The Impact of Obesity on the Incidence and Treatment of... : Obstetrical & Gynecological Survey (original) (raw)
CME Program: CATEGORY 1 CME REVIEW ARTICLES 27, 28, AND 29: CME Review Article 29
The Impact of Obesity on the Incidence and Treatment of Gynecologic Cancers: A Review
* Assistant Professor, Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center, Lucille Markey Cancer Center, Lexington, Kentucky; and †Assistant Professor and Director, Gynecologic Oncology Division and American Cancer Society Professor of Clinical Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center, Lucille Markey Cancer Center, Lexington, Kentucky
Chief Editor’s Note: This article is the 29th of 36 that will be published in 2005 for which a total of up to 36 Catgory 1 CME credits can be earned. Instructions for how credits can be earned appear on the last page of the Table of Contents.
The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.
Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity.
Reprint requests to: Susan C. Modesitt, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0298. E-mail: [email protected].
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Abstract
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.
Target Audience:
Obstetricians & Gynecologists, Family Physicians.
Learning Objectives:
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.
© 2005 Lippincott Williams & Wilkins, Inc.