Morbid obesity increases risk for cervical cancer death

1. Morbidly obese (BMI≥35.0) women were significantly more likely to die from cervical cancer.

2. Underweight, overweight, and obesity were not independently linked to cervical cancer death.

Evidence Rating Level: 2 (Good)           

Study Rundown: Cervical cancer, caused by the Human Papilloma Virus (HPV), was formerly the leading cause of cancer death in U.S. women. With the development and popularization of Pap smears, cervical cancer deaths decreased dramatically in the 1970s-1990s but have plateaued, albeit at a much lower baseline, in recent years. Given that cervical cancer is almost entirely preventable with appropriate screening, it’s concerning that more than 4,000 women still die from the disease every year. A report released by the CDC this week found that about eight million women haven’t had a pap smear in the past five years, and more than half of new cervical cancer cases are diagnosed in women who have rarely or never been screened. Certain groups of women are at higher risk, including African Americans, women residing in Southern U.S. states and the uninsured. Obesity has also been linked to an increased risk of developing and dying from cancer, including colo-rectal, postmenopausal breast, and endometrial cancers. The mechanism behind this is presumed to be multifactorial, related to both biological consequences of obesity and differences in screening, diagnosis, and treatment. In this study, researchers controlled for a number of known cancer risk factors, to test whether obesity is an independent predictor of mortality in women with cervical cancer.

In a multivariate-adjusted model, obesity (BMI≥35.0) was identified as an independent risk factor for cervical cancer death. Other weight classes, including underweight, overweight and obese, were not associated with cervical cancer death. Strengths include a large cohort with a sizeable number of deaths and assessment of numerous confounders which allowed for generation of multivariate-adjusted effect estimates. Researchers did not account for treatment regimens—for example surgery versus radiation therapy first—and this variable did vary significantly by weight class such that results may be biased away from the null. Prospective investigation that accounts for variation in treatment regimen and cancer stage at diagnosis would better characterize the association between obesity and cervical cancer death.

Click to read the study in Obstetrics & Gynecology

Relevant Reading: Factors underlying disparities in cervical cancer incidence, screening, and treatment in the United States

Study Author, Dr. Michael Frumovitz, MD, MPH, talks to 2 Minute Medicine: University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology

“This is yet another study that shows obesity not only increases the risk of developing cancer, but portends a higher risk of dying from cancer once diagnosed. As the obesity epidemic in the United States continues to spiral each year, we will likely see increased cancer related mortality in people with high BMIs.”

In-Depth [retrospective cohort]: Women with stages IB1-IVA cervical cancer treated at a major, academic cancer center in the U.S. from 1980-2007 (n=3,086) were categorized as underweight (BMI<18.5, n=155), normal weight (BMI18.5-24.9, n=1,096), overweight (BMI 25.0-29.9, n=809), obese (BMI 30.0-34.9, n=557) and morbidly obese (BMI≥35.0, n=469). The primary outcomes were all-cause death and cervical cancer death. Prognostic indicators for survival were assessed and included age, smoking status, race, socioeconomic status, comorbidities, and various factors related to tumor grade, stage and treatment.

Morbidly obese women were more likely to die from cervical cancer (HR=1.24, 95% CI=1.06-1.47) and any cause (HR=1.26, 95% CI=1.10-1.45) compared to normal weight women. Underweight, overweight, and obese classifications were not independently associated with an increased likelihood of death compared to normal weight. Median survival was 81 months (0-365 months).

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Image: PD

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