The impact of obesity on the incidence and treatment of gynecologic cancers: a review.
Sixty-five percent of the adult population in the United States is overweight and 30% of the population is obese. There is mounting evidence that obesity is a risk factor for gynecologic cancers and may also adversely impact survival. The objectives of this review were to systematically evaluate and discuss the impact of overweight and obesity on endometrial, ovarian, and cervical cancer incidence and to review the data on the impact of obesity on treatment of these same gynecologic cancers. A PUBMED literature search was performed to identify articles in the English language that focused on the impact of obesity on cancer incidence and treatment. References of identified articles were also used to find additional related articles. Obesity profoundly increases the incidence of endometrial cancer, predominantly through the effects of unopposed estrogen. Although the data are less compelling in ovarian and cervical cancer, obesity may modestly increase the incidence of premenopausal ovarian cancer and might potentially increase cervical cancer incidence, perhaps as a result of the impact on glandular cancers or decreased screening compliance. Obese women with cancer have decreased survival; this may be disease-specific, the result of comorbid illnesses, or response to treatment. Obese women have increased surgical complications, may also have increased radiation complications, and there is no current consensus regarding appropriate chemotherapy dosing in the obese patient. Obesity is a serious health problem with significant effects on the incidence and treatment of the gynecologic malignancies.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader should be able to summarize the clear evidence that obesity is a risk factor for many cancers, including gynecologic malignancies; describe the role of unopposed estrogen in gynecologic cancers; and explain that obese women overall have a poorer survival rate when afflicted with cancer.
Modesitt
Susan C
SC
Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center, Lucille Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0298, USA. smode2@uky.edu
van Nagell
John R
JR
D000230:Adenocarcinoma / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology; D015897:Comorbidity; D016889:Endometrial Neoplasms / Q000453:epidemiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D009765:Obesity / Q000453:epidemiology*; D010051:Ovarian Neoplasms / Q000453:epidemiology; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology