Original Research ArticleCancers in France in 2015 attributable to high body mass index
Introduction
Overweight and obesity are established risk factors for cancer and other chronic diseases with reports of an increasing prevalence over the past few decades in most parts of the world [1]. According to recent global estimates, about half a million cancer cases were attributable to a high body mass index (BMI) in the year 2012 alone [2]. To-date, the effects of this development have become most evident in high-income regions, including North America and Western Europe, where levels of overweight and obesity have been consistently high, in relative terms. However the prevalence of obesity (defined as BMI ≥ 30 kg/m2) continues to increase: in France, prevalence has doubled from 10% to 22% between 1975 and 2014, while in other Western European countries the increases are even more marked, in the UK, an estimated 28% of the population is currently obese [1].
Continuous updates of the literature have confirmed the association between overweight, obesity and the risk of oesophageal adenocarcinoma and cancers of the gastric cardia, colon, rectum, liver, gallbladder, pancreas, postmenopausal breast, ovary, endometrium and kidney [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. Additional cancer sites associated with overweight and obesity were recently identified by the International Agency for Research on Cancer (IARC) working group on the preventive effects of avoidance of excess body fatness on cancer risk [13].
In order to inform cancer control on a national level using most recent data, the aim of this study was to estimate the proportion and numbers of cancer cases attributable to high BMI in France in 2015 by cancer site and sex.
Section snippets
Exposure prevalence
Data on mean BMI in the French population by sex and age group (20–29, 30–39, 40–49, 50–59, 60–69, 70+ years) were obtained from measurements of height and weight of participants in the 2006 National Nutrition and Health Survey (Etude nationale nutrition santé, ENNS) (Table 1) [14]. ENNS is a nationally representative cross-sectional dietary and health survey conducted between February 2006 and March 2007 by the French Institute for Health Surveillance involving 3115 adults aged 18–74 residing
Results
Estimates of the population mean BMI and its associated prevalence of overweight and obesity in the adult French population in 2006 are presented in Table 1. The mean BMI in French men was 26.1 and in women 25.1 kg/m2, corresponding to an overall respective prevalence of overweight (BMI 25–29.9 kg/m2) and obesity (BMI ≥ 30 kg/m2) in French adults of 32% and 17%. Overweight was more prevalent in men relative to women (41 vs 24%) and more common at older relative to younger ages.
An estimated 18,639
Discussion
Of the greater than 350,000 new cancer cases estimated in France in 2015, over 18,500 were attributable to high BMI, corresponding to 5.3% of all cancer cases. This proportion was higher in women than in men (6.7% vs 4.1%) and varied considerably by cancer site, with the highest PAFs observed for oesophageal adenocarcinoma and corpus uteri cancer (37% and 34%, respectively). While PAFs were more moderate for postmenopausal breast (11%) and colon cancer (14%), these two sites contributed
Conclusion
In summary, we estimate that more than 18,500 cancer cases are caused by high BMI annually in France. In view of ongoing increases in the prevalence of adult obesity in France and worldwide [34], these results reinforce the necessity for prioritising the prevention of overweight and obesity in France and embedding such interventions in national cancer control plans in general. The consequences of the obesity epidemic and public health efforts to curb the increasing burden of associated cancers
Contributors
MA and IS contributed to data collection, study design, analysis, and wrote the first draft of the paper. VD contributed to study design, data collection and finalising the report. MT, LD, HF, FB and IM contributed to study design and drafting of the report. All authors read and approved the final report.
Funding
This work was funded by the French National Cancer Institute (INCa, grant nr. 2015-002). The funding source had no role in the collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication.
Conflict of interest
None declared.
Acknowledgements
The authors would like to thank Catherine Hill from Gustave Roussy (Villejuif) for critical input in several stages of the project and the team from FRANCIM for the provision of the cancer data.
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