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High body-mass index (BMI; defined as 25 kg/m2 or greater) is associated with increased risk of cancer. To inform public health policy and future research, we estimated the global burden of cancer attributable to high BMI in 2012. In this population-based study, we derived population attributable fractions (PAFs) using relative risks and BMI estimates in adults by age, sex, and country. Assuming a 10-year lag-period between high BMI and cancer occurrence, we calculated PAFs using BMI estimates from 2002 and used GLOBOCAN2012 data to estimate numbers of new cancer cases attributable to high BMI. We also calculated the proportion of cancers that were potentially avoidable had populations maintained their mean BMIs recorded in 1982. We did secondary analyses to test the model and to estimate the effects of hormone replacement therapy (HRT) use and smoking. Worldwide, we estimate that 481 000 or 3·6% of all new cancer cases in adults (aged 30 years and older after the 10-year lag period) in 2012 were attributable to high BMI. PAFs were greater in women than in men (5·4% vs 1·9%). The burden of attributable cases was higher in countries with very high and high human development indices (HDIs; PAF 5·3% and 4·8%, respectively) than in those with moderate (1·6%) and low HDIs (1·0%). Corpus uteri, postmenopausal breast, and colon cancers accounted for 63·6% of cancers attributable to high BMI. A quarter (about 118 000) of the cancer cases related to high BMI in 2012 could be attributed to the increase in BMI since 1982. These findings emphasise the need for a global effort to abate the increasing numbers of people with high BMI. Assuming that the association between high BMI and cancer is causal, the continuation of current patterns of population weight gain will lead to continuing increases in the future burden of cancer. World Cancer Research Fund International, European Commission (Marie Curie Intra-European Fellowship), Australian National Health and Medical Research Council, and US National Institutes of Health.

•The prevalence of obesity is increasing and only in a few countries it starts to flatten.•As a consequence of the global rise of obesity, the current and the future burden of cancers related to obesity are rising.•Not only affecting the occurrence of cancer, the increasing prevalence of obesity also affects prognosis among cancer survivors.•The prevention of the obesity pandemic is complex and requires a locally tailored approach to reduce harms on cancers and other diseases. In view of the growing global obesity epidemic, this paper reviews the relation between recent trends in body mass index (BMI) and the changing profile of cancer worldwide. By examining seven selected countries, each representing a world region, a pattern of increasing BMI with region and gender-specific diversity is noted: increasing levels of BMI were most pronounced in the Middle East (Saudi Arabia), rather modest in Eastern Asia (India) and generally more rapid in females than in males. This observation translates into a disproportionate distribution of cancer attributable to high levels of BMI, ranging by sex from 4–9% in Saudi Arabia and from 0.2–1.2% in India. Overweight and obesity may also influence cancer outcomes, and hence have a varying impact on cancer survival and death in different world regions. Future challenges in cancer studies exploring the association with overweight and obesity concern the measurement of adiposity and its potentially cumulative effect over the life course. Given the limitations of BMI as an imperfect measure of body fatness, routine anthropometric data collection needs to be extended to develop more informative measures, such as waist circumference in settings where the gold standard tools remain unaffordable. Furthermore, questions surrounding the dose-response and timing of obesity and their associations with cancer remain to be answered. Improved surveillance of health risk factors including obesity as well as the scale and profile of cancer in every country of the world is urgently needed. This will enable the design of cost-effective actions to curb the growing burden of cancer related to excess body weight.

Background Patients with breast cancer undergoing chemotherapy and radiotherapy experience fatigue and other treatment side effects. Integrative therapies combining physical activity and dietary counseling are recommended; however to date no large randomized controlled trial has been conducted during adjuvant therapy. The Adapted Physical Activity and Diet (APAD) intervention was evaluated for its ability to decrease fatigue (primary outcome), anxiety, depression, body mass index (BMI), and fat mass, and enhance muscular and cognitive performances, and quality-of-life (QoL). Methods Women diagnosed with early breast cancer ( N  = 143, mean age = 52 ± 10 years) were randomized to APAD or usual care (UC). APAD included thrice-weekly moderate-intensity mixed aerobic and resistance exercise sessions and 9 dietetic consultations. Patient-reported outcomes (PROs) and anthropometric, muscular, and cognitive variables were measured at baseline, 18 weeks (end of chemotherapy), and 26 weeks (end of radiotherapy and intervention), and at 6- and 12-month post-intervention follow-ups. Multi-adjusted linear mixed-effects models were used to compare groups over time. Results Significant beneficial effects of the APAD intervention were observed on all PROs (i.e., fatigue, QoL, anxiety, depression) at 18 and 26 weeks. The significant effect on fatigue and QoL persisted up to 12-month follow-up. Significant decreases in BMI, fat mass, and increased muscle endurance and cognitive flexibility were observed at 26 weeks, but did not persist afterward. Leisure physical activity was enhanced in the APAD group vs UC group at 18 and 26 weeks. No significant effect of the intervention was found on major macronutrients intake. Conclusions A combined diet and exercise intervention during chemotherapy and radiotherapy in patients with early breast cancer led to positive changes in a range of psychological, physiological and behavioral outcomes at the end of intervention. A beneficial effect persisted on fatigue and QoL at long term, i.e., 1 year post-intervention. Diet-exercise supportive care should be integrated into the management of early breast cancer patients. Trial registration The APAD study was prospectively registered on ClinicalTrials.gov ( NCT01495650 ; date of registration: December 20, 2011).

Single body mass index (BMI) measurements have been associated with increased risk of 13 cancers. Whether life course adiposity-related exposures are more relevant cancer risk factors than baseline BMI (ie, at start of follow-up for disease outcome) remains unclear. We conducted a cohort study from 2009 until 2018 with population-based electronic health records in Catalonia, Spain. We included 2,645,885 individuals aged ≥40 years and free of cancer in 2009. After 9 years of follow-up, 225,396 participants were diagnosed with cancer. This study shows that longer duration, greater degree, and younger age of onset of overweight and obesity during early adulthood are positively associated with risk of 18 cancers, including leukemia, non-Hodgkin lymphoma, and among never-smokers, head and neck, and bladder cancers which are not yet considered as obesity-related cancers in the literature. Our findings support public health strategies for cancer prevention focussing on preventing and reducing early overweight and obesity. Here, the authors show that longer duration and greater degree of overweight and obesity during early adulthood as well as younger age of onset of a high body mass index are associated with a higher risk of 18 cancer types.

PurposeYounger women diagnosed with breast cancer have poorer prognoses and higher mortality compared to older women. Young black women have higher incidence rates of breast cancer and more aggressive subtypes than women of other races/ethnicities. In this study, we examined recent trends and variations in breast cancer incidence among young women in the United States.MethodsUsing 2004–2013 National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program data, we calculated breast cancer incidence rates and trends and examined variations in stage, grade, and tumor subtype by age and race/ethnicity among young women aged 20–49 years.ResultsThe majority of breast cancer cases occurred in women aged 40–44 and 45–49 years (77.3%). Among women aged < 45 years, breast cancer incidence was highest among black women. Incidence trends increased from 2004 to 2013 for Asian or Pacific Islander (API) women and white women aged 20–34 years. Black, American Indian or Alaska Native, and Hispanic women had higher proportions of cases diagnosed at later stages than white and API women. Black women had a higher proportion of grade III–IV tumors than other racial/ethnic groups. Across all age groups, incidence rates for triple-negative breast cancer were significantly higher in black women than women of other races/ethnicities, and this disparity increased with age.ConclusionsBreast cancer among young women is a highly heterogeneous disease. Differences in tumor characteristics by age and race/ethnicity suggest opportunities for further research into personal and cultural factors that may influence breast cancer risk among younger women.

Background A high body mass index (BMI) has been associated with increased risk of several cancers; however, whether BMI is related to a larger number of cancers than currently recognized is unclear. Moreover, whether waist circumference (WC) is more strongly associated with specific cancers than BMI is not well established. We aimed to investigate the associations between BMI and 26 cancers accounting for non-linearity and residual confounding by smoking status as well as to compare cancer risk estimates between BMI and WC. Methods Prospective cohort study with population-based electronic health records from Catalonia, Spain. We included 3,658,417 adults aged ≥ 18 years and free of cancer at baseline between 2006 and 2017. Our main outcome measures were cause-specific hazard ratios (HRs) with 99% confidence intervals (CIs) for incident cancer at 26 anatomical sites. Results After a median follow-up time of 8.3 years, 202,837 participants were diagnosed with cancer. A higher BMI was positively associated with risk of nine cancers (corpus uteri, kidney, gallbladder, thyroid, colorectal, breast post-menopausal, multiple myeloma, leukemia, non-Hodgkin lymphoma) and was positively associated with three additional cancers among never smokers (head and neck, brain and central nervous system, Hodgkin lymphoma). The respective HRs (per 5 kg/m 2 increment) ranged from 1.04 (99%CI 1.01 to 1.08) for non-Hodgkin lymphoma to 1.49 (1.45 to 1.53) for corpus uteri cancer. While BMI was negatively associated to five cancer types in the linear analyses of the overall population, accounting for non-linearity revealed that BMI was associated to prostate cancer in a U-shaped manner and to head and neck, esophagus, larynx, and trachea, bronchus and lung cancers in an L-shaped fashion, suggesting that low BMIs are an approximation of heavy smoking. Of the 291,305 participants with a WC measurement, 27,837 were diagnosed with cancer. The 99%CIs of the BMI and WC point estimates (per 1 standard deviation increment) overlapped for all cancers. Conclusions In this large Southern European study, a higher BMI was associated with increased risk of twelve cancers, including four hematological and head and neck (only among never smokers) cancers. Furthermore, BMI and WC showed comparable estimates of cancer risk associated with adiposity.

Although cigarette smoking is the most important cause of chronic obstructive pulmonary disease (COPD), a substantial proportion of COPD cases cannot be explained by smoking alone. To evaluate the risk factors for COPD besides personal cigarette smoking. We constituted an ad hoc subcommittee of the American Thoracic Society Environmental and Occupational Health Assembly. An international group of members was invited, based on their scientific expertise in a specific risk factor for COPD. For each risk factor area, the committee reviewed the literature, summarized the evidence, and developed conclusions about the likelihood of it causing COPD. All conclusions were based on unanimous consensus. The population-attributable fraction for smoking as a cause of COPD ranged from 9.7 to 97.9%, but was less than 80% in most studies, indicating a substantial burden of disease attributable to nonsmoking risk factors. On the basis of our review, we concluded that specific genetic syndromes and occupational exposures were causally related to the development of COPD. Traffic and other outdoor pollution, secondhand smoke, biomass smoke, and dietary factors are associated with COPD, but sufficient criteria for causation were not met. Chronic asthma and tuberculosis are associated with irreversible loss of lung function, but there remains uncertainty about whether there are important phenotypic differences compared with COPD as it is typically encountered in clinical settings. In public health terms, a substantive burden of COPD is attributable to risk factors other than smoking. To prevent COPD-related disability and mortality, efforts must focus on prevention and cessation of exposure to smoking and these other, less well-recognized risk factors.

Several descriptive studies on the intake of polyphenols, mostly flavonoids, have been published, especially in Europe and the USA, but insufficient data are still available in Latin-American countries, where different types of foods are consumed and different dietary habits are observed. The goal of this cross-sectional study was to estimate dietary intakes of polyphenols, including grand total, total per classes and subclasses and individual compounds, and to identify their main food sources in Mexican women. The Mexican Teachers’ Cohort includes 115 315 female teachers, 25 years and older, from twelve states of Mexico, including urban and rural areas. Dietary data were collected in the period 2008–2011 using a validated FFQ, and individual polyphenol intake was estimated using food composition data from the Phenol-Explorer database. Median total polyphenol intake was the highest in Baja California (750 mg/d) and the lowest in Yucatan (536 mg/d). The main polyphenols consumed were phenolic acids (56·3–68·5 % total polyphenols), followed by flavonoids (28·8–40·9 %). Intake of other polyphenol subclasses (stilbenes, lignans and others) was insignificant. Coffee and fruits were the most important food sources of phenolic acids and flavonoids, respectively. Intake of a total of 287 different individual polyphenols could be estimated, of which forty-two were consumed in an amount ≥1 mg/d. The most largely consumed polyphenols were several caffeoylquinic acids (ranging from 20 and 460 mg/d), ferulic acid, hesperidin and proanthocyanidins. This study shows a large heterogeneity in intakes of individual polyphenols among Mexican women, but a moderate heterogeneity across Mexican states. Main food sources were also similar in the different states.

Breast cancer is the most common cancer in women worldwide. In the Moroccan context, the role of well-known reproductive factors in breast cancer remains poorly documented. The aim of this study was to explore the relationship between menstrual and reproductive factors and breast cancer risk in Moroccan women in the Fez region. A case-control study was conducted at the Hassan II University Hospital of Fez between January 2014 and April 2015. A total of 237 cases of breast cancer and 237 age-matched controls were included. Information on sociodemographic characteristics, menstrual and reproductive history, family history of breast cancer, and lifestyle factors was obtained through a structured questionnaire. Conditional logistic regression models were used to estimate odds ratios and 95% confidence intervals for breast cancer by menstrual and reproductive factors adjusted for potential confounders. Early menarche (OR = 1.60, 95% CI: 1.08-2.38) and nulliparity (OR = 3.77, 95% CI: 1.98-7.30) were significantly related to an increased risk of breast cancer, whereas an early age at first full-term pregnancy was associated with a decreased risk of breast cancer (OR = 0.41, 95% CI: 0.25-0.65). The results of this study confirm the role of established reproductive factors for breast cancer in Moroccan women. It identified some susceptible groups at high risk of breast cancer. Preventive interventions and screening should focus on these groups as a priority. These results should be confirmed in a larger, multicenter study.

An estimated 1.38 million new cases of breast cancer (BC) are diagnosed each year in women worldwide. Of these, the majority are categorized as invasive ductal cell carcinoma. Subgroups of BC are frequently distinguished into five “intrinsic” subtypes, namely, luminal A, luminal B, normal-like, HER2-positive, and basal-like subtypes. Epidemiological evidence has shown that anthropometric factors are implicated in BC development. Overall consistent positive associations have been observed between high body mass index (BMI) and waist-to-hip ratio (WHR) and the risk of BC among postmenopausal women, while conflicting results persist for premenopausal BC, both for BMI and for other anthropometric parameters as well as across ethnic groups. Furthermore, some evidence suggests that body size, body shape, and weight gain during childhood or adolescence may play a role in the risk of BC. In this paper, we describe the evidence linking anthropometric indices at different ages and BC risk, in order to improve our understanding of the role of body fat distribution in the risk of BC, investigate differences in these associations according to menopausal status and ethnic groups, and discuss the potential biological mechanisms linking body size and BC risk.