MDNews - Greater Kansas

"There was a dose-response relationship," Jemal says. "As age decreased, the rate of increase in the incidence rates increased [in a] stepwise fashion." That surprised the researchers, who had not expected to see such a marked association between decreasing age and increasing incidence rates in so many obesity-related cancers. For certain cancers, including endometrial, colorectal and pancreas, millennials' incidence rates were nearly twice as high as baby boomers' had been at the same age. Incidence rates in all but two of the 18 non-obesity-related cancers declined or held steady in successively younger groups, likely due to a decline in risk factors, such as smoking and certain infections, including HIV, that are associated with some of those cancers. The study appeared in The Lancet Public Health. PORTENTS OF TROUBLE Jemal says if the trends his group's study describes continue, progress researchers and clinicians have made in combating cancer may come to a halt. He is not alone in that concern. "[W]ith the increasing obesity pandemic worldwide, it means we're going to be seeing a lot of cancer at a much earlier age, and we're going to have all of the comorbidities associated with cancer," says Nathan Berger, MD, Hanna-Payne Professor of Experimental Medicine and Distinguished University Professor at Case Western Reserve University in Cleveland, who was not involved with Jemal's study. "We're going to have a lot more very critically ill young people. A lot of these cancers in young people are getting diagnosed late, so they're much harder ... and more expensive to treat. [Cancer] is going to be affecting people who should be in their prime in terms of raising a family and [contributing] in the workforce." Kenneth Carson, MD, PhD, Assistant Professor in the Department of Medicine, Oncology Division, Medical Oncology at Washington University School of Medicine in St. Louis, believes progress in the realms of early detection and more effective cancer treatments could be overwhelmed by higher incidences. Dr. Carson, who was not involved in the study, says that necessitates rethinking medicine's current approach to obesity prevention and management in young people. "[T]he guidelines and recommendations and having a physician say, 'You know, you really need to lose weight,' aren't moving the needle," Dr. Carson says. "[Obesity] is a very difficult disease to combat, so it may require drastic measures like bariatric surgery in order to make real headway." n Next Step: Etiologic Studies A HMEDIN JEM A L , DV M, PHD, Vice President of the Surveillance and Health Services Research Program at the American Cancer Society, and his col- leagues are investigating whether the pattern they discovered in a recent study — a progressively steeper increase in incidence rates for cer- tain obesity-associated cancers in successively younger age groups in the U.S. — holds true in other countries as well. In the meantime, Jemal says, additional studies are necessary to build on his team's descrip- tive work. "Diabetes ... is a risk factor for some of the obesity-related cancers," he says. "Is it because of diabetes [that these cancers are increasing]? We don't know. Is it because of diet, ... or are there other factors that are related to obesity that may be contributing to this increase? This study raises questions that should be addressed by etiologic studies." With better understanding of obesity-associated risk factors that may contribute to cancer, Jemal says, clinicians can devise potentially more effective preven- tive strategies. M D N E W S . C O M /// M D N E W S G R E AT E R K A N S A S ■ 2 019 1 7

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