedGoogle ScholarCrossref
24.
Chen  FW, Sundaram  V, Chew  TA, Ladabaum  U.  Advanced-stage colorectal cancer in persons younger than 50 years not associated with longer duration of symptoms or time to diagnosis.  Clin Gastroenterol Hepatol. 2017;15(5):728-737.e3. doi:10.1016/j.cgh.2016.10.038PubMedGoogle ScholarCrossref
25.
Tao  L, Schwab  RB, San Miguel  Y,  et al.  Breast cancer mortality in older and younger patients in California.  Cancer Epidemiol Biomarkers Prev. 2019;28(2):303-310. doi:10.1158/1055-9965.EPI-18-0353PubMedGoogle ScholarCrossref
26.
Mauri  G, Sartore-Bianchi  A, Russo  AG, Marsoni  S, Bardelli  A, Siena  S.  Early-onset colorectal cancer in young individuals.  Mol Oncol. 2019;13(2):109-131. doi:10.1002/1878-0261.12417PubMedGoogle ScholarCrossref
27.
Siegel  R, Desantis  C, Jemal  A.  Colorectal cancer statistics, 2014.  CA Cancer J Clin. 2014;64(2):104-117. doi:10.3322/caac.21220PubMedGoogle ScholarCrossref
28.
Edwards  BK, Ward  E, Kohler  BA,  et al.  Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates.  Cancer. 2010;116(3):544-573. doi:10.1002/cncr.24760PubMedGoogle ScholarCrossref
29.
Bluethmann  SM, Mariotto  AB, Rowland  JH.  Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States.  Cancer Epidemiol Biomarkers Prev. 2016;25(7):1029-1036. doi:10.1158/1055-9965.EPI-16-0133PubMedGoogle ScholarCrossref
30.
Kenzik  KM, Kent  EE, Martin  MY, Bhatia  S, Pisu  M.  Chronic condition clusters and functional impairment in older cancer survivors: a population-based study.  J Cancer Surviv. 2016;10(6):1096-1103. doi:10.1007/s11764-016-0553-4PubMedGoogle ScholarCrossref
31.
Kreatsoulas  C, Anand  SS, Subramanian  SV.  An emerging double burden of disease: the prevalence of individuals with cardiovascular disease and cancer.  J Intern Med. 2014;275(5):494-505. doi:10.1111/joim.12165PubMedGoogle ScholarCrossref
32.
Shankaran  V, Jolly  S, Blough  D, Ramsey  SD.  Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis.  J Clin Oncol. 2012;30(14):1608-1614. doi:10.1200/JCO.2011.37.9511PubMedGoogle ScholarCrossref
33.
Ramsey  S, Blough  D, Kirchhoff  A,  et al.  Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis.  Health Aff (Millwood). 2013;32(6):1143-1152. doi:10.1377/hlthaff.2012.1263PubMedGoogle ScholarCrossref
34.
Siegel  RL, Fedewa  SA, Anderson  WF,  et al.  Colorectal cancer incidence patterns in the United States, 1974-2013.  J Natl Cancer Inst. 2017;109(8). doi:10.1093/jnci/djw322PubMedGoogle Scholar
35.
Anderson  WF, Camargo  MC, Fraumeni  JF  Jr, Correa  P, Rosenberg  PS, Rabkin  CS.  Age-specific trends in incidence of noncardia gastric cancer in US adults.  JAMA. 2010;303(17):1723-1728. doi:10.1001/jama.2010.496PubMedGoogle ScholarCrossref
36.
Sung  H, Siegel  RL, Rosenberg  PS, Jemal  A.  Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry.  Lancet Public Health. 2019;4(3):e137-e147. doi:10.1016/S2468-2667(18)30267-6PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Original Investigation
    Oncology
    August 14, 2019

    Changes in Age Distribution of Obesity-Associated Cancers

    Author Affiliations
    • 1Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
    • 2Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
    JAMA Netw Open. 2019;2(8):e199261. doi:10.1001/jamanetworkopen.2019.9261
    Key Points español 中文 (chinese)

    Question  What are the temporal shifts in age distribution for obesity-associated cancers across sex- and race/ethnicity-specific strata?

    Findings  In this cross-sectional study of 2 665 574 incident obesity-associated cancer cases and 3 448 126 incident non–obesity-associated cancer cases from 2000 to 2016, the percentage of individuals diagnosed with incident obesity-associated cancers increased in younger age groups, with some of the greatest increases observed for liver and thyroid cancers (all sex- and race/ethnicity-specific strata), gallbladder and other biliary cancers (non-Hispanic black men and women and Hispanic men), and uterine cancer (in Hispanic women in the 50- to 64-year age group).

    Meaning  The findings suggest that there has been a shift of obesity-associated cancer burden to younger age groups and that interventions to reduce obesity and to implement individualized screening programs are needed.

    Abstract

    Importance  Recent studies have documented an association between overweight and obesity and certain cancers, as well as an increased incidence of obesity-associated cancers (OACs) in younger individuals. However, although important for cancer-control efforts, it is not known which subgroups of the population are most affected by these changes.

    Objective  To examine temporal shifts in age distribution of OACs and non-OACs across race/ethnicity- and sex-specific strata.

    Design, Setting, and Participants  This population-based, cross-sectional study assessed individuals residing in Surveillance, Epidemiology, and End Results sites who were diagnosed with incident OACs and non-OACs from January 1, 2000, to December 31, 2016. Data analysis was performed from August 1, 2018, to June 30, 2019.

    Exposure  Study years.

    Main Outcomes and Measures  Changes in the age distribution of incident cases across race/ethnicity- and sex-specific strata over time. For all OACs and non-OACs, changes in the incidence rates, the number of incident cases, and the distribution of the cases across population subgroups were studied. Race/ethnicity- and sex-stratified logistic regression analysis was performed to determine whether the annual change in the odds associated with an age group increased (or decreased) to a greater (or lesser) extent in OACs than in non-OACs. Heat maps were created to highlight the change in the number of cases during the study period for each OAC and select non-OACs.

    Results  The study population included 2 665 574 incident OAC cases (70.3% women) and 3 448 126 incident non-OAC cases (32.0% women). From 2000 to 2016, the distribution by age showed that the percentage of incident cases increased in the 50- to 64-year age group for both OACs and non-OACs. The increase in the number of OACs in this age group ranged from 25.3% in non-Hispanic white women to 197.8% in Hispanic men. The change in the number of OACs in the 20- to 49-year age group ranged from −5.9% in non-Hispanic white women to 94.6% in Hispanic women, and the increase in the number of OACs in the 65 years or older group ranged from 2.5% in non-Hispanic white women to 102.0% in Hispanic women. Logistic regression analysis revealed a greater annual increase in the odds for OACs than for non-OACs for individuals in the 50- to 64-year age group but a decrease for individuals in the 65 years or older group. Among men in the 50- to 64-year age group, the OAC to non-OAC ratio of odds ratios (ORs) ranged from 1.005 (95% CI, 1.002-1.008) in non-Hispanic black men to 1.013 (95% CI, 1.012-1.014) in non-Hispanic white men, implying that the annual increase was 0.5% higher for OACs than for non-OACs in non-Hispanic black men and 1.3% higher for OACs than for non-OACs in non-Hispanic white men. Among women in the 50- to 64-year age group, the OAC to non-OAC ratio of ORs ranged from 1.002 (95% CI, 0.999-1.006) in Hispanic women to 1.005 (95% CI, 1.002-1.009) in non-Hispanic black women. In men and women aged 65 or older, the OAC vs non-OAC ratio of ORs was consistently less than 1.000 for all race/ethnicity groups, indicating that whereas the OAC group experienced a decrease in this age group, the non-OACs experienced either a smaller decrease or an increase over time.

    Conclusions and Relevance  This study indicates that from 2000 to 2016, a shift toward younger age groups occurred in incident OACs. The findings have important public health implications and suggest that interventions to reduce obesity and to implement individualized screening programs are needed.

    ×