Obesity and Esophageal Cancer

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Anatomical model of the esophagus and the first part of the stomach. ericsphotography/Getty Images

Obesity has now been found to be a risk factor for a number of different cancers, including breast cancer, esophageal cancer, and colon cancer, among others.

What Is Esophageal Cancer?

Esophageal cancer, or carcinoma, refers to cancer of the esophagus which is the organ that connects the mouth to the stomach. There are two main subtypes of esophageal cancer: squamous-cell carcinoma and adenocarcinoma.

While squamous-cell carcinoma of the esophagus is the most common form of esophageal cancer worldwide (accounting for approximately 90% of cases), the incidence of esophageal adenocarcinoma has been on the rise and has even exceeded that of squamous-cell in several areas of Europe and North America.

Risk Factors for Esophageal Cancer

Several risk factors have been identified for esophageal cancer, and obesity is one of them. Cancer of the esophagus is rare in younger people and the risk increases with age, peaking in the 60s and 70s.

The main risk factors for developing esophageal cancer are gastroesophageal reflux disease (GERD), cigarette smoking, and obesity. Alcohol use is also a risk factor. Men are three to four times more likely to develop esophageal adenocarcinoma than women are.

Obesity as a Risk Factor

Obesity has been associated with a risk of esophageal adenocarcinoma that is 2.4 to 2.8 times greater than in those who are not obese.

Abdominal obesity, or too much weight around the waistline, in particular, has been associated with a greater risk of cancer.

Experts have postulated that abdominal obesity may be a greater risk factor because of the extra pressure it puts on the waistline and the organs beneath, leading to higher pressure on the stomach and hiatal hernia, and these circumstances in turn can cause GERD.

Abdominal obesity, or “belly fat,” is also more common in men, who, as noted above, are at a higher risk of developing esophageal adenocarcinoma.

Obesity is also associated with greater systemic inflammation on a chronic basis, and this has been associated with an increased risk of cancer.

Weight Loss May Decrease Cancer Risk

There is limited data on whether or not weight loss can directly decrease cancer risk in adults who are obese. However, in patients who have had bariatric surgery to lose weight and treat obesity, studies have shown that these patients appear to have lower rates of obesity-related cancers than do similarly obese patients who did not undergo bariatric surgery.

However, while the evidence directly linking weight loss to decreased cancer risk is scarce—in part because of the difficulty of a clinical trial design that would be adequate to answer this question—it is important to note that many of the healthy behaviors that prevent obesity are also behaviors that reduce cancer risk.

These include regular exercise, eating seven servings of whole vegetables and fruits every day, getting enough sleep on a regular basis, and avoiding trans fats, among others.

Sources

Ballard-Barbash R, Berrigan D, Potischmann N, Dowling E. Obesity and cancer epidemiology. In: Berger NA, editor. Cancer and Energy Balance, Epidemiology and Overview. New York: Springer-Vertag New York, LLC, 2010.

Rustgi AK and El-Serag HB. Esophageal carcinoma. N Engl J Med 2014;371:2499-509.

Hur C, Miller M, Kong CY, et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer 2013;119:1149-59.

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