Skip to main content

Advertisement

Log in

Association Between Obesity and Clinical Outcomes in Gynecologic Cancer

  • Gynecologic Oncology (R Salani, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Obesity is a known risk factor for many cancers, including gynecologic malignancies. While the association between obesity and risk for endometrial cancer is well established, the association with clinical outcomes has been more controversial. Most studies demonstrate an association between obesity and worse all-cause survival in endometrial cancer; however, it is unclear whether this effect is cancer-specific or secondary to comorbid conditions. In ovarian cancer, studies have shown an association between decreased survival and pre-diagnosis obesity, but not obesity at diagnosis. There are also studies that suggest a modest negative association between obesity and survival in women with cervical cancer. Comorbid conditions, lack of screening, and suboptimal chemotherapy dosing in obese women may contribute to decreased survival. Further research is necessary to understand the role of obesity on mortality in gynecologic malignancies in order to improve cancer prevention and therapeutic strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Webb PM. Obesity and gynecologic cancer etiology and survival. Am Soc Clin Oncol Educ Book / ASCO Am Soc Clin Oncol Meet. 2013.

  2. World Cancer Research Fund / American Institute of Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007.

    Google Scholar 

  3. Olsen CM, Green AC, Whiteman DC, Sadeghi S, Kolahdooz F, Webb PM. Obesity and the risk of epithelial ovarian cancer: a systematic review and meta-analysis. Eur J Cancer (Oxf: 1990). 2007;43(4):690–709.

    Article  Google Scholar 

  4. Ovarian cancer and body size: individual participant meta-analysis including 25,157 women with ovarian cancer from 47 epidemiological studies. PLoS Med. 2012;9(4):e1001200.

  5. Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lancet. 2014;384(9945):755–65.

    Article  PubMed Central  PubMed  Google Scholar 

  6. World Health Organization. Global database on body mass index. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. 2006.

  7. World Health Organization. Obesity and overweight fact sheet. http://www.who.int/mediacentre/factsheets/fs311/en/. January 2015.

  8. National Institute of Diabetes and Digestive and Kidney Diseases. Overweight and obesity statistics. http://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx. October 2012.

  9. American Society of Clinical Oncology. Obesity and cancer, a guide for oncology providers. http://www.asco.org/sites/www.asco.org/files/obesity_provider_guide_final.pdf. 2014. This article provides an important guide for oncology providers outlining obesity’s impact on cancer risk and outcomes as well as tools for weight loss strategies and clinical practice guidelines

  10. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.

    Article  PubMed  Google Scholar 

  11. Crosbie EJ, Roberts C, Qian W, Swart AM, Kitchener HC, Renehan AG. Body mass index does not influence post-treatment survival in early stage endometrial cancer: results from the MRC ASTEC trial. Eur J Cancer (Oxf: 1990). 2012;48(6):853–64.

    Article  Google Scholar 

  12. Gunderson CC, Java J, Moore KN, Walker JL. The impact of obesity on surgical staging, complications, and survival with uterine cancer: a Gynecologic Oncology Group LAP2 ancillary data study. Gynecol Oncol. 2014;133(1):23–7.

    Article  PubMed  Google Scholar 

  13. Akbayir O, Corbacioglu Esmer A, Numanoglu C, Cilesiz Goksedef BP, Akca A, Bakir LV, et al. Influence of body mass index on clinicopathologic features, surgical morbidity and outcome in patients with endometrial cancer. Arch Gynecol Obstet. 2012;286(5):1269–76.

    Article  PubMed  Google Scholar 

  14. Gates EJ, Hirschfield L, Matthews RP, Yap OW. Body mass index as a prognostic factor in endometrioid adenocarcinoma of the endometrium. J Natl Med Assoc. 2006;98(11):1814–22.

    PubMed Central  PubMed  Google Scholar 

  15. Mauland KK, Trovik J, Wik E, Raeder MB, Njolstad TS, Stefansson IM, et al. High BMI is significantly associated with positive progesterone receptor status and clinico-pathological markers for non-aggressive disease in endometrial cancer. Br J Cancer. 2011;104(6):921–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Munstedt K, Wagner M, Kullmer U, Hackethal A, Franke FE. Influence of body mass index on prognosis in gynecological malignancies. Cancer Causes Control: CCC. 2008;19(9):909–16.

    Article  PubMed  Google Scholar 

  17. Benedetto C, Salvagno F, Canuto EM, Gennarelli G. Obesity and female malignancies. Best Pract Res Clin Obstet Gynaecol. 2015;29(4):528–40.

    Article  PubMed  Google Scholar 

  18. Khandekar MJ, Cohen P, Spiegelman BM. Molecular mechanisms of cancer development in obesity. Nat Rev Cancer. 2011;11(12):886–95.

    Article  CAS  PubMed  Google Scholar 

  19. Gilbert CA, Slingerland JM. Cytokines, obesity, and cancer: new insights on mechanisms linking obesity to cancer risk and progression. Annu Rev Med. 2013;64:45–57.

    Article  CAS  PubMed  Google Scholar 

  20. American Cancer Society. Cancer facts and figures 2015. Atlanta: ACS; 2015.

    Google Scholar 

  21. Kaaks R, Lukanova A, Kurzer MS. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomark Prev: Publ Am Assoc Cancer Res Cosponsored Ame Soc Prev Oncol. 2002;11(12):1531–43.

    CAS  Google Scholar 

  22. Setiawan VW, Yang HP, Pike MC, McCann SE, Yu H, Xiang YB, et al. Type I and II endometrial cancers: have they different risk factors? J Clin Oncol: Off J Am Soc Clin Oncol. 2013;31(20):2607–18.

    Article  Google Scholar 

  23. Arem H, Chlebowski R, Stefanick ML, Anderson G, Wactawski-Wende J, Sims S, et al. Body mass index, physical activity, and survival after endometrial cancer diagnosis: results from the Women’s Health Initiative. Gynecol Oncol. 2013;128(2):181–6.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Arem H, Park Y, Pelser C, Ballard-Barbash R, Irwin ML, Hollenbeck A, et al. Prediagnosis body mass index, physical activity, and mortality in endometrial cancer patients. J Natl Cancer Inst. 2013;105(5):342–9. This is one of the most recent large analyses on the topic of mortality and endometrial cancer. Not only did they investigate both all-cause survival and cancer-specific survival, but they also investigated cardiovascular survival.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ. 2007;335(7630):1134.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Bjorge T, Stocks T, Lukanova A, Tretli S, Selmer R, Manjer J, et al. Metabolic syndrome and endometrial carcinoma. Am J Epidemiol. 2010;171(8):892–902.

    Article  PubMed  Google Scholar 

  27. von Gruenigen VE, Tian C, Frasure H, Waggoner S, Keys H, Barakat RR. Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma: a Gynecologic Oncology Group study. Cancer. 2006;107(12):2786–91.

    Article  Google Scholar 

  28. Modesitt SC, Tian C, Kryscio R, Thigpen JT, Randall ME, Gallion HH, et al. Impact of body mass index on treatment outcomes in endometrial cancer patients receiving doxorubicin and cisplatin: a Gynecologic Oncology Group study. Gynecol Oncol. 2007;105(1):59–65.

    Article  CAS  PubMed  Google Scholar 

  29. Jeong NH, Lee JM, Lee JK, Kim JW, Cho CH, Kim SM, et al. Role of body mass index as a risk and prognostic factor of endometrioid uterine cancer in Korean women. Gynecol Oncol. 2010;118(1):24–8.

    Article  PubMed  Google Scholar 

  30. Kodama J, Seki N, Ojima Y, Nakamura K, Hongo A, Hiramatsu Y. Correlation of presenting symptoms and patient characteristics with endometrial cancer prognosis in Japanese women. Int J Gynaecol Obstet: Off Organ Int Fed Gynaecol Obstet. 2005;91(2):151–6.

    Article  CAS  Google Scholar 

  31. Martra F, Kunos C, Gibbons H, Zola P, Galletto L, DeBernardo R, et al. Adjuvant treatment and survival in obese women with endometrial cancer: an international collaborative study. Am J Obstet Gynecol. 2008;198(1):89. e81-88.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Rabischong B, Larrain D, Canis M, Le Bouedec G, Pomel C, Jardon K, et al. Long-term follow-up after laparoscopic management of endometrial cancer in the obese: a fifteen-year cohort study. J Minim Invasive Gynecol. 2011;18(5):589–96.

    Article  PubMed  Google Scholar 

  33. Temkin SM, Pezzullo JC, Hellmann M, Lee YC, Abulafia O. Is body mass index an independent risk factor of survival among patients with endometrial cancer? Am J Clin Oncol. 2007;30(1):8–14.

    Article  PubMed  Google Scholar 

  34. Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies. Lancet. 2015.

  35. Olsen CM, Nagle CM, Whiteman DC, Ness R, Pearce CL, Pike MC, et al. Obesity and risk of ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consortium. Endocr Relat Cancer. 2013;20(2):251–62.

    Article  PubMed  Google Scholar 

  36. Protani MM, Nagle CM, Webb PM. Obesity and ovarian cancer survival: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2012;5(7):901–10.

    Article  Google Scholar 

  37. Yang HS, Yoon C, Myung SK, Park SM. Effect of obesity on survival of women with epithelial ovarian cancer: a systematic review and meta-analysis of observational studies. Int JGynecol Cancer : Off J Int Gynecol Cancer Soc. 2011;21(9):1525–32.

    Article  Google Scholar 

  38. Bae HS, Kim HJ, Hong JH, Lee JK, Lee NW, Song JY. Obesity and epithelial ovarian cancer survival: a systematic review and meta-analysis. J Ovarian Research. 2014;7:41.

    Article  Google Scholar 

  39. Previs RA, Kilgore J, Craven R, Broadwater G, Bean S, Wobker S, et al. Obesity is associated with worse overall survival in women with low-grade papillary serous epithelial ovarian cancer. Int J Gynecol Cancer : Off J Intern Gynecol Cancer Soc. 2014;24(4):670–5.

    Article  Google Scholar 

  40. Lee JK, So KA, Piyathilake CJ, Kim MK. Mild obesity, physical activity, calorie intake, and the risks of cervical intraepithelial neoplasia and cervical cancer. PLoS One. 2013;8(6):e66555.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Aldrich T, Hackley B. The impact of obesity on gynecologic cancer screening: an integrative literature review. J Midwifery Womens Health. 2010;55(4):344–56.

    Article  PubMed  Google Scholar 

  42. Wee CC, McCarthy EP, Davis RB, Phillips RS. Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med. 2000;132(9):697–704.

    Article  CAS  PubMed  Google Scholar 

  43. Maruthur NM, Bolen SD, Brancati FL, Clark JM. The association of obesity and cervical cancer screening: a systematic review and meta-analysis. Obesity (Silver Spring). 2009;17(2):375–81.

    Article  Google Scholar 

  44. Lacey Jr JV, Swanson CA, Brinton LA, Altekruse SF, Barnes WA, Gravitt PE, et al. Obesity as a potential risk factor for adenocarcinomas and squamous cell carcinomas of the uterine cervix. Cancer. 2003;98(4):814–21.

    Article  PubMed  Google Scholar 

  45. Frumovitz M, Jhingran A, Soliman PT, Klopp AH, Schmeler KM, Eifel PJ. Morbid obesity as an independent risk factor for disease-specific mortality in women with cervical cancer. Obstet Gynecol. 2014;124(6):1098–104. This recent article serves as one of the very few studies investigating the association specifically between obesity and cervical cancer mortality. Additionally, this study had the benefit of evaluating a large cohort of patients with a large number of death events. They also accounted for socioeconomic status and medical comorbidities in their analysis (in addition to usual demographics and tumor characteristics).

    Article  CAS  PubMed  Google Scholar 

  46. Robbins JR, Gayar OH, Zaki M, Mahan M, Buekers T, Elshaikh MA. Impact of age-adjusted Charlson comorbidity score on outcomes for patients with early-stage endometrial cancer. Gynecol Oncol. 2013;131(3):593–7.

    Article  PubMed  Google Scholar 

  47. Ward KK, Shah NR, Saenz CC, McHale MT, Alvarez EA, Plaxe SC. Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol. 2012;126(2):176–9.

    Article  PubMed  Google Scholar 

  48. Folsom AR, Anderson KE, Sweeney C, Jacobs Jr DR. Diabetes as a risk factor for death following endometrial cancer. Gynecol Oncol. 2004;94(3):740–5.

    Article  PubMed  Google Scholar 

  49. Horowitz NS, Wright AA. Impact of obesity on chemotherapy management and outcomes in women with gynecologic malignancies. Gynecol Oncol. 2015. This is a recent article that discusses the effect of obesity on chemotherapy dosing as well as guidelines for chemotherapy management for obese women

  50. Nimptsch K, Pischon T. Body fatness, related biomarkers and cancer risk: an epidemiological perspective. Horm Mol Biol Clin Investig. 2015;22(2):39–51.

    CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lauren Patterson Cobb.

Additional information

This article is part of the Topical Collection on Gynecologic Oncology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cobb, L.P., Secord, A.A. Association Between Obesity and Clinical Outcomes in Gynecologic Cancer. Curr Obstet Gynecol Rep 4, 240–248 (2015). https://doi.org/10.1007/s13669-015-0131-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-015-0131-1

Keywords

Navigation