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Garcia L, Pearce M, Abbas A, Mok A, Strain T, Ali S, Crippa A, Dempsey PC, Golubic R, Kelly P, Laird Y, McNamara E, Moore S, de Sa TH, Smith AD, Wijndaele K, Woodcock J, Brage S. Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose-response meta-analysis of large prospective studies. Br J Sports Med 2023; 57:979-989. [PMID: 36854652 PMCID: PMC10423495 DOI: 10.1136/bjsports-2022-105669] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To estimate the dose-response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. DESIGN Systematic review and cohort-level dose-response meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science and reference lists of published studies. ELIGIBILITY CRITERIA Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney). RESULTS 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted. CONCLUSIONS Inverse non-linear dose-response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. PROSPERO registration number CRD42018095481.
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Affiliation(s)
- Leandro Garcia
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ali Abbas
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alexander Mok
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Sara Ali
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paddy C Dempsey
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rajna Golubic
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh Institute for Sport, Physical Education and Health Sciences, Edinburgh, UK
| | - Yvonne Laird
- Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Eoin McNamara
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Economic and Social Research Institute, Dublin, Ireland
| | - Samuel Moore
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Thiago Herick de Sa
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Andrea D Smith
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Kitson SJ, Aurangzeb O, Parvaiz J, Lophatananon A, Muir KR, Crosbie EJ. Quantifying the Effect of Physical Activity on Endometrial Cancer Risk. Cancer Prev Res (Phila) 2022; 15:605-621. [PMID: 35696722 PMCID: PMC7613481 DOI: 10.1158/1940-6207.capr-22-0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/03/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
Endometrial cancer incidence is rising, with 435,000 global cases in 2019. An effective, low-cost primary prevention strategy is required to reduce disease burden. Obesity, insulin resistance, and inflammation contribute to endometrial carcinogenesis and physical activity targets these pathways. This study sought to quantify the amount of physical activity required to impact upon endometrial cancer risk. Physical activity data from 222,031 female participants with an intact uterus in the UK Biobank study were analyzed using a multivariable Cox proportional hazards model. A systematic review of the literature was performed, searching CENTRAL, Embase, and MEDLINE databases up to April 19, 2021. Studies including participants with and without endometrial cancer investigating the effect of physical activity measured in MET-hours/week (MET-h/week) on disease risk were included. Two reviewers independently selected studies, extracted data, and evaluated the risk of bias. Within the UK Biobank, each 1 MET-h/week increase in total physical activity was associated with a 0.2% [95% confidence interval (CI), 0.1-0.4; P = 0.020] reduction in endometrial cancer risk, equating to a 10.4% reduction if performing 50 MET-h/week or 7 hours of jogging per week. Eleven cohort and 12 case-control studies were identified in the systematic review, including 821,599 participants. One study reported a nonsignificant effect of 1 MET-h/week increases in physical activity on endometrial cancer risk (OR, 1.00; 95% CI, 0.99-1.00). Eight studies found significant reductions in disease risk of 15%-53%, but only in the most physically active individuals. Physical activity reduces endometrial cancer risk, but the effect size appears small. Regular vigorous activity should be encouraged to maximize the health benefit observed. PREVENTION RELEVANCE Effective, low-cost primary prevention strategies are urgently needed to tackle the rapid global increase in endometrial cancer. We sought to quantify the effect of physical activity on endometrial cancer risk, noting a linear inverse relationship influenced by body mass index. The most beneficial type and amount of activity remain unclear.
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Affiliation(s)
- Sarah J Kitson
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Olivia Aurangzeb
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Jawaria Parvaiz
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kenneth R Muir
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Emma J Crosbie
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom.,Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Nguyen P, Ananthapavan J, Tan EJ, Crosland P, Bowe SJ, Gao L, Dunstan DW, Moodie M. Modelling the potential health and economic benefits of reducing population sitting time in Australia. Int J Behav Nutr Phys Act 2022; 19:28. [PMID: 35305678 PMCID: PMC8934131 DOI: 10.1186/s12966-022-01276-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/28/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives. METHODS A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014-2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings. RESULTS According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year. CONCLUSIONS Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives.
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Affiliation(s)
- Phuong Nguyen
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia.
- Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia.
| | - Jaithri Ananthapavan
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
- Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
| | - Eng Joo Tan
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
| | - Paul Crosland
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
| | - Steve J Bowe
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Lan Gao
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Marj Moodie
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
- Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
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Li S, Chen H, Zhang T, Li R, Yin X, Man J, He Q, Yang X, Lu M. Spatiotemporal trends in burden of uterine cancer and its attribution to body mass index in 204 countries and territories from 1990 to 2019. Cancer Med 2022; 11:2467-2481. [PMID: 35156336 PMCID: PMC9189473 DOI: 10.1002/cam4.4608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Uterine cancer is one of the most common female cancers worldwide, with huge heterogeneity in morbidity and mortality. Although a high body-mass index (BMI) has been linked to uterine cancer, systematic reports about the influence of high BMI and its temporal trends are scarce. METHODS The annual morbidity, mortality, and disability-adjusted life years (DALYs) of uterine cancer in 204 countries or territories were retrieved from the GBD 2019 study. To reflect trends in disease burden, we also calculated the estimated annual percentage change (EAPC) based on the age-standardized rates of uterine cancer from 1990 to 2019. RESULTS The global incident cases of uterine cancer increased 2.3 times from 187,190 in 1990 to 435,040 in 2019. Although the age-standardized incidence rate (ASIR) of uterine cancer increased worldwide from 8.67/100,000 in 1990 to 9.99/100,000 in 2019, the age-standardized death rate (ASDR) and DALY rate decreased during the same period. High socio-demographic index (SDI) countries tended to have a higher ASIR than developing regions, and their increasing trend in ASIR was also more pronounced. The disease was rare before 40 years old, but its risk rose sharply among women aged 50-70. A high BMI was linked to more than one-third of deaths from uterine cancer in 2019. CONCLUSIONS The incidence in developed areas was significantly higher than in developing areas and also increased much more rapidly. Elderly females, especially those with a high BMI, have a higher risk of uterine cancer. Therefore, more health resources may be needed to curb the rising burden in specific populations.
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Affiliation(s)
- Songbo Li
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tongchao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Rongrong Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaolin Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jinyu Man
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qiufeng He
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ming Lu
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Metabolic Activity of Visceral Adipose Tissue Is Associated with Metastatic Status of Lymph Nodes in Endometrial Cancer: A 18F-FDG PET/CT Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010092. [PMID: 35010352 PMCID: PMC8751038 DOI: 10.3390/ijerph19010092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
Obesity contributes to increased cancer incidence and aggressiveness in patients with endometrial cancer. Inflamed metabolic activity of visceral adipose tissue (VAT) is regarded as a key underlying mechanism of adverse consequences of obesity. The aim of this study was to investigate the association between inflammatory metabolic activity of VAT evaluated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and metastatic status of lymph nodes (LN) in patients with endometrial cancer. In total, 161 women with newly diagnosed endometrial cancer, who received preoperative 18F-FDG PET/CT, were enrolled. VAT inflammatory metabolic activity was defined as V/S ratio and measured from the maximum standardized uptake value (SUVmax) of VAT normalized to the SUVmax of subcutaneous adipose tissue (SAT). The positive LN metastasis group exhibited a significantly higher V/S ratio than the negative LN metastasis group. Systemic inflammatory surrogate markers including high sensitivity C-reactive protein, spleen SUVmax, and bone marrow SUVmax were also higher in the LN metastasis group than in the negative LN metastasis group, showing significant correlations with V/S ratio. In multivariate logistic regression analysis, V/S ratio was independently associated with LN metastasis. V/S ratio is independently associated with the LN metastasis status in patients with endometrial cancer. This finding could be useful as a potential surrogate marker of obesity-induced VAT inflammation associated with tumor aggressiveness.
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Saint-Maurice PF, Sampson JN, Michels KA, Moore SC, Loftfield E, McClain K, Cook MB, Trabert B, Matthews CE. Physical Activity From Adolescence Through Midlife and Associations With Body Mass Index and Endometrial Cancer Risk. JNCI Cancer Spectr 2021; 5:pkab065. [PMID: 34476340 PMCID: PMC8406434 DOI: 10.1093/jncics/pkab065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 01/31/2023] Open
Abstract
Background Physical activity is associated with lower risk for endometrial cancer, but the extent to which the association is mediated by body mass index (BMI) in midlife is unclear. This study describes the physical activity-endometrial cancer association and whether BMI mediates this relationship. Methods Participants were 67 705 women in the National Institutes of Health-AARP Diet and Health Study (50-71 years) who recalled their physical activity patterns starting at age 15-18 years. We identified 5 long-term physical activity patterns between adolescence and cohort entry (ie, inactive, maintained low, maintained high, increasers, decreasers). We used Cox regression to assess the relationship between these patterns and midlife BMI and endometrial cancer, adjusting for covariates. Mediation analysis was used to estimate the proportion of the physical activity-endometrial cancer association that was mediated by midlife BMI. Results During an average 12.4 years of follow-up 1468 endometrial cancers occurred. Compared with long-term inactive women, women who maintained high or increased activity levels had a 19% to 26% lower risk for endometrial cancer (maintained high activity: hazard ratio = 0.81, 95% confidence interval [CI] = 0.67 to 0.98; increasers: hazard ratio = 0.74, 95% CI = 0.61 to 0.91). They also had a 50% to 77% lower risk for obesity in midlife (eg, maintained high activity: odds ratio for a BMI of 30-39.9 kg/m2 = 0.50, 95% CI = 0.46 to 0.55; and maintained high activity, odds ratio for a BMI of ≥40 kg/m2 = 0.32, 95% CI = 0.26 to 0.39). BMI was a statistically significant mediator accounting for 55.5% to 62.7% of the physical activity-endometrial cancer associations observed. Conclusions Both maintaining physical activity throughout adulthood and adopting activity later in adulthood can play a role in preventing obesity and lowering the risk for endometrial cancer.
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Affiliation(s)
- Pedro F Saint-Maurice
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Kara A Michels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Erikka Loftfield
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Kathleen McClain
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Michael B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Zeng J, Peng L. Comparison of the effect of resistance training on the body compositions of different women groups: a systematic review and meta-analysis of randomized controlled trials. J Sports Med Phys Fitness 2020; 60:1118-1127. [PMID: 32955838 DOI: 10.23736/s0022-4707.20.10533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION This study attempts to investigate whether simple resistance training (RT) exerts different effects on the body composition of different women groups. EVIDENCE ACQUISITION Relevant articles from PubMed and Web of Science databases were searched and simultaneously screened by two authors. Twenty-three randomized controlled trials are included. The qualities were evaluated by the Cochrane bias risk evaluation tool. Data about sample size, Means and SD of FM, BF %, FFM and MM from original articles were extracted and processed by Reviewer Manager 5.3 software. EVIDENCE SYNTHESIS For women with postmenopausal, RT can significantly reduce their BF% and FM, and increase their FFM; while for women with premenopausal, it can only obviously reduce their BF%. RT can significantly reduce the FM and BF% of women with overweight/obese and increase their FFM, however, it has no significant effect on women with non-overweight/obese. RT can substantially and positively affect the FM, BF% and FFM of women with sedentary, and can significantly increase the FFM of women with non-sedentary. CONCLUSIONS The effect of RT on women's body composition varies across different subgroups with different physiological characteristics. As a consequence, it is more recommended to use RT as a training method for women with postmenopausal, overweight/obese or sedentary, which can achieve a better effect of improving body composition.
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Affiliation(s)
- Jie Zeng
- Physical Education College of Southwest University, Chongqing, China
| | - Li Peng
- Physical Education College of Southwest University, Chongqing, China -
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Hidayat K, Zhou HJ, Shi BM. Influence of physical activity at a young age and lifetime physical activity on the risks of 3 obesity-related cancers: systematic review and meta-analysis of observational studies. Nutr Rev 2020; 78:1-18. [PMID: 31393566 DOI: 10.1093/nutrit/nuz024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Excess weight has been linked to increased risks of 13 types of cancers. Physical activity is a non-nutritional modifiable lifestyle factor that is not only crucial for weight control but is also known to regulate hormones and metabolic pathways that may contribute to carcinogenesis. There is solid evidence that being physically active during middle and late adulthood lowers the risks of 3 obesity-related cancers, namely breast cancer, colon cancer, and endometrial cancer. However, the associations between physical activity at a young age (childhood, adolescence, and young adulthood; age 5 to ≤30 yr) and lifetime physical activity and the risks of breast cancer, colon cancer, and endometrial cancer are less defined. OBJECTIVE The present systematic review and meta-analysis of observational studies was performed in accordance with the MOOSE guidelines to determine whether physical activity at a young age and lifetime physical activity may lower the risks of breast cancer, colon cancer, and endometrial cancer. DATA SOURCES The PubMed and Web of Science databases were searched for relevant observational studies published from inception to July 2018. STUDY SELECTION Observational studies (prospective cohort, case-cohort, nested case-control, historical cohort, and case-control) were considered relevant if they investigated the association between physical activity at a young age or lifetime physical activity and the risks of developing selected cancers. DATA EXTRACTION A random-effects meta-analysis was performed to generate the summary relative risk (RR) with 95%CI for the highest vs the lowest category of physical activity of any type. RESULTS Eighty publications were included in the present meta-analysis. Higher physical activity at a young age was associated with lower risks of breast cancer (RR 0.81, 95%CI 0.76, 0.87) and colon cancer (RR 0.67, 95%CI 0.50, 0.88). Similarly, lifetime physical activity was inversely associated with the risks of breast cancer (RR 0.79, 95%CI 0.72, 0.86) and colon cancer (RR 0.75, 95%CI 0.69, 0.82). For breast cancer, menopausal status did not appear to modify the observed inverse association. The benefit with respect to endometrial cancer risk reduction was only observed with higher lifetime physical activity (RR 0.77, 95%CI 0.67, 0.88), not with higher physical activity at a young age (RR 0.89, 95%CI 0.73, 1.07). CONCLUSIONS Being physically active over a lifetime, starting from early childhood, may lower the risks of developing breast cancer, colon cancer, and endometrial cancer.
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Affiliation(s)
- Khemayanto Hidayat
- K. Hidayat, H.-J. Zhou, and B.-M. Shi are with the Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui-Juan Zhou
- K. Hidayat, H.-J. Zhou, and B.-M. Shi are with the Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bi-Min Shi
- K. Hidayat, H.-J. Zhou, and B.-M. Shi are with the Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
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Patel AV, Hodge JM, Rees-Punia E, Teras LR, Campbell PT, Gapstur SM. Relationship Between Muscle-Strengthening Activity and Cause-Specific Mortality in a Large US Cohort. Prev Chronic Dis 2020; 17:E78. [PMID: 32762807 PMCID: PMC7417019 DOI: 10.5888/pcd17.190408] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Muscle-strengthening activity (MSA) has beneficial effects on hypertension, glucose homeostasis, and other health conditions; however, its association with mortality is not as well understood. METHODS We analyzed data from the Cancer Prevention Study-II Nutrition Cohort (data collection 1982-2014), a prospective US cohort that consisted of 72,462 men and women who were free of major chronic diseases; 18,034 of the cohort died during 13 years of follow-up (2001-2014). We used Cox proportional hazards modeling, controlling for various potential confounding factors, to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for MSA (none, >0 to <1 h/wk, 1 to <2 h/wk, and ≥2 h/wk) in relation to mortality risk, independent of and in combination with aerobic physical activity. RESULTS The association between MSA and mortality appeared to be nonlinear (quadratic trend P value, <.001). After multivariable adjustment and comparison with no MSA, engaging in less than 2 hours per week of MSA was associated with lowered all-cause mortality (>0 to <1 h/wk: HR = 0.88, 95% CI, 0.82-0.94; 1 to <2 h/wk: HR = 0.90, 95% CI, 0.84-0.97), but engaging in 2 or more hours per week was not associated with reduced risk (HR = 1.01; 95% CI, 0.92-1.09). Associations were similar but not significant for cancer mortality. Engaging in >0 to <1 hr/wk of MSA was associated with a 19% lower risk (HR = 0.81; 95% CI, 0.71-0.92) of cardiovascular disease mortality, but more time spent in MSA was not associated with reduced risk (quadratic trend P value =.005). Associations did not vary by amount of moderate-to-vigorous aerobic physical activity. CONCLUSION Engaging in ≥2 hours per week of MSA was associated with lower all-cause mortality, independent of aerobic activity. Reasons for the lack of association with higher amounts of MSA are unclear. Our findings support recommending muscle-strengthening activities for overall health.
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Affiliation(s)
- Alpa V Patel
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St NW, Atlanta, GA 30303.
| | - James M Hodge
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Erika Rees-Punia
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Lauren R Teras
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Peter T Campbell
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
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10
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Hunter RF, Murray JM, Coleman HG. The association between recreational screen time and cancer risk: findings from the UK Biobank, a large prospective cohort study. Int J Behav Nutr Phys Act 2020; 17:97. [PMID: 32746843 PMCID: PMC7398067 DOI: 10.1186/s12966-020-00997-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Evidence is suggestive of sedentary behaviour being associated with an increased risk of endometrial cancer, but the evidence base is too limited to draw any conclusions for other cancers. The aim of the study was to investigate the association between recreational screen time and site-specific cancer risk. Methods We analysed data from the prospective UK Biobank cohort study. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between daily recreational screen time (including television (TV) viewing time, computer use time and total screen time) and site-specific cancer risk. Partition models and isotemporal substitution models investigated the impact of substituting recreational screen time with physical activity. Results During a mean follow-up of 7.6 years, 28,992 incident cancers were identified among 470,578 adults. A 1-h increase in daily TV viewing time was associated with higher risks of oropharyngeal, oesophago-gastric and colon cancer in fully adjusted models. Participants who reported ≤1, compared with 1- ≤ 3, hours/day of TV viewing time had lower risks of lung, breast, and oesophago-gastric cancer. Findings were inconsistent for daily recreational computer use and daily total recreational screen time. The majority of observed associations were small, and were attenuated after excluding cancers diagnosed within the first two years of follow-up, except for oesophago-gastric and colon cancers (HR 1.05, 95% CI: 1.01, 1.10; and HR 1.04, 95% CI: 1.01, 1.07 per 1-h increase in daily TV viewing time, respectively). However, isotemporal substitution models showed reduced risk of some site-specific (oropharyngeal, lung, breast and colorectal) cancers when replacing 1-h/day of TV viewing with 1-h of moderate-intensity physical activity or walking. Conclusions Our findings show that daily recreational screen time, particularly TV viewing, was associated with small increased risks of oesophago-gastric and colon cancer. Replacing 1-h/day of TV viewing with 1-h of moderate-intensity physical activity or walking was associated with lower risk of oropharyngeal, lung, breast and colorectal cancers. Further research from other large prospective cohort studies is required, while mechanistic research is warranted to enhance the biological plausibility of these findings.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, Northern Ireland, BT12 6BJ, UK.
| | - Jennifer M Murray
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, Northern Ireland, BT12 6BJ, UK.
| | - Helen G Coleman
- Centre for Public Health and Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
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11
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Zhang C, Yue C, Herrmann A, Song J, Egelston C, Wang T, Zhang Z, Li W, Lee H, Aftabizadeh M, Li YJ, Lee PP, Forman S, Somlo G, Chu P, Kruper L, Mortimer J, Hoon DSB, Huang W, Priceman S, Yu H. STAT3 Activation-Induced Fatty Acid Oxidation in CD8 + T Effector Cells Is Critical for Obesity-Promoted Breast Tumor Growth. Cell Metab 2020; 31:148-161.e5. [PMID: 31761565 PMCID: PMC6949402 DOI: 10.1016/j.cmet.2019.10.013] [Citation(s) in RCA: 203] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/21/2019] [Accepted: 10/28/2019] [Indexed: 12/21/2022]
Abstract
Although obesity is known to be critical for cancer development, how obesity negatively impacts antitumor immune responses remains largely unknown. Here, we show that increased fatty acid oxidation (FAO) driven by activated STAT3 in CD8+ T effector cells is critical for obesity-associated breast tumor progression. Ablating T cell Stat3 or treatment with an FAO inhibitor in obese mice spontaneously developing breast tumor reduces FAO, increases glycolysis and CD8+ T effector cell functions, leading to inhibition of breast tumor development. Moreover, PD-1 ligation in CD8+ T cells activates STAT3 to increase FAO, inhibiting CD8+ T effector cell glycolysis and functions. Finally, leptin enriched in mammary adipocytes and fat tissues downregulates CD8+ T cell effector functions through activating STAT3-FAO and inhibiting glycolysis. We identify a critical role of increased oxidation of fatty acids driven by leptin and PD-1 through STAT3 in inhibiting CD8+ T effector cell glycolysis and in promoting obesity-associated breast tumorigenesis.
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Affiliation(s)
- Chunyan Zhang
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
| | - Chanyu Yue
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; Sorrento Therapeutics Inc. 4955 Directors PI, San Diego, CA 92121, USA
| | - Andreas Herrmann
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; Sorrento Therapeutics Inc. 4955 Directors PI, San Diego, CA 92121, USA
| | - Jieun Song
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Colt Egelston
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Tianyi Wang
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Zhifang Zhang
- Department of Immunology, Beckman Research Institute and City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Wenzhao Li
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Heehyoung Lee
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Maryam Aftabizadeh
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Yi Jia Li
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Peter P Lee
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Stephen Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Cancer Center, Duarte, CA 91010, USA
| | - George Somlo
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Peiguo Chu
- Department of Pathology, City of Hope Medical Center, Duarte, CA 91010, USA
| | - Laura Kruper
- Department of Surgery, City of Hope Medical Center, Duarte, CA 91010, USA
| | - Joanne Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Dave S B Hoon
- Department of Translational Molecular Medicine, John Wayne Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA 90404, USA
| | - Wendong Huang
- Diabetes & Metabolism Research Institute, City of Hope Medical Center, Duarte, CA 91010, USA
| | - Saul Priceman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Cancer Center, Duarte, CA 91010, USA.
| | - Hua Yu
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
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12
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Alshahrani S, Hablas A, Chamberlain RM, Meza J, Remmenga S, Seifeldin IA, Ramadan M, Soliman AS. Changing Incidence of Uterine Cancer in Rural Egypt: Possible Impact of Nutritional and Epidemiologic Transitions. J Glob Oncol 2019; 5:1-7. [PMID: 31365301 PMCID: PMC6690630 DOI: 10.1200/jgo.18.00255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Uterine cancer is a top-ranking women's cancer worldwide, with wide incidence variations across countries and by rural and urban areas. Hormonal exposures and access to health care vary between rural and urban areas, globally. Egypt has an overall low incidence of uterine cancer but variable rural and urban lifestyles. Are there changes in the incidence of uterine cancer in rural and urban areas in middle-income countries such as Egypt? No previous studies have addressed this question from a well-characterized and validated population-based cancer registry resource in middle-income countries. The aim of this study was to explore the differences in clinical and demographic characteristics of uterine cancer over the period of 1999 to 2010 in rural and urban Gharbiah province, Egypt. METHODS Data were abstracted for all 660 patients with uterine cancer included in the Gharbiah Population-based Cancer Registry. Clinical variables included tumor location, histopathologic diagnosis, stage, grade, and treatment. Demographic variables included age, rural or urban residence, parity, and occupation. Crude and age-adjusted incidence rates (IRs) and rate ratios by rural or urban residence were calculated. RESULTS No significant differences were observed in most clinical and demographic characteristics between rural and urban patients. The age standardized IR (ASR) was 2.5 times higher in urban than in rural areas (6.9 and 2.8 per 100,000 in urban and rural areas, respectively). The rate ratio showed that the IR in urban areas was 2.46 times the rate in rural areas. CONCLUSION This study showed that the disease IR in rural areas has increased in the past decade but is still low compared with the incidence in urban areas in Egypt, which did not show a significant increase in incidence. Nutritional transitions, obesity, and epidemiologic and lifestyle changes toward Westernization may have led to IRs increasing more in rural than in urban areas in Egypt. This pattern of increasing incidence in Egypt, which used to have a low incidence of uterine cancer, may appear in other middle-income countries that experience emerging nutritional and epidemiologic transitions. The rate of uterine cancer in urban areas in Gharbiah is almost similar to the corresponding rates globally. However, the rate in rural areas in this population has increased over the past decade but is still lower than the corresponding global rates. Future studies should examine the etiologic factors related to increasing rates in rural areas and quantify the improvement in rural case finding.
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Affiliation(s)
| | - Ahmed Hablas
- Gharbiah Cancer Society and Gharbiah Population-based Cancer Registry, Tanta, Egypt
| | - Robert M Chamberlain
- City University of New York Medical School, New York, NY.,University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane Meza
- University of Nebraska Medical Center, Omaha, NE
| | | | - Ibrahim A Seifeldin
- Gharbiah Cancer Society and Gharbiah Population-based Cancer Registry, Tanta, Egypt
| | - Mohamed Ramadan
- Gharbiah Cancer Society and Gharbiah Population-based Cancer Registry, Tanta, Egypt
| | - Amr S Soliman
- City University of New York Medical School, New York, NY
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Miyamoto T, Shiozawa T. Two-sided role of estrogen on endometrial carcinogenesis: stimulator or suppressor? Gynecol Endocrinol 2019; 35:370-375. [PMID: 30668178 DOI: 10.1080/09513590.2018.1549219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Endometrial carcinoma (EC) often expresses estrogen receptors (ER), and the growth of EC is stimulated by estrogen. Therefore, EC is considered to be an estrogen-dependent tumor. However, the role of estrogen in endometrial carcinogenesis is somewhat unclear because the majority of EC occurs at peri- or post menopause when serum estrogen levels are generally decreased. In this article, we describe the double-edged role of estrogen in the genesis of EC, especially in terms of mismatch repair functions in vitro and in vivo, i.e. when serum estradiol (E2) levels are relatively low (approximately less than 90 pg/ml), and E2 enhance the carcinogenesis, whereas high E2 levels may suppress the carcinogenesis. This will deepen mechanistic insight into unopposed estrogen.
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Affiliation(s)
- Tsutomu Miyamoto
- a Department of Obstetrics and Gynecology , Shinshu University School of Medicine , Matsumoto , Japan
| | - Tanri Shiozawa
- a Department of Obstetrics and Gynecology , Shinshu University School of Medicine , Matsumoto , Japan
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14
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Renaud MC, Le T. No. 291-Epidemiology and Investigations forSuspected Endometrial Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e703-e711. [PMID: 30268319 DOI: 10.1016/j.jogc.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To review the evidence relating to the epidemiology of endometrial cancer and its diagnostic workups. OPTIONS Women with possible endometrial cancer can undergo an endometrial evaluation by office biopsy, hysteroscopy, or dilatation and curettage. To assist in treatment planning, pelvic ultrasound, CT scan, or MRI may be considered. OUTCOMES The identification of optimal diagnostic tests to evaluate patients with possible endometrial cancer. EVIDENCE Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary (e.g., endometrial neoplasms) and key words (e.g., endometrium cancer, endometrial carcinoma). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 31, 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, national and international medical specialty societies, and recent conference abstracts. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS This document is intended to guide the development of a standardized cost-effective investigation of patients with suspected endometrial cancer. VALIDATION The guideline was reviewed for accuracy by experts in pathology, radiation oncology, and medical oncology. Guideline content was also compared with relevant documents from the American Congress of Obstetricians and Gynecologists. RECOMMENDATIONS
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15
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Renaud MC, Le T. No 291 - Épidémiologie et explorations visant la présence soupçonnée d’un cancer de l’endomètre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e712-e722. [DOI: 10.1016/j.jogc.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Changes in Uterine Cancer Incidence Rates in Egypt. Obstet Gynecol Int 2018; 2018:3632067. [PMID: 30013598 PMCID: PMC6022259 DOI: 10.1155/2018/3632067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/11/2018] [Indexed: 01/23/2023] Open
Abstract
Background Uterine cancer is one of the top-ranking cancers in women with wide international variations in incidence rates. Developed countries have higher incidence rates than the developing countries. Egypt has significantly lower incidence of uterine cancer than other countries in the Middle East. This study aimed at verifying the incidence rate of uterine cancer and characterizing the demographic and clinical profiles of patients residing in the Gharbiah province in the Nile delta region of Egypt. Methods Data from 660 uterine cancer patients diagnosed during the period of 1999 to 2010 were abstracted from the Gharbiah Cancer Registry, the only population-based registry in Egypt. The data included age, marital status, number of children, residence, smoking, occupation, date and basis of diagnosis, tumor topography, morphology, stage and grade, and treatment. Crude rate, age-standardized rate (ASR), and age-specific rate were calculated and associated with demographic and clinical characteristics of patients. Results The study confirmed the low ASR of uterine cancer in Egypt, (4.1 per 100,000 (95% CI: 3.8-4.4)). The incidence rate increased significantly over the 12-year period. The crude rate (CR) was 1.95, 95% CI (1.64-2.25) in 1999-2002; 2.9, 95% CI (2.5-3.2) in 2003-2006; and 3.5, 95% CI (3.1-3.9) in 2007-2010. The rate ratio was 1.5, 95% CI (1.2-1.8) in 2003-2006 and 1.8, 95% CI (1.5-2.2) in 2007-2010 compared to 1999-2002. The majority of patients (83%) were postmenopausal with the highest age-specific rate in the 60-69-year age group (22.07 per 100,000 (95% CI: 19.3-25.2). The majority of patients were diagnosed at early stages (60% localized and 5% regional), had adenocarcinoma (68%), and resided in urban areas (54%). Conclusions The study confirmed the low incidence rate of uterine cancer in the Gharbiah province of Egypt and significant increase in incidence in recent years. Future studies should focus on verifying the possible effect of hysterectomy on lowering the incidence, the factors related to the changes in rates between rural and urban areas, and the possible impact of nutritional and epidemiologic transitions on the increasing rates.
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Effect of Physical Activity on Quality of Life as Perceived by Endometrial Cancer Survivors: A Systematic Review. Int J Gynecol Cancer 2018; 26:1727-1740. [PMID: 27654260 DOI: 10.1097/igc.0000000000000821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE A combination of the relatively high prevalence among gynecologic cancers, high survival, and the myriads of factors that negatively impact the quality of life (QoL) among endometrial cancer (EC) survivors underscores the potential benefits of meeting guideline physical activity (PA) guidelines of 150 minutes per week among EC survivors. The objective of the present systematic review was to collate and critically evaluate the currently available literature on the effects of PA on QoL among EC survivors. METHODS Medline and Web of Science databases were searched for articles on EC, QoL, and PA. We also inspected bibliographies of relevant publications to identify related articles. Our search criteria yielded 70 studies, 7 of which met the inclusion criteria. RESULTS Of the 7 studies examined, 2 of them were intervention studies, whereas 5 were cross-sectional studies. Meeting guideline PA was significantly associated with better QoL score in 4 of the 5 cross-sectional studies. CONCLUSIONS Results from the cross-sectional studies suggest that EC survivors' inactivity is significantly correlated with poorer QoL. This correlation was worse among obese survivors compared with normal weight survivors. Endometrial cancer survivors may benefit from interventions that incorporate PA. More randomized intervention studies among EC survivors are needed to add to this body of evidence.
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18
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Lynch BM, Mahmood S, Boyle T. Sedentary Behaviour and Cancer. SEDENTARY BEHAVIOUR EPIDEMIOLOGY 2018. [DOI: 10.1007/978-3-319-61552-3_10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Borch KB, Weiderpass E, Braaten T, Jareid M, Gavrilyuk OA, Licaj I. Physical activity and risk of endometrial cancer in the Norwegian Women and Cancer (NOWAC) study. Int J Cancer 2017; 140:1809-1818. [DOI: 10.1002/ijc.30610] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/23/2016] [Accepted: 01/13/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Kristin B. Borch
- Department of Community MedicineFaculty of Health Sciences, UiT, The Arctic University of NorwayTromsø Norway
| | - Elisabete Weiderpass
- Department of Community MedicineFaculty of Health Sciences, UiT, The Arctic University of NorwayTromsø Norway
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholm Sweden
- Department of ResearchCancer Registry of Norway, Institute of Population‐Based Cancer ResearchOslo Norway
- Genetic Epidemiology Group, Folkhälsan Research Centre, Samfundet FolkhälsanHelsinki Finland
| | - Tonje Braaten
- Department of Community MedicineFaculty of Health Sciences, UiT, The Arctic University of NorwayTromsø Norway
| | - Mie Jareid
- Department of Community MedicineFaculty of Health Sciences, UiT, The Arctic University of NorwayTromsø Norway
| | - Oxana A. Gavrilyuk
- Department of Community MedicineFaculty of Health Sciences, UiT, The Arctic University of NorwayTromsø Norway
| | - Idlir Licaj
- Department of Community MedicineFaculty of Health Sciences, UiT, The Arctic University of NorwayTromsø Norway
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Renaud MC, Le T. Épidémiologie et explorations visant la présence soupçonnée d’un cancer de l’endomètre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S220-S230. [DOI: 10.1016/j.jogc.2016.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Crowley O, Pugliese L, Kachnowski S. The Impact of Wearable Device Enabled Health Initiative on Physical Activity and Sleep. Cureus 2016; 8:e825. [PMID: 27882272 PMCID: PMC5106347 DOI: 10.7759/cureus.825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives The Personal Health Management Study (PHMS) is an assessment of the effect of a voluntary employee-facing health initiative using a commercially-available wearable device implemented among 565 employees of Boehringer Ingelheim Pharmaceuticals, Inc. The results of the initiative on physical activity (measured as steps) and sleep is reported. Methods This was a 12-month, prospective, single-cohort intervention study using a wearable activity-measuring device tracking steps and sleep (entire study period) and a system of health-promoting incentives (first nine months of study period). The findings from the first nine study months are reported. Results The mixed model repeated measures approach was used to analyze the data. There was no significant difference in steps between the first month (7915.6 mean steps per person per day) and the last month (7853.4 mean steps per person per day) of the intervention. However, there was a seasonal decline in steps during the intervention period from fall to winter, followed by an increase in steps from winter to spring. In contrast, sleep tended to increase steadily throughout the study period, and the number of hours slept during the last month (7.52 mean hours per person per day) of the intervention was significantly greater than the number of hours slept during the first month (7.16 mean hours per person per day). Conclusions The impact of the initiative on physical activity and sleep differed over the period of time studied. While physical activity did not change between the first and last month of the intervention, the number of hours slept per night increased significantly. Although seasonal changes and study-device habituation may explain the pattern of change in physical activity, further evaluation is required to clarify the reasons underlying the difference in the impact of the initiative on the dynamics of steps and sleep.
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Affiliation(s)
- Olga Crowley
- Innovation Research, Healthcare Innovation and Technology Lab, Inc
| | - Laura Pugliese
- Innovation Research, Healthcare Innovation and Technology Lab, Inc
| | - Stan Kachnowski
- Department of Management Studies, Indian Institute of Technology - New Delhi ; New York Psychiatric Institute, Columbia University Medical Center ; Ryder Trauma Center, University of Miami, Medical School ; HITLAB, Healthcare Innovation & Technology Lab
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Papatla K, Huang M, Slomovitz B. The obese endometrial cancer patient: how do we effectively improve morbidity and mortality in this patient population? Ann Oncol 2016; 27:1988-1994. [PMID: 27502716 DOI: 10.1093/annonc/mdw310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/22/2016] [Indexed: 12/29/2022] Open
Abstract
The relationship between obesity, metabolic syndrome, and endometrial cancer has been established and accepted for decades. However, despite this understanding, endometrial cancer patients continue to die of their obesity-related comorbidities such as cardiovascular disease and diabetes. Furthermore, studies show that gynecologic oncologists, general obstetrician/gynecologists, and bariatric specialists do not appropriately address obesity as a risk factor for cancer and also do not provide appropriate counseling on weight loss and lifestyle modification during screening, diagnosis, and follow-up for endometrial cancer. Given the increasing numbers of obese women both in the United States as well as globally, it is imperative that this risk be addressed and mitigated during patient interactions. Therefore, this article reviews the literature on obesity, metabolic syndrome, and endometrial cancer, as well as the literature on causes of death in endometrial cancer patients. Given the increased cardiovascular and all-cause mortality, we provide a number of methods to address obesity as a risk factor for cancer during patient visits. These methods include self-directed diet and exercise, supervised diet and exercise programs, medical management with insulin-sensitizing agents and statins, as well as bariatric surgery in extreme cases. Furthermore, we also encourage collaboration between general obstetrician/gynecologists, gynecologic oncologists, and bariatric specialists in the care of obese endometrial cancer patients to ensure that they not only survive their diagnosis, but also go on to live long, healthy lives.
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Affiliation(s)
- K Papatla
- Department of Obstetrics, Gynecology and Reproductive Services, Temple University Hospital, Philadelphia
| | - M Huang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
| | - B Slomovitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
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Edwards ES, Sackett SC. Psychosocial Variables Related to Why Women are Less Active than Men and Related Health Implications. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:47-56. [PMID: 27398045 PMCID: PMC4933535 DOI: 10.4137/cmwh.s34668] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/12/2016] [Accepted: 05/15/2016] [Indexed: 12/22/2022]
Abstract
This article reviews psychosocial influences on women’s participation in physical activity as they differ from men and how associated activity differences impact women’s risk for a number of chronic diseases. This topic directly aligns with the mission of this special edition related to disparities in women’s health as the typically lower level of physical activity in females directly impacts their health. On average, females participate in physical activity at lower rates than their male counterparts. These lower rates of physical activity are directly related to both incidence of and outcomes from cardiovascular disease, type 2 diabetes, and breast and gynecological cancers. The relationship between psychosocial factors that are understood to affect physical activity differs between men and women. Specifically, self-efficacy, social support, and motivation are empirically substantiated factors that found to impact physical activity participation among women differently than men. Understanding these relationships is integral to designing effective interventions to target physical activity participation in women so that the related health risks are adequately addressed.
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Affiliation(s)
| | - Sarah Carson Sackett
- Department of Kinesiology, James Madison University, Morrison Bruce Center, Harrisonburg, VA, USA
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Flannery CA, Saleh FL, Choe GH, Selen DJ, Kodaman PH, Kliman HJ, Wood TL, Taylor HS. Differential Expression of IR-A, IR-B and IGF-1R in Endometrial Physiology and Distinct Signature in Adenocarcinoma. J Clin Endocrinol Metab 2016; 101:2883-91. [PMID: 27088794 PMCID: PMC4929835 DOI: 10.1210/jc.2016-1795] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/13/2016] [Indexed: 01/07/2023]
Abstract
CONTEXT Type 2 diabetes and obesity are risk factors for endometrial hyperplasia and cancer, suggesting that hyperinsulinemia contributes to pathogenesis. Insulin action through insulin receptor (IR) splice variants IR-A and IR-B regulates cellular mitogenesis and metabolism, respectively. OBJECTIVE We hypothesized that IR-A and IR-B are differentially regulated in normal endometrium, according to mitogenic and metabolic requirements through the menstrual cycle, as well as in endometrial hyperplasia and cancer. DESIGN IR-A, IR-B, and IGF-1 receptor (IGF-1R) mRNA was quantified in endometrium, endometrial epithelial and stromal cells, and in vitro after hormone stimulation. SETTING Academic center. PATIENTS Endometrium was collected from women with regular cycles (n = 71), complex hyperplasia (n = 5), or endometrioid adenocarcinoma (n = 11). INTERVENTION(S) In vitro sex-steroid treatment. MAIN OUTCOME MEASURE(S) IR-A and IR-B expression Results: IR-A increased dramatically during the early proliferative phase, 20-fold more than IR-B. In early secretory phase, IR-B and IGF-1R expression increased, reaching maximal expression, whereas IR-A decreased. In adenocarcinoma, IR-B and IGF-1R expression was 5- to 6-fold higher than normal endometrium, whereas IR-A expression was similar to IR-B. Receptor expression was unrelated to body mass index. CONCLUSION IR-A was elevated during the normal proliferative phase, and in endometrial hyperplasia and adenocarcinoma. The dramatic early rise of IR-A in normal endometrium indicates IR-A is the predominant isoform responsible for initial estrogen-independent endometrial proliferation as well as that of cancer. IR-B is elevated during the normal secretory phase when glucose uptake and glycogen synthesis support embryo development. Differing from other cancers, IR-B expression equals mitogenic IR-A in endometrial adenocarcinoma. Differential IR isoform expression suggests a distinct role for each in endometrial physiology and cancer.
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MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/metabolism
- Adenocarcinoma/pathology
- Adult
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Carcinoma, Endometrioid/genetics
- Carcinoma, Endometrioid/metabolism
- Carcinoma, Endometrioid/pathology
- Cells, Cultured
- Endometrial Hyperplasia/genetics
- Endometrial Hyperplasia/metabolism
- Endometrial Hyperplasia/pathology
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/metabolism
- Endometrial Neoplasms/pathology
- Endometrium/metabolism
- Endometrium/physiology
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Humans
- Menstrual Cycle/genetics
- Menstrual Cycle/metabolism
- Middle Aged
- Protein Subunits/genetics
- Protein Subunits/metabolism
- Receptor, IGF Type 1/genetics
- Receptor, IGF Type 1/metabolism
- Receptor, Insulin/genetics
- Receptor, Insulin/metabolism
- Transcriptome
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Affiliation(s)
- Clare A Flannery
- Obstetrics, Gynecology, and Reproductive Sciences (C.A.F., F.L.S., G.H.C., D.J.S., P.H.K., H.J.K., H.S.T.), Yale School of Medicine, New Haven, Connecticut 06520; Internal Medicine (C.A.F.), Yale School of Medicine, New Haven, Connecticut 06520; and Pharmacology, Physiology and Neuroscience and Cancer Center (T.L.W.), NJ Medical School, Rutgers University, Newark, New Jersey 07101
| | - Farrah L Saleh
- Obstetrics, Gynecology, and Reproductive Sciences (C.A.F., F.L.S., G.H.C., D.J.S., P.H.K., H.J.K., H.S.T.), Yale School of Medicine, New Haven, Connecticut 06520; Internal Medicine (C.A.F.), Yale School of Medicine, New Haven, Connecticut 06520; and Pharmacology, Physiology and Neuroscience and Cancer Center (T.L.W.), NJ Medical School, Rutgers University, Newark, New Jersey 07101
| | - Gina H Choe
- Obstetrics, Gynecology, and Reproductive Sciences (C.A.F., F.L.S., G.H.C., D.J.S., P.H.K., H.J.K., H.S.T.), Yale School of Medicine, New Haven, Connecticut 06520; Internal Medicine (C.A.F.), Yale School of Medicine, New Haven, Connecticut 06520; and Pharmacology, Physiology and Neuroscience and Cancer Center (T.L.W.), NJ Medical School, Rutgers University, Newark, New Jersey 07101
| | - Daryl J Selen
- Obstetrics, Gynecology, and Reproductive Sciences (C.A.F., F.L.S., G.H.C., D.J.S., P.H.K., H.J.K., H.S.T.), Yale School of Medicine, New Haven, Connecticut 06520; Internal Medicine (C.A.F.), Yale School of Medicine, New Haven, Connecticut 06520; and Pharmacology, Physiology and Neuroscience and Cancer Center (T.L.W.), NJ Medical School, Rutgers University, Newark, New Jersey 07101
| | - Pinar H Kodaman
- Obstetrics, Gynecology, and Reproductive Sciences (C.A.F., F.L.S., G.H.C., D.J.S., P.H.K., H.J.K., H.S.T.), Yale School of Medicine, New Haven, Connecticut 06520; Internal Medicine (C.A.F.), Yale School of Medicine, New Haven, Connecticut 06520; and Pharmacology, Physiology and Neuroscience and Cancer Center (T.L.W.), NJ Medical School, Rutgers University, Newark, New Jersey 07101
| | - Harvey J Kliman
- Obstetrics, Gynecology, and Reproductive Sciences (C.A.F., F.L.S., G.H.C., D.J.S., P.H.K., H.J.K., H.S.T.), Yale School of Medicine, New Haven, Connecticut 06520; Internal Medicine (C.A.F.), Yale School of Medicine, New Haven, Connecticut 06520; and Pharmacology, Physiology and Neuroscience and Cancer Center (T.L.W.), NJ Medical School, Rutgers University, Newark, New Jersey 07101
| | - Teresa L Wood
- Obstetrics, Gynecology, and Reproductive Sciences (C.A.F., F.L.S., G.H.C., D.J.S., P.H.K., H.J.K., H.S.T.), Yale School of Medicine, New Haven, Connecticut 06520; Internal Medicine (C.A.F.), Yale School of Medicine, New Haven, Connecticut 06520; and Pharmacology, Physiology and Neuroscience and Cancer Center (T.L.W.), NJ Medical School, Rutgers University, Newark, New Jersey 07101
| | - Hugh S Taylor
- Obstetrics, Gynecology, and Reproductive Sciences (C.A.F., F.L.S., G.H.C., D.J.S., P.H.K., H.J.K., H.S.T.), Yale School of Medicine, New Haven, Connecticut 06520; Internal Medicine (C.A.F.), Yale School of Medicine, New Haven, Connecticut 06520; and Pharmacology, Physiology and Neuroscience and Cancer Center (T.L.W.), NJ Medical School, Rutgers University, Newark, New Jersey 07101
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Beavis AL, Smith AJB, Fader AN. Lifestyle changes and the risk of developing endometrial and ovarian cancers: opportunities for prevention and management. Int J Womens Health 2016; 8:151-67. [PMID: 27284267 PMCID: PMC4883806 DOI: 10.2147/ijwh.s88367] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Modifiable lifestyle factors, such as obesity, lack of physical activity, and smoking, contribute greatly to cancer and chronic disease morbidity and mortality worldwide. This review appraises recent evidence on modifiable lifestyle factors in the prevention of endometrial cancer (EC) and ovarian cancer (OC) as well as new evidence for lifestyle management of EC and OC survivors. For EC, obesity continues to be the strongest risk factor, while new evidence suggests that physical activity, oral contraceptive pills, and bariatric surgery may be protective against EC. Other medications, such as metformin and nonsteroidal anti-inflammatory drugs, may be protective, and interventional research is ongoing. For OC, we find increasing evidence to support the hypothesis that obesity and hormone replacement therapy increase the risk of developing OC. Oral contraceptive pills are protective against OC but are underutilized. Dietary factors such as the Mediterranean diet and alcohol consumption do not seem to affect the risk of either OC or EC. For EC and OC survivors, physical activity and weight loss are associated with improved quality of life. Small interventional trials show promise in increasing physical activity and weight maintenance for EC and OC survivors, although the impact on long-term health, including cancer recurrence and overall mortality, is unknown. Women's health providers should integrate counseling about these modifiable lifestyle factors into both the discussion of prevention for all women and the management of survivors of gynecologic cancers.
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Affiliation(s)
- Anna L Beavis
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Amanda Nickles Fader
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
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Matsuo K, Moeini A, Cahoon SS, Machida H, Ciccone MA, Grubbs BH, Muderspach LI. Weight Change Pattern and Survival Outcome of Women with Endometrial Cancer. Ann Surg Oncol 2016; 23:2988-97. [PMID: 27112587 DOI: 10.1245/s10434-016-5237-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to determine the association between weight change patterns and survival outcomes of women with endometrial cancer. METHODS This retrospective study examined surgically-staged endometrial cancer cases with available weight information between 1999 and 2013 (n = 665). Proportional body mass index (delta-BMI) change at 6 months, 1 and 2 years after hysterectomy was compared with baseline BMI and correlated to patient demographics, tumor characteristics, treatment type, and disease-free survival (DFS) and overall survival (OS). RESULTS Mean BMI was 35.6, and 69 % of cases were obese. At 6 months, 1 and 2 years after surgery, 39.1, 51.6, and 57.0 % of the study population, respectively, gained weight compared with pre-treatment baseline. In univariate analysis, 6-month delta-BMI change was significantly associated with DFS and OS, demonstrating bidirectional effects (both p < 0.001): 5-year rates, ≥15.0 % delta-BMI loss (33.5 and 59.1 %), 7.5-14.9 % loss (67.3 and 70.0 %), <7.5 % loss (87.8 and 95.7 %), <7.5 % gain (87.2 and 90.3 %), 7.5-14.9 % gain (64.6 and 67.6 %), and ≥15.0 % gain (32.5 and 66.7 %). In multivariable analysis controlling for age, ethnicity, baseline BMI, histology, grade, stage, chemotherapy, and radiotherapy, 6-month delta-BMI change remained an independent prognostic factor for DFS and OS (all p < 0.05): adjusted hazard ratios, ≥15 % delta-BMI loss (3.35 and 5.39), 7.5-14.9 % loss (2.35 and 4.19), 7.5-14.9 % gain (2.58 and 3.33), and ≥15.0 % gain (2.50 and 3.45) compared with <7.5 % loss. Similar findings were observed at a 1-year time point (p < 0.05). Baseline BMI was not associated with survival outcome (p > 0.05). CONCLUSION Our results demonstrated that endometrial cancer patients continued to gain weight after hysterectomy, and post-treatment weight change had bidirectional effects on survival outcome.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, 90033, USA. .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Aida Moeini
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, 90033, USA
| | - Sigita S Cahoon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, 90033, USA
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, 90033, USA
| | - Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, 90033, USA
| | - Brendan H Grubbs
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, 90033, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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27
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Liu L, Shi Y, Li T, Qin Q, Yin J, Pang S, Nie S, Wei S. Leisure time physical activity and cancer risk: evaluation of the WHO's recommendation based on 126 high-quality epidemiological studies. Br J Sports Med 2015; 50:372-8. [PMID: 26500336 DOI: 10.1136/bjsports-2015-094728] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The WHO has concluded that physical activity reduces the risk of numerous diseases. However, few systemic reviews have been performed to assess the role of leisure time physical activity (LTPA) in lowering the risk of cancer in a dose-dependent manner and furthermore the suitability of recommendation of physical activity by the WHO. METHODS A systematic review and meta-analysis was designed to estimate cancer risk by LTPA in binary comparison and in a dose-dependent manner. MEDLINE and Web of Science were searched up to 30 December 2014 without language restrictions. Reference lists were reviewed for potential articles. RESULTS A total of 126 studies were recruited into the meta-analysis. Overall, the total cancer risk was reduced by 10% in people who undertook the most LTPA as compared with those who did the least. Dose-response meta-analysis indicated that the current WHO recommendation (equal to an average of 10 metabolic equivalents of energy hours per week) induced a 7% (95% CI 5% to 9%) cancer reduction. Moreover, the protective role of LTPA against cancer becomes saturated at 20 metabolic equivalents of energy hours per week, with a relative risk of 0.91 (95% CI 0.88 to 0.93). Subanalyses results based on cancer types showed that LTPA only exhibited significant protection against breast cancer and colorectal cancer. CONCLUSIONS Our meta-analysis indicates that the current WHO recommendation of physical activity can result in a 7% reduction in cancer risk, which is mainly attributed to its protective role against breast cancer and colorectal cancer. Furthermore, two-fold of current recommendation level is considered to give its saturated protection against cancer.
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Affiliation(s)
- Li Liu
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yun Shi
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tingting Li
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qin Qin
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jieyun Yin
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuo Pang
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sheng Wei
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Hammer SM, Brown JC, Segal S, Chu CS, Schmitz KH. Cancer-related impairments influence physical activity in uterine cancer survivors. Med Sci Sports Exerc 2015; 46:2195-201. [PMID: 24781886 DOI: 10.1249/mss.0000000000000360] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The extent to which physical activity (PA) participation among uterine cancer survivors may be limited by physical and functional impairments (PFI) related to cancer treatment is unknown. We sought to describe PA participation, characterize the prevalence of PFI, and examine the association between PFI status and PA participation within this population. METHODS We conducted a study using a mailed survey among uterine cancer survivors who received treatment at a university hospital. We asked about PA and PFI using validated self-report questionnaires. PA was calculated using MET-hours per week (MET·h·wk). PFI was defined as having one or more of the following symptoms: lower limb lymphedema, general pain, fatigue, or severe bladder, bowel, or pelvic issues. Ordinal logistic regression was used to quantify the odds ratio (OR) between PA and PFI. RESULTS The response rate to our survey was 43%. Among the 213 study participants, 40%, 13%, 13%, 12%, and 23% reported participating in <3.0, 3.0-8.9, 9.0-17.9, 18.0-26.9, and ≥27.0 MET·h·wk of PA, respectively. Walking is the preferred mode of exercise for physically active uterine cancer survivors. Of the survivors, 53% experience at least one PFI. The most common PFI is lower limb lymphedema (36.2%), followed by general pain (22.5%). The OR of PFI decreased as MET-hours per week of PA increased (OR, 0.51; 95% confidence interval, 0.31-0.84; P = 0.009). CONCLUSIONS The majority of uterine cancer survivors experience PFI that significantly reduce the likelihood of PA participation. PA recommendations for uterine cancer survivors should take into account treatment-related impairments that can affect PA participation.
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Affiliation(s)
- Sean M Hammer
- 1Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; 2Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology; Department of Surgery (Urology), University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; and 3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
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Patel AV, Hildebrand JS, Campbell PT, Teras LR, Craft LL, McCullough ML, Gapstur SM. Leisure-Time Spent Sitting and Site-Specific Cancer Incidence in a Large U.S. Cohort. Cancer Epidemiol Biomarkers Prev 2015; 24:1350-9. [DOI: 10.1158/1055-9965.epi-15-0237] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/21/2015] [Indexed: 11/16/2022] Open
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A systematic review and meta-analysis of physical activity and endometrial cancer risk. Eur J Epidemiol 2015; 30:397-412. [PMID: 25800123 DOI: 10.1007/s10654-015-0017-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 03/10/2015] [Indexed: 12/11/2022]
Abstract
Physical activity is related to decreased endometrial cancer risk. However, a comprehensive investigation of activity domains, intensities, time periods in life, and potential interaction with body mass index is unavailable. We performed a meta-analysis of physical activity and endometrial cancer studies published through October 2014. We identified 33 eligible studies comprising 19,558 endometrial cancer cases. High versus low physical activity was related to reduced endometrial cancer risk [relative risk (RR) = 0.80; 95% confidence interval (CI) 0.75-0.85]. The corresponding RRs for recreational activity, occupational activity, household activity, and walking were 0.84 (95% CI 0.78-0.91), 0.81 (95% CI 0.75-0.87), 0.70 (95% CI 0.47-1.02), and 0.82 (95% CI 0.69-0.97), respectively (Pdifference). Walking/biking for transportation, walking for recreation, and walking without specification revealed summary RRs of 0.70 (95% CI 0.58-0.85), 0.94 (95% CI 0.76-1.17), and 0.88 (95% CI 0.52-1.50), respectively (Pdifference). Inverse associations were noted for light (RR 0.65; 95% CI 0.49-0.86), moderate to vigorous (RR 0.83; 95 % CI 0.71-0.96), and vigorous activity (RR 0.80; 95% CI 0.72-0.90; (Pdifference). A statistically significant inverse relation was found for postmenopausal (RR 0.81; 95% CI 0.67-0.97), but not premenopausal women (RR 0.74; 95% CI 0.49-1.13; (Pdifference). Physical activity performed during childhood/adolescence, young adulthood/midlife, and older age yielded RRs of 0.94 (95% CI 0.82-1.08), 0.77 (95% CI 0.58-1.01), and 0.69 (95% CI 0.37-1.28), respectively (Pdifference). An inverse relation was evident in overweight/obese (RR 0.69; 95% CI 0.52-0.91), but not normal weight women (RR 0.97; 95% CI 0.84-1.13; (Pdifference). In conclusion, recreational physical activity, occupational physical activity, and walking/biking for transportation are related to decreased endometrial cancer risk. Inverse associations are evident for physical activity of light, moderate to vigorous, and vigorous intensities. The inverse relation with physical activity is limited to women who are overweight or obese.
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Shen D, Mao W, Liu T, Lin Q, Lu X, Wang Q, Lin F, Ekelund U, Wijndaele K. Sedentary behavior and incident cancer: a meta-analysis of prospective studies. PLoS One 2014; 9:e105709. [PMID: 25153314 PMCID: PMC4143275 DOI: 10.1371/journal.pone.0105709] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/23/2014] [Indexed: 12/14/2022] Open
Abstract
Background Sedentary behavior is ubiquitous in modern adults' daily lives and it has been suggested to be associated with incident cancer. However, the results have been inconsistent. In this study, we performed a systematic review and meta-analysis of prospective cohort studies to clarify the association between sedentary behavior and incident cancer. Method PubMed and Embase databases were searched up to March 2014. All prospective cohort studies on the association between sedentary behavior and incident cancer were included. The summary relative risks (RRs) with 95% confidence intervals (CIs) were estimated using random effect model. Results A total of 17 prospective studies from 14 articles, including a total of 857,581 participants and 18,553 cases, were included in the analysis for sedentary behavior and risk of incident cancer. The overall meta-analysis suggested that sedentary behavior increased risk of cancer (RR = 1.20, 95%CI = 1.12–1.28), with no evidence of heterogeneity between studies (I2 = 7.3%, P = 0.368). Subgroup analyses demonstrated that there were statistical associations between sedentary behavior and some cancer types (endometrial cancer: RR = 1.28, 95% CI = 1.08–1.53; colorectal cancer: RR = 1.30, 95%CI = 1.12–1.49; breast cancer: RR = 1.17, 95%CI = 1.03–1.33; lung cancer: RR = 1.27, 95%CI = 1.06–1.52). However, there was no association of sedentary behavior with ovarian cancer (RR = 1.26, 95%CI = 0.87–1.82), renal cell carcinoma (RR = 1.11, 95%CI = 0.87–1.41) or non-Hodgkin lymphoid neoplasms (RR = 1.09, 95%CI = 0.82–1.43). Conclusion The present meta-analysis suggested that prolonged sedentary behavior was independently associated with an increased risk of incident endometrial, colorectal, breast, and lung cancers, but not with ovarian cancer, renal cell carcinoma or non-Hodgkin lymphoid neoplasms.
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Affiliation(s)
- Dong Shen
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
- * E-mail: (DS); (WM)
| | - Weidong Mao
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
- * E-mail: (DS); (WM)
| | - Tao Liu
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
| | - Qingfeng Lin
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
| | - Xiangdong Lu
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
| | - Qiong Wang
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
| | - Feng Lin
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Katrien Wijndaele
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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Imanieh MH, Bagheri F, Alizadeh AM, Ashkani-Esfahani S. Oxytocin has therapeutic effects on cancer, a hypothesis. Eur J Pharmacol 2014; 741:112-23. [PMID: 25094035 DOI: 10.1016/j.ejphar.2014.07.053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 01/25/2023]
Abstract
Oxytocin (OT) is the first peptide hormone structurally assessed and chemically synthesized in biologically active form. This hormone acts as an important factor in a human reproductive system particularly during pregnancy and lactation in women. So far, different therapeutic roles for OT have been identified as a spectrum from central and peripheral actions on male and female reproductive systems, circulatory system, musculoskeletal system, etc. Some in vitro and in vivo studies also revealed that OT is responsible for bivariate biological functions involved in cancer as following. By activating OT receptor in tumoral cells, OT enacts as a growth regulator, whether activator or inhibitor. Regarding the increase of OT in some conditions such as breastfeeding, exercise, and multiparity, we can relate the effect of these conditions on cancer with OT effects. Based on this hypothesis, we present a review on the effects of this neuropeptide on various types of cancer and also the influence of these conditions on the same cancer.
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Affiliation(s)
| | - Fereshte Bagheri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammad Alizadeh
- Cancer Research Center, Tehran University of Medical Sciences, PO Box 1419733141, Tehran, Iran.
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Schmid D, Leitzmann MF. Television viewing and time spent sedentary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst 2014; 106:dju098. [PMID: 24935969 DOI: 10.1093/jnci/dju098] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sedentary behavior is emerging as an independent risk factor for chronic disease and mortality. However, the evidence relating television (TV) viewing and other sedentary behaviors to cancer risk has not been quantitatively summarized. METHODS We performed a comprehensive electronic literature search in Cochrane, EMBASE, Medline, and SciSearch databases through February 2014 for published articles investigating sedentary behavior in relation to cancer incidence. Because randomized controlled trials are difficult to perform on this topic, we focused on observational studies that met uniform inclusion criteria. Data were extracted independently by both authors and summarized using random-effects meta-analysis and meta-regression. All statistical tests were two-sided. RESULTS Data from 43 observational studies including a total of 68936 cancer cases were analyzed. Comparing the highest vs lowest levels of sedentary time, the relative risks (RRs) for colon cancer were 1.54 (95% confidence interval [CI] = 1.19 to 1.98) for TV viewing time, 1.24 (95% CI = 1.09 to 1.41) for occupational sitting time, and 1.24 (95% CI = 1.03 to 1.50) for total sitting time. For endometrial cancer, the relative risks were 1.66 (95% CI = 1.21 to 2.28) for TV viewing time and 1.32 (95% CI = 1.08 to 1.61) for total sitting time. A positive association with overall sedentary behavior was also noted for lung cancer (RR = 1.21; 95% CI = 1.03 to 1.43). Sedentary behavior was unrelated to cancers of the breast, rectum, ovaries, prostate, stomach, esophagus, testes, renal cell, and non-Hodgkin lymphoma. CONCLUSIONS Prolonged TV viewing and time spent in other sedentary pursuits is associated with increased risks of certain types of cancer.
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Affiliation(s)
- Daniela Schmid
- Affiliation of authors: Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (DS, MFL).
| | - Michael F Leitzmann
- Affiliation of authors: Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (DS, MFL)
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Basen-Engquist K, Carmack C, Brown J, Jhingran A, Baum G, Song J, Scruggs S, Swartz MC, Cox MG, Lu KH. Response to an exercise intervention after endometrial cancer: differences between obese and non-obese survivors. Gynecol Oncol 2014; 133:48-55. [PMID: 24680591 PMCID: PMC3979927 DOI: 10.1016/j.ygyno.2014.01.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/15/2014] [Accepted: 01/16/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The objective of this paper is to describe baseline differences between obese and non-obese endometrial cancer survivor in anthropometrics, exercise behavior, fitness, heart rate and blood pressure, and quality of life, and to analyze whether the effect of a home-based exercise intervention on these outcomes differed for obese and non-obese participants. METHODS One hundred post-treatment Stage I-IIIa endometrial cancer survivors participated in a single arm 6month study in which they received a home-based exercise intervention. Cardiorespiratory fitness, anthropometrics, and exercise behavior were measured every two months, and quality of life (QOL) and psychological distress were measured at baseline and 6months. RESULTS Adjusting for potential confounders, at baseline obese survivors had poorer cardiorespiratory fitness (p=.002), higher systolic blood pressure (p=.018), and lower physical functioning (p<.001) and ratings of general health (p=.002), and more pain (p=.037) and somatization (.002). Significant improvements were seen in exercise behavior, resting heart rate, systolic blood pressure, and multiple QOL domains over the course of the intervention. Obese survivors had less improvement in exercise behavior and cardiorespiratory fitness than non-obese survivors, but there were no differences with regard to improvements in QOL and stress. CONCLUSIONS Home based exercise interventions are beneficial to endometrial cancer survivors, including those whose BMI is in the obese range. While obese survivors have lower levels of physical activity and fitness, they experienced similar activity, fitness, quality of life and mental health benefits. Exercise should be encouraged in endometrial cancer survivors, including those who are obese.
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Affiliation(s)
- K Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, USA.
| | - C Carmack
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, USA
| | - J Brown
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, USA
| | - A Jhingran
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, USA
| | - G Baum
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, USA
| | - J Song
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, USA
| | - S Scruggs
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, USA
| | - M C Swartz
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, USA
| | - M G Cox
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, USA
| | - K H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, USA
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Gianos M, Abdemur A, Szomstein S, Rosenthal R. Laparoscopic sleeve gastrectomy as a step approach for morbidly obese patients with early stage malignancies requiring rapid weight loss for a final curative procedure. Obes Surg 2014; 23:1370-4. [PMID: 23564466 DOI: 10.1007/s11695-013-0933-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy is a relatively new treatment modality implemented in the surgical management for morbid obesity. It has been well documented that obesity is not only associated with an increased risk of malignancies but is also consistent with a higher incidence of surgical complications related to its definitive management. In spite of the weight loss experienced by patients with malignancy due to a catabolic state, bariatric surgery might be considered as a step procedure allowing for a more efficient and suitable surgical approach to treat early stage malignancies, thereby decreasing the procedure-related morbidity and mortality. This study aims to examine the effectiveness of laparoscopic sleeve gastrectomy as a primary weight loss procedure in patients with untreated malignancy facilitating a definitive oncologic surgical approach. METHODS After institutional review board approval and following Health Insurance Portability and Accountability Act guidelines, we conducted a retrospective review of a prospectively collected database. From September 2006 to March 2009, we analyzed all morbidly obese patients with early stage malignancy that underwent laparoscopic sleeve gastrectomy at the Bariatric and Metabolic Institute as a weight loss surgery prior to a second oncologic procedure. The variables examined were excess body weight, percent excess weight loss, comorbidities, malignancy type, preoperative body mass index (BMI), postoperative BMI, morbidity, and mortality. Mean follow-up time was 3 months until an oncologic procedure was performed. RESULTS Our series included four morbidly obese patients. There were three males and one female, with a mean age of 53.75 years (range 27-67 years) and a mean BMI of 48.25 kg/m(2) (range 42-55 kg/m(2)). Mean excess weight in our patient population 176 lbs. Mean weight loss at 3 months after laparoscopic sleeve gastrectomy was 59.35 lbs (range 28-79 lbs). Comorbidities included diabetes mellitus, hypertension, obstructive sleep apnea, chronic obstructive pulmonary disease, Crohn's disease, coronary artery disease, and previous history of DVT. One patient was diagnosed with a small bowel carcinoid, two patients with renal hypernephroma, and one patient with prostate cancer. After an average time of 3 months, patients underwent a definitive procedure in accordance to their type of malignancy. There were neither postoperative complications nor mortality. CONCLUSIONS Laparoscopic sleeve gastrectomy is a safe and reasonable approach to effectively reduce weight in order to allow morbidly obese patients with early stage malignancies to undergo a second oncologic procedure.
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Affiliation(s)
- Melissa Gianos
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Keum N, Ju W, Lee DH, Ding EL, Hsieh CC, Goodman JE, Giovannucci EL. Leisure-time physical activity and endometrial cancer risk: Dose-response meta-analysis of epidemiological studies. Int J Cancer 2014; 135:682-94. [DOI: 10.1002/ijc.28687] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/08/2013] [Accepted: 12/11/2013] [Indexed: 12/20/2022]
Affiliation(s)
- NaNa Keum
- Department of Nutrition; Harvard School of Public Health; Boston MA
- Department of Epidemiology; Harvard School of Public Health; Boston MA
| | - Woong Ju
- Department of Obstetrics and Gynecology; Ewha Womans University, School of Medicine; Seoul Republic of Korea
| | - Dong Hoon Lee
- Department of Epidemiology; Harvard School of Public Health; Boston MA
| | - Eric L. Ding
- Department of Epidemiology; Harvard School of Public Health; Boston MA
| | - Chung C. Hsieh
- Department of Epidemiology; Harvard School of Public Health; Boston MA
| | - Julie E. Goodman
- Department of Epidemiology; Harvard School of Public Health; Boston MA
| | - Edward L. Giovannucci
- Department of Nutrition; Harvard School of Public Health; Boston MA
- Department of Epidemiology; Harvard School of Public Health; Boston MA
- Channing Division of Network Medicine Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston MA
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Abstract
Medical authorities advise US adults to perform a minimum of 30 minutes of moderate-intensity aerobic physical activity on most days of the week to improve health and reduce risk for many chronic conditions. New findings from epidemiologic studies suggest that physical activity not only reduces the risk of developing coronary heart disease, stroke, and type 2 diabetes but also may prevent certain cancers (including colon and breast cancer), osteoporotic fracture, falls, cognitive decline, mood disturbances, and adverse pregnancy outcomes. Physical activity is important for regulating body weight, but many cardiometabolic benefits of exercise are independent of such regulation. This article reviews recent epidemiologic evidence on physical activity with respect to a variety of health outcomes in women and concludes with guidance for clinicians seeking to boost activity levels in sedentary patients. However, additional research is needed on features of individual- and community-based interventions and policies that successfully promote healthful levels of physical activity.
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Affiliation(s)
- Shari S. Bassuk
- Division of Preventive Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
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Duska LR, Fader AN, Dizon DS. Survivorship in gynecologic cancer: enduring the treatment toward a new normal. Am Soc Clin Oncol Educ Book 2014:e288-e294. [PMID: 24857115 DOI: 10.14694/edbook_am.2014.34.e288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Women are living longer after a cancer diagnosis because of advances in early detection and treatment. However, although our ability to effectively treat gynecologic malignancies has improved, survivors of gynecologic cancer often face profound physical, emotional, sexual, and psychosocial challenges as a result of their cancer diagnosis and treatment. In this article, we discuss how patient comorbidities (i.e., obesity) and cancer treatment effects may adversely affect sexual health outcomes, gastrointestinal function, and general health among survivors of gynecologic cancer. The importance of a multidisciplinary, patient-centered approach to survivorship care is emphasized.
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Affiliation(s)
- Linda R Duska
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Amanda N Fader
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Don S Dizon
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Du M, Kraft P, Eliassen AH, Giovannucci E, Hankinson SE, De Vivo I. Physical activity and risk of endometrial adenocarcinoma in the Nurses' Health Study. Int J Cancer 2013; 134:2707-16. [PMID: 24213924 DOI: 10.1002/ijc.28599] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/22/2013] [Indexed: 11/10/2022]
Abstract
Studies suggest that greater physical activity may reduce endometrial cancer risk. However, the role of the timing, duration and intensity of activity is unclear. We therefore examined recent and past recreational activities in relation to incident endometrial adenocarcinoma, and compared the importance of total and moderate- or vigorous-intensity activities as well as walking. We analyzed data from 71,570 women in the Nurses' Health Study, a prospective cohort that assessed activity in 1986, with updates every 2-4 years. Cox proportional hazards models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). During follow-up from 1986 to 2008 (1.2 million person-years), 777 invasive endometrial adenocarcinoma cases were documented. In multivariable models, compared with <3 MET-hr/week (<1 hr/week walking), women engaged in moderate (9 to <18 MET-hr/week: RR = 0.61, 95% CI: 0.48-0.78) or high (≥27 MET-hr/week: RR = 0.73, 95% CI: 0.58-0.92) amounts of recent total recreational activity were at reduced risk (p-trend = 0.001). Past total activity was not associated with risk. Greater recent moderate- or vigorous-intensity activity was associated with reduced risk (≥4 vs. 0 hr/week: RR = 0.65, 95% CI: 0.47-0.88, p-trend = 0.002). Among women who did not perform any vigorous activity, recent walking was associated with reduced risk (≥3 vs. <0.5 hr/week: RR = 0.65, 95% CI: 0.45-0.93, p-trend = 0.01), and faster walking pace was independently associated with risk reduction. After additional adjustment for body mass index, all associations were statistically non-significant. Greater recent physical activity, including activity of moderate duration and intensity such as walking, may reduce endometrial adenocarcinoma risk. This relation is largely mediated or confounded by body mass index.
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Affiliation(s)
- Mengmeng Du
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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King B, Jiang Y, Su X, Xu J, Xie L, Standard J, Wang W. Weight control, endocrine hormones and cancer prevention. Exp Biol Med (Maywood) 2013; 238:502-8. [PMID: 23856901 DOI: 10.1177/1535370213480695] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The prevalence of obesity is increasing which becomes worrisome due to its association with several diseases and certain types of cancers. While weight control through dietary caloric restriction and/or physical activity protects against cancer in animal models, the underlying mechanisms are not fully defined. Weight loss due to negative energy balance is associated with alterations of multiple growth factors and endocrine hormones. The altered hormones and hormone-related functions appear to be responsible for anti-cancer mechanisms. In this review, we summarize the recent studies related to weight loss and the altered endocrine hormones, focusing on the reduced levels of the mitogenic insulin-like growth factor 1 (IGF-1) and adipokine leptin as well as the raised levels of adiponectin and glucocorticoids. The potential molecular targets of these hormone-dependent signalling pathways are also discussed. Considering the increasing trends of obesity throughout the world, a better understanding of the underlying mechanisms between body weight, endocrine hormones and cancer risk may lead to novel approaches to cancer prevention and treatment.
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Affiliation(s)
- Brenee King
- Department of Human Nutrition, Kansas State University, Manhattan, KS 66506, USA
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Dieli-Conwright CM, Ma H, Lacey JV, Henderson KD, Neuhausen S, Horn-Ross PL, Deapen D, Sullivan-Halley J, Bernstein L. Long-term and baseline recreational physical activity and risk of endometrial cancer: the California Teachers Study. Br J Cancer 2013; 109:761-8. [PMID: 23860525 PMCID: PMC3738142 DOI: 10.1038/bjc.2013.61] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 01/02/2013] [Accepted: 05/28/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Physical activity may be associated with decreasing endometrial cancer risk; it remains unclear whether the association is modified by body size. METHODS Among 93 888 eligible California Teachers Study participants, 976 were diagnosed with incident endometrial cancer between 1995-1996 and 2007. Cox proportional hazards regression methods were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for endometrial cancer associated with long-term (high school through age 54 years) and baseline (3 years prior to joining the cohort) strenuous and moderate recreational physical activity, overall and by body size. RESULTS Increased baseline strenuous recreational physical activity was associated with decreased endometrial cancer risk (Ptrend=0.006) with approximately 25% lower risk among women exercising >3 h per week per year than among those exercising <1/2 h per week per year (RR, 0.76; 95% CI, 0.63-0.92). This inverse association was observed among overweight/obese women (body mass index ≥25 kg m(-2); Ptrend=0.006), but not among thinner women (Ptrend=0.12). Baseline moderate activity was associated with lower risk among overweight/obese women. CONCLUSION Increasing physical activity, particularly strenuous activity, may be a lifestyle change that overweight and obese women can implement to reduce their endometrial cancer risk.
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Affiliation(s)
- C M Dieli-Conwright
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.
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Lynch BM, Dunstan DW, Vallance JK, Owen N. Don't take cancer sitting down. Cancer 2013; 119:1928-35. [DOI: 10.1002/cncr.28028] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 01/30/2013] [Accepted: 01/31/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Brigid M. Lynch
- Physical Activity Laboratory; Baker IDI Heart and Diabetes Institute; Melbourne Victoria Australia
- Melbourne School of Population Health; Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - David W. Dunstan
- Physical Activity Laboratory; Baker IDI Heart and Diabetes Institute; Melbourne Victoria Australia
- School of Population Health; The University of Queensland; Brisbane Queensland Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- School of Exercise and Nutrition Sciences; Deakin University; Melbourne Victoria Australia
| | - Jeff K. Vallance
- Faculty of Health Disciplines; Athabasca University; Athabasca Alberta Canada
| | - Neville Owen
- Melbourne School of Population Health; Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- School of Population Health; The University of Queensland; Brisbane Queensland Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Behavioral Epidemiology Laboratory; Baker IDI Heart and Diabetes Institute; Melbourne Victoria Australia
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Peeters GMEEG, Burton NW, Brown WJ. Associations between sitting time and a range of symptoms in mid-age women. Prev Med 2013; 56:135-41. [PMID: 23262361 DOI: 10.1016/j.ypmed.2012.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/18/2012] [Accepted: 12/09/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to explore longitudinal associations between sitting and physical and psychological symptoms in mid-age women. METHOD Mid-age (53-58 years) participants in the Australian Longitudinal Study on Women's Health completed mail surveys in 2004 (n=10,286), 2007 (n=10,128) and 2010 (n=9452) with questions about sitting time (<6, 6-9, and ≥ 9 h/day) and frequency of 19 symptoms in the preceding 12 months (often vs. never/rarely/sometimes). Associations between sitting and symptoms were examined using two logistic generalized estimating equations models: (a) sequential cross-sectional data from 3 surveys, and (b) prospective model with a 3-year time lag (significance level=0.01). RESULTS Approximately 53%, 30% and 17% of the women were classified as sitting <6, 6-9 and ≥ 9 h/day in 2004. In adjusted cross-sectional models, women sitting ≥ 9 h/day had significantly higher odds of breathing difficulties (OR=1.52, 99% CI=1.17-2.00), tiredness (OR=1.21, CI=1.05-1.40), bowel problems (OR=1.26, CI=1.02-1.56), eyesight problems (OR=1.16, CI=1.01-1.34), and depression (OR=1.39, CI=1.15-1.68) than women sitting <6h/day. Adjusted prospective models showed higher odds of breathing difficulties (OR=1.94, CI=1.40-2.69), chest pain (OR=2.04, CI=1.14-3.70), and tiredness (OR=1.24, CI=1.04-1.48). Associations with breathing difficulties and chest pain remained significant after excluding participants with chronic conditions in 2004. CONCLUSION Prolonged sitting may a determinant of breathing difficulties and chest pain three years later in mid-age women.
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Affiliation(s)
- G M E E Geeske Peeters
- The University of Queensland, School of Human Movement Studies, St Lucia Queensland 4072, Australia.
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Campagnoli C, Abbà C, Ambroggio S, Brucato T, Pasanisi P. Life-style and metformin for the prevention of endometrial pathology in postmenopausal women. Gynecol Endocrinol 2013; 29:119-24. [PMID: 22946682 DOI: 10.3109/09513590.2012.706671] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In western women, the endometrium is frequently exposed, even after menopause, to the endogenous hormonal stimulation. Such a stimulation increases the risk of pathologic conditions such as endometrial hyperplasia and type I (endometrioid) endometrial adenocarcinoma. Metabolic syndrome, obesity, insulin resistance and type II diabetes promote the endometrial stimulation, and are recognized risk factors for endometrial cancer. Furthermore, chronic hyperinsulinemia linked both to obesity and metabolic syndrome influences endometrial proliferation through direct and indirect actions. Intentional weight loss, calorie restriction and physical activity are associated with a reduced risk of the endometrial pathology. Biological mechanisms include reduction in insulin and sex steroid hormone levels. In addition to life-style modifications, the antidiabetic metformin may be proposed as preventive agent. Metformin reduces the metabolic syndrome, lowers insulin and testosterone levels in postmenopausal women, and it is a potent inhibitor of endometrial cancer cell proliferation.
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Affiliation(s)
- Carlo Campagnoli
- Unit of Endocrinological Gynecology, Ospedale Ginecologico Sant' Anna, Turin, Italy
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Bittoni MA, Fisher JL, Fowler JM, Maxwell GL, Paskett ED. Assessment of the effects of severe obesity and lifestyle risk factors on stage of endometrial cancer. Cancer Epidemiol Biomarkers Prev 2012; 22:76-81. [PMID: 23118146 DOI: 10.1158/1055-9965.epi-12-0843] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lifestyle risk factors, including obesity, have been associated with increased risk of endometrial cancer (EC). Women with higher obesity levels tend to have less aggressive EC disease stage and histology. This study further investigated associations between nonmodifiable risk factors, such as age, race, and grade, and modifiable lifestyle factors, such as diet and physical activity expenditure, in relation to severe obesity and late versus early EC stage at diagnosis. METHODS Demographic, anthropometric, and lifestyle surveys were administered to 177 women with histologically confirmed EC. Logistic regression analyses assessed the relationship between obesity and other risk factors on EC stage at diagnosis. RESULTS In multivariate models, body mass index (BMI) < 35 was not significantly associated with late EC stage at diagnosis (OR = 1.67, P = 0.219) when adjusting for grade and age. Grade was significantly associated with EC stage when controlling for BMI and age (OR = 8.48, P = .000). Women more than the age of 60 had a fourfold increased risk of diagnosis at late versus early EC stage when adjusting for other risk factors. Age had a confounding effect on the obesity-EC stage association. CONCLUSIONS Our results corroborate those of past studies showing that BMI is not an independent risk factor for EC stage and that age may have confounded the obesity-EC stage association. Because of mixed results and implications for treatment outcomes, however, further research examining these variables is warranted. IMPACT Our results provide further insight into the obesity EC-stage association, especially the confounding effect of age. Future studies should examine modifiable lifestyle factors in larger and more diverse populations.
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Affiliation(s)
- Marisa A Bittoni
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
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Meredith I, Sarfati D, Ikeda T, Atkinson J, Blakely T. High rates of endometrial cancer among Pacific women in New Zealand: the role of diabetes, physical inactivity, and obesity. Cancer Causes Control 2012; 23:875-85. [PMID: 22527165 DOI: 10.1007/s10552-012-9956-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 04/05/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the endometrial cancer rates, and the proportion attributable to diabetes mellitus (DM), physical inactivity, and overweight/obesity, by ethnicity with a focus on Pacific women in New Zealand. METHODS Linked census-cancer records (1981-2004) were used to determine incidence rates of endometrial cancer by ethnicity. Health survey data (2006-2007) were used to determine risk factor prevalence by ethnicity. Relative risks for the association between diabetes, obesity, physical inactivity and endometrial cancer were sourced from published studies. Population attributable risk (PAR) methods, with Monte Carlo simulation, were used to estimate the PAR% by ethnicity and applied to 2001-2004 cancer rates. RESULTS Pacific women had 2.61 (95 % confidence interval 2.22-3.05) times the endometrial cancer rate of European/Other women pooled over time, and the most rapidly increasing rates over time with the rate ratio increasing from 1.96 (1.14-3.37) in 1981/1986 to 3.78 (3.03-4.71) in 2001/2004 (p for trend = 0.14). Pacific women had the highest PAR% for DM, physical inactivity, and overweight/obesity (63.1 %), followed by Māori (58.6 %) and European/Other (48.6 %). Applying these PAR% to 2001-2004 endometrial cancer rates, the rate ratio comparing Pacific to European/Other endometrial cancer reduced from 3.8 for total cancer (attributable plus non-attributable) to 2.3 for non-attributable cancer, and the rate difference reduced by 79 % from 51 to 11 per 100,000. CONCLUSIONS Pacific women have high endometrial cancer rates in New Zealand. Some, but not all, of the ethnic inequalities were explained by measured differences in obesity/overweight, DM, and physical inactivity.
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Affiliation(s)
- Ineke Meredith
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
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Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2012; 62:30-67. [PMID: 22237782 DOI: 10.3322/caac.20140] [Citation(s) in RCA: 868] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The American Cancer Society (ACS) publishes Nutrition and Physical Activity Guidelines to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. These Guidelines, published approximately every 5 years, are developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and they reflect the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS Guidelines focus on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. The ACS Guidelines are consistent with guidelines from the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes, as well as for general health promotion, as defined by the 2010 Dietary Guidelines for Americans and the 2008 Physical Activity Guidelines for Americans.
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SCHMANDT RE, IGLESIAS DA, CO NN, LU KH. Understanding obesity and endometrial cancer risk: opportunities for prevention. Am J Obstet Gynecol 2011; 205:518-25. [PMID: 21802066 PMCID: PMC4264838 DOI: 10.1016/j.ajog.2011.05.042] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/05/2011] [Accepted: 05/30/2011] [Indexed: 12/28/2022]
Abstract
Worldwide, obesity has become a major public health crisis. Overweight and obesity not only increase the risk of cardiovascular disease and type-2 diabetes mellitus but also are now known risk factors for a variety of cancer types. Among all cancers, increasing body mass index is associated most strongly with endometrial cancer incidence and death. The molecular mechanisms underlying how adipose tissue and obesity contribute to the pathogenesis of endometrial cancer are becoming better understood and have revealed a number of rational strategies, both behavioral and pharmaceutical, for the prevention of both primary and recurrent disease.
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Affiliation(s)
- Rosemarie E. SCHMANDT
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David A. IGLESIAS
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ngai Na CO
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen H. LU
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011. Am J Prev Med 2011; 41:207-15. [PMID: 21767729 DOI: 10.1016/j.amepre.2011.05.004] [Citation(s) in RCA: 955] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 04/14/2011] [Accepted: 05/05/2011] [Indexed: 11/26/2022]
Abstract
CONTEXT To systematically review and provide an informative synthesis of findings from longitudinal studies published since 1996 reporting on relationships between self-reported sedentary behavior and device-based measures of sedentary time with health-related outcomes in adults. EVIDENCE ACQUISITION Studies published between 1996 and January 2011 were identified by examining existing literature reviews and by systematic searches in Web of Science, MEDLINE, PubMed, and PsycINFO. English-written articles were selected according to study design, targeted behavior, and health outcome. EVIDENCE SYNTHESIS Forty-eight articles met the inclusion criteria; of these, 46 incorporated self-reported measures including total sitting time; TV viewing time only; TV viewing time and other screen-time behaviors; and TV viewing time plus other sedentary behaviors. Findings indicate a consistent relationship of self-reported sedentary behavior with mortality and with weight gain from childhood to the adult years. However, findings were mixed for associations with disease incidence, weight gain during adulthood, and cardiometabolic risk. Of the three studies that used device-based measures of sedentary time, one showed that markers of obesity predicted sedentary time, whereas inconclusive findings have been observed for markers of insulin resistance. CONCLUSIONS There is a growing body of evidence that sedentary behavior may be a distinct risk factor, independent of physical activity, for multiple adverse health outcomes in adults. Prospective studies using device-based measures are required to provide a clearer understanding of the impact of sedentary time on health outcomes.
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Affiliation(s)
- Alicia A Thorp
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Al-Jarrah M, Matalka I, Aseri HA, Mohtaseb A, Smirnova IV, Novikova L, Stehno-Bittel L, Alkhateeb A. Exercise training prevents endometrial hyperplasia and biomarkers for endometrial cancer in rat model of type 1 diabetes. J Clin Med Res 2011; 2:207-14. [PMID: 21629542 PMCID: PMC3104659 DOI: 10.4021/jocmr444e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2010] [Indexed: 12/13/2022] Open
Abstract
Background Endometrial cancer is one of the most common types of gynecologic cancers. The ability of exercise to reduce the risk of endometrial cancer in women with type 2 diabetes has been established, but no studies have examined this link in type 1 diabetes.A randomized, controlled animal study was designed using a standard rat model of type 1 diabetes. The goal of this study was to investigate the ability of exercise to prevent increased levels of endometrial cancer biomarkers, estrogen receptor (ERα) and p16, and endometrial hyperplasia associated with diabetes. Methods Forty female rats were randomized into four groups: sedentary control, exercise control, sedentary or exercised diabetic. Diabetes was induced by alloxan injection. A 4-week treadmill training program was initiated with the development of diabetes. Endometrial tissues were evaluated for hyperplasia and ERα and p16 levels and subcellular localization using microscopy. Results Severe diabetes lead to hyperplasia in the endometrial tissue in 70% of sedentary diabetic rats. Exercise-trained diabetic rats and the non-diabetic rats displayed no hyperplasia. The expression of ERα increased significantly (p < 0.02) while the expression level of p16 decreased significantly (p < 0.04) in the diabetic sedentary group compared to the non-diabetic groups. Exercise training led to a reversal in the percentage of p16 and ERα positive cells in diabetic rats. Conclusions Severe diabetes leads to hyperplasia of the endometrial tissue and increased ERα levels and decreased p16 levels in rats, which can be prevented with aerobic exercise. Keywords Diabetes; Estrogen receptor alpha; P16; Endometrial hyperplasia; Endometrial cancer; Exercise
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Affiliation(s)
- Muhammed Al-Jarrah
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Jordan
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