A new study looking at the share of cancers related to obesity finds an at least 1.5-fold difference between states with the highest and lowest proportions. The proportion of cancer cases that could be attributable to excess body weight ranged from a high of 8.3% in the District of Columbia to a low of 5.9% in Hawaii, reflecting variations in obesity rates in the states.

The study (“Proportion of Cancer Cases Attributable to Excess Body Weight by US State”) appears in JAMA Oncology.

“Excess body weight (EBW) is an established cause of cancer. Despite variations in the prevalence of EBW among U.S. states, there is little information on the EBW-related cancer burden by state; this information would be useful for setting priorities for cancer-control initiatives.

“The objective of this study was to calculate the population attributable fraction (PAF) of incident cancer cases attributable to EBW among adults 30 years or older in 2011 to 2015 in all 50 states and the District of Columbia. State-level, self-reported body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) data from the Behavioral Risk Factor Surveillance System were adjusted by sex, age, race/ethnicity, and education using objectively measured BMI values from the National Health and Nutrition Examination Survey. Age- and sex-specific cancer incidence data by state were obtained from the U.S. Cancer Statistics database. All analyses were performed between February 15, 2018, and July 17, 2018,” wrote the investigators.

“Sex-, age-, and state-specific adjusted prevalence estimates for four high BMI categories and corresponding relative risks from large-scale pooled analyses or meta-analyses were used to compute the PAFs for each U.S. state for esophageal adenocarcinoma, multiple myeloma, and cancers of the gastric cardia, colorectum, liver, gallbladder, pancreas, female breast, corpus uteri, ovary, kidney and renal pelvis, and thyroid.

“Each year, an estimated 37,670 cancer cases in men (4.7% of all cancer cases excluding nonmelanoma skin cancers) and 74,690 cancer cases in women (9.6%) 30 years or older in the U.S. were attributable to EBW from 2011 to 2015. In both men and women, there was at least a 1.5-fold difference in the proportions of cancers attributable to EBW between states with the highest and lowest PAFs. Among men, the PAF ranged from 3.9% (95% CI, 3.6%-4.3%) in Montana to 6.0% (95% CI, 5.6%-6.4%) in Texas. The PAF for women was approximately twice as high as for men, ranging from 7.1% (95% CI, 6.7%-7.6%) in Hawaii to 11.4% (95% CI, 10.7%-12.2%) in the District of Columbia. The largest PAFs were found mostly in southern and midwestern states, as well as Alaska and the District of Columbia.”

Excess body weight is an established cause of cancer, currently known to be linked to 13 cancers. While differences in excess body weight among states in the U.S. are well-known, there is little information on the burden of obesity-related cancers by state, information that would be useful for setting priorities for cancer control initiatives.

To learn more, American Cancer Society investigators led by Farhad Islami, M.D., Ph.D., scientific director, surveillance research, calculated the PAF of incident cancer cases attributable to excess body weight among adults aged 30 years or older in 2011–2015 in all 50 states and the District of Columbia.

The proportion was far greater for some individual cancer types. For endometrial cancer, for example, the PAF ranged from 36.5% in Hawaii to 54.9% in Mississippi and was 50.0% or more in 19 states.

“The proportion of cancers attributable to EBW varies among states, but EBW accounts for at least 1 in 17 of all incident cancers in each state,” concluded the authors. “Broad implementation of known community- and individual-level interventions is needed to reduce access to and marketing of unhealthy foods (e.g., through a tax on sugary drinks) and to promote and increase access to healthy foods and physical activity, as well as preventive care.”

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