Elsevier

Cancer Epidemiology

Volume 52, February 2018, Pages 15-19
Cancer Epidemiology

Original Research Article
Cancers in France in 2015 attributable to high body mass index

https://doi.org/10.1016/j.canep.2017.11.006Get rights and content

Highlights

  • The French have historically been reported to have low prevalence of obesity.

  • High BMI is today associated with 18,500 cancer cases, similar to the UK where obesity is prevalent.

  • Women were most impacted with 7% of all cancers attributable to obesity versus 4% among men.

  • Oesophageal adenocarcinoma has the highest attributable fraction (37%).

Abstract

Background

Overweight, as defined by high body mass index (BMI), is an established risk factor for various morbidities including cancer. Globally, its prevalence has increased markedly over the past decades. The aim of this study was to estimate the proportion and number of cancers that were attributable to high BMI in France in 2015.

Methods

Population attributable fractions (PAFs) and numbers of cancer cases attributable to high BMI (a population mean BMI above the optimum of 22 kg/m2) were estimated by age and sex, for cancer sites with convincing or probable evidence of an established causal link. Assuming a 10-year lag-period, PAFs were calculated using mean BMI estimates from a cross-sectional French population survey, and relative risk estimates from published meta-analyses.

Results

An estimated 18,639 cancer cases diagnosed in France in 2015 were attributable to high BMI, corresponding to 5.3% of all cancer cases (6.7% in women and 4.1% in men). This included 4507 cases of postmenopausal breast and 3380 cases of colon cancer. The highest estimated PAFs were for oesophageal adenocarcinoma and corpus uteri cancer (37% and 34%, respectively).

Conclusion

High BMI is associated with a substantial number of cancer cases in France, a country with a low but increasing prevalence of overweight and obesity when compared to other European countries. Assuming that the association between high BMI and cancer is causal, these results highlight the need to prioritise the prevention of this risk factor as part of cancer control planning in France and elsewhere in Europe.

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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