title: Global burden of cancer attributable to high body-mass index in 2012: a population-based study.
abstract: BACKGROUND
  High body-mass index (BMI; defined as 25 kg/m(2) 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  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.
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
authors.forename: Melina
authors.initials: M
authors.lastname: Arnold
authors.affiliation: School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Pandeya
authors.affiliation: Biostatistics Group, International Agency for Research on Cancer, Lyon, France.
authors.forename: Graham
authors.initials: G
authors.lastname: Byrnes
authors.affiliation: Faculty Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors.forename: Prof Andrew G
authors.initials: PAG
authors.lastname: Renehan
authors.affiliation: Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Stevens
authors.affiliation: MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom.|Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Prof Majid
authors.initials: PM
authors.lastname: Ezzati
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Ferlay
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.affiliation: Nutrition and Metabolism Section/Epidemiology Group, International Agency for Research on Cancer, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.affiliation: Department of Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Dikshit
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
authors.forename: David
authors.initials: D
authors.lastname: Forman
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Soerjomataram
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003906:Developing Countries; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D015430:Weight Gain