title: Body mass index and risk of second obesity-associated cancers after colorectal cancer: a pooled analysis of prospective cohort studies.
abstract: OBJECTIVE
  To determine whether prediagnostic body mass index (BMI) is associated with risk of second obesity-associated cancers in colorectal cancer (CRC) survivors, and whether CRC survivors have increased susceptibility to obesity-associated cancer compared with cancer-free individuals.
  
  
  METHODS
  Incident first primary CRC cases (N = 11,598) were identified from five prospective cohort studies. We used Cox proportional hazards regression models to examine associations between baseline (prediagnostic) BMI and risk of second obesity-associated cancers (postmenopausal breast, kidney, pancreas, esophageal adenocarcinoma, endometrium) in CRC survivors, and compared associations to those for first obesity-associated cancers in the full cohort.
  
  
  RESULTS
  Compared with survivors with normal prediagnostic BMI (18.5-24.9 kg/m(2)), those who were overweight (25-29.9 kg/m(2)) or obese (30+ kg/m(2)) had greater risk of a second obesity-associated cancer (n = 224; overweight hazard ratio [HR], 1.39; 95% CI, 1.01 to 1.92; obese HR, 1.47; 95% CI, 1.02 to 2.12; per 5-unit change in BMI HR, 1.12; 95% CI, 0.98 to 1.29). The magnitude of risk for developing a first primary obesity-associated cancer was similar (overweight HR, 1.18; 95% CI, 1.14 to 1.21; obese HR, 1.61; 95% CI, 1.56 to 1.66; per 5-unit change in BMI HR, 1.23; 95% CI, 1.21 to 1.24). Before diagnosis CRC patients were somewhat more likely than the overall cohort to be overweight (44% v 41%) or obese (25% v 21%).
  
  
  CONCLUSIONS
  CRC survivors who were overweight or obese before diagnosis had increased risk of second obesity-associated cancers compared with survivors with normal weight. The risks were similar in magnitude to those observed for first cancers in this population, suggesting increased prevalence of overweight or obesity, rather than increased susceptibility, may contribute to elevated second cancer risks in colorectal cancer survivors compared with the general population. These results support emphasis of existing weight guidelines for this high-risk group.
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC. todd.gibson@stjude.org.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Gibson
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Yikyung
authors.initials: Y
authors.lastname: Park
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Kim
authors.initials: K
authors.lastname: Robien
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Meredith S
authors.initials: MS
authors.lastname: Shiels
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Amanda
authors.initials: A
authors.lastname: Black
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Sampson
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Purdue
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Laura E Beane
authors.initials: LE
authors.lastname: Freeman
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Andreotti
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Weinstein
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Demetrius
authors.initials: D
authors.lastname: Albanes
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fraumeni
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Curtis
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Amy
authors.initials: A
authors.lastname: Berrington de Gonzalez
authors.affiliation: Todd M. Gibson, Yikyung Park, Meredith S. Shiels, Amanda Black, Joshua N. Sampson, Mark P. Purdue, Laura E. Beane Freeman, Gabriella Andreotti, Stephanie J. Weinstein, Demetrius Albanes, Joseph F. Fraumeni Jr, Rochelle E. Curtis, Amy Berrington de Gonzalez, Lindsay M. Morton, National Cancer Institute, Bethesda, MD; and Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Morton
mesh_terms: D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000150:complications* / Q000453:epidemiology; D009765:Obesity / Q000150:complications*; D050177:Overweight; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome