Breaking News
February 20, 2018 - Lab-grown cerebellar cells may help explain how ASD develops at molecular level
February 20, 2018 - New Treatment Apalutamide (Erleada) Approved for Prostate Cancer That Resists Hormone Therapy
February 20, 2018 - Do You Really Need My Signature on That?
February 20, 2018 - HIV-1 genetic diversity is higher in vaginal tract than in blood during early infection
February 20, 2018 - Diabetes does not increase work-loss years due to early retirement
February 20, 2018 - Researchers aim to find out how PTSD affects decisions of police
February 20, 2018 - UH Cleveland Medical Center explores novel treatments for uterine fibroids
February 20, 2018 - Flu Vax Efficacy 25% Against Predominant H3N2 Strain So Far
February 20, 2018 - HIV screening most optimal at 25 years of age if no risk factors
February 20, 2018 - Loyola Medicine primary care physician offers advice to minimize risk of flu
February 20, 2018 - Safe sleep recommendations for parents that may help reduce child’s risk of SUID
February 20, 2018 - Why Do So Few Docs Have Buprenorphine Waivers?
February 20, 2018 - Low levels of alcohol good for the brain
February 20, 2018 - Experimental treatment improves invisible symptoms of a man with spinal cord injury
February 20, 2018 - Myriad’s EndoPredict offers better prediction of breast cancer recurrence, analysis shows
February 20, 2018 - Researchers identify fifteen genes that determine our facial features
February 20, 2018 - Morning Break: New Health IT Player; Luxturna No Bargain; Nuclear Freakout
February 20, 2018 - How does it compare? Hospice care at home, at assisted living facility, at nursing home
February 19, 2018 - Scientists develop water-soluble warped nanographene for bioimaging
February 19, 2018 - It’s Not Your Imagination: You’re Hungrier After Losing Weight
February 19, 2018 - Antihypertensive Use At Delivery Rising in Preeclampsia
February 19, 2018 - A centuries-old math equation used to solve a modern-day genetics challenge
February 19, 2018 - Liquid biopsies could be used as new predictive marker for metastatic TNBC
February 19, 2018 - Russian researchers develop new multi-layered biodegradable scaffolds
February 19, 2018 - Are ‘Vaccine Skeptics’ Responsible for Flu Deaths?
February 19, 2018 - Hidden genetic effects behind immune diseases may be missed, study suggests
February 19, 2018 - Emergency nurses experience regular verbal and physical abuse
February 19, 2018 - Study sheds light on biology that guides behavior across different stages of life
February 19, 2018 - Morning Break: Transgender Breast Feeding; Brazilian ‘Pro-Vaxxers’; Post-Stroke Exercise
February 19, 2018 - Meningitis vaccination strategy in Africa found to be effective, economical
February 19, 2018 - Researchers uncover how excess calcium may influence development of Parkinson’s disease
February 19, 2018 - Psoriasis drug also effective at reducing aortic inflammation
February 19, 2018 - Excess emissions can make serious contributions to air pollution, study shows
February 19, 2018 - Researchers reveal potential biological roots behind individuality
February 19, 2018 - Diabetes Drugs Differ on HF; School-Based Obesity Program Flop; Plaque Type in ACS
February 19, 2018 - Surgical infections linked to drug-resistant bugs, study suggests
February 19, 2018 - Poor awareness may hinder a child’s early dental care
February 19, 2018 - Research finds rising trend in incidence of merkel cell carcinoma
February 19, 2018 - Researchers uncover Ras protein’s role in uncontrolled cancer growth
February 19, 2018 - FDA Approves Apalutamide (Erleada) to Help Curb a Tough-to-Treat Prostate Cancer
February 19, 2018 - Educational Tool Boosts Cervical Length Screening
February 19, 2018 - Spider’s web inspires removable implant that may control type 1 diabetes
February 19, 2018 - Scientists develop fluorescent probe to identify cancer stem cells
February 19, 2018 - University Hospital of Santiago de Compostela participates in large pancreatic cancer study
February 19, 2018 - New blood test shows promise to revolutionize diagnosis of tick-borne diseases
February 19, 2018 - Report: Use, Not Price, Drives State Health Costs
February 19, 2018 - Emergency services crews often unprepared for diabetic crises
February 19, 2018 - Scientists in Sweden create DNA nanowires that offer hope for treatment of diseases
February 19, 2018 - ID Break: Clean Hands, Fewer Abx; $11 Million HIV Cure?; MenB Vax for Kids
February 19, 2018 - Patient exposure to X-rays depends on how dentists are paid
February 19, 2018 - Study reveals parents’ views toward children’s tanning bed use
February 19, 2018 - Shot may help reduce risk of shingles
February 19, 2018 - FDA approves first treatment to reduce risk of NSCLC progression
February 19, 2018 - FDA Expands Approval of Imfinzi (durvalumab) to Reduce the Risk of Non-Small Cell Lung Cancer Progressing
February 19, 2018 - D.C. Week: Congress Passes Spending Bill
February 19, 2018 - Heart-muscle patches made with human cells improve heart attack recovery
February 19, 2018 - FDA Approves First Blood Test to Detect Concussions
February 19, 2018 - Survival Bump in Bladder Cancer with Keytruda
February 18, 2018 - Scientists describe the mechanism of heart regeneration in the zebrafish
February 18, 2018 - Scientists uncover the structure of microtubule motor proteins
February 18, 2018 - Light-activated cancer drugs without toxic side effects are closer to becoming reality
February 18, 2018 - Pioneering research could provide novel insight into how genomic information is read
February 18, 2018 - Pearls From: David Putrino, PhD
February 18, 2018 - Researchers uncover how cancer stem cells drive triple-negative breast cancer
February 18, 2018 - Morning Break: Anti-Anti-Vaxxers; Private Piercings Prohibited; A Case for Pelvic Massage
February 18, 2018 - Lower-dose radiation effective, safe for HPV+ head and neck cancer after induction chemo
February 18, 2018 - Specialist residential service for adults with autism opens in Swansea
February 18, 2018 - FDA Moves to Limit Loperamide Doses per Package
February 18, 2018 - Alcohol use disorder – Genetics Home Reference
February 18, 2018 - Autism might be better detected using new two-minute questionnaire
February 18, 2018 - Hand hygiene-intervention practices may reduce risk of infection among nursing home patients
February 18, 2018 - Researchers develop most sophisticated mini-livers to date
February 18, 2018 - Obamacare Helped More Young Women Get Prenatal Care: Study
February 18, 2018 - School-Based Program Fails to Dent Kids’ Obesity
February 18, 2018 - Research compares neural activity in children with and without autism spectrum disorder
February 18, 2018 - Poor fitness levels increase the risk dementia, concludes study
February 18, 2018 - Risk Score May Reveal if Kids are Victims of Ill-Treatment
February 18, 2018 - Adding Folic Acid to Corn Masa Flour May Prevent Birth Defects
February 18, 2018 - Acute treatment suppresses posttraumatic arthritis in ankle injury
February 18, 2018 - A Role for Budesonide in Autoimmune Hepatitis?
Excess Weight Boosts Cervical Cancer Risk

Excess Weight Boosts Cervical Cancer Risk

image_pdfDownload PDFimage_print

Action Points

  • In a large population screened for cervical cancer with state-of-the art techniques, overweight and obese women had a lower rate of precancer but an elevated risk of invasive cervical cancer.
  • Note that the findings are likely due to the failure to detect precancer in women with a high body mass index.

In a large population screened for cervical cancer with state-of-the art techniques, overweight and obese women had a lower rate of precancer but an elevated risk of invasive cervical cancer. The findings are likely due to the failure to detect precancer in women with a high body mass index (BMI), the researchers said.

Obese women had the lowest 5-year risk of precancer at 0.51% (95% CI 0.48-0.54) versus 0.73% (95% CI 0.70-0.76) for their normal or underweight counterparts (P trend <0.001). Overweight women also had a lower rate: 0.61% (95% CI 0.58-0.64). But obese women had the highest 5-year cancer risk at 0.083% (95% CI 0.072-0.096) compared with 0.056% (95% CI 0.048-0.066) in normal or underweight women (P trend <0.001).

In the study, published online in the Journal of Clinical Oncology, the investigators suggested that detecting precancerous lesions in these weight categories may be challenging with routine screening, but better techniques and equipment to ensure adequate cervical biopsies and visualization could potentially reduce the incidence of cervical cancer in heavy women.

Led by epidemiologist Megan A. Clarke, PhD, MHS, of the National Cancer Institute in Bethesda, MD, the retrospective cohort study looked at 944,227 women ages 30 to 64 who underwent cytology and human papillomavirus (HPV) DNA testing at Kaiser Permanente Northern California during 2003-2015.

Using values recorded in the preceding 5 years, the researchers categorized BMI as normal/underweight (<25), overweight (25 to <30), or obese (>30). The patients were followed for a mean of 4.4 years, and most were ages 30 to 49; close to 40% were white, although heavy women were more likely to be black or Hispanic. About 6.3% were HPV-positive.

Overall, approximately 20% of cervical cancers were attributable to overweight or obesity.

A total of 4,489 women (0.48%) developed precursor cervical intraepithelial neoplasia 3 or adenocarcinoma in situ, and of these, 1,998 were classified as normal/underweight (44.4%); 1,339 as overweight (29.8%); and 1,152 as obese (25.6%). A total of 490 women (0.05%) were diagnosed with cancer, and of these, 149 were classified as normal/underweight (30.4%); 154 as overweight (31.4%); and 187 as obese (38.2%).

Patients thus appeared to have a lower risk of having clinical precursors of cervical cancer but a higher risk of invasive cancer with increasing BMI. The results were consistent in subgroups defined by age (30-49 versus 50-64), HPV status (positive versus negative), and histologic subtype (glandular versus squamous).

“Any risk factor associated with increased cervical cancer risk would also be expected to increase precancer risk, and likewise, a decreased precancer risk should lead to a corresponding decreased risk of cancer, Clarke and associates wrote. “Thus, the apparent paradoxical association of excess BMI with decreased risk of precancer, but increased risk of cancer is likely related to underdiagnosis of cervical precancer in overweight and obese patients who were screened for cervical cancer.”

Asked for his perspective, Don S. Dizon, MD, of Brown University and Lifespan Cancer Institute in Providence, RI, who was part of the study, said he agreed with the authors that the results are likely due to underdetection rather than a direct causal effect of obesity. He also agreed that screening heavy women is challenging from a practical standpoint: “Can the patient get on the table and into the stirrups? Can you find an appropriate speculum with adequate tensile stretch that will allow for direct visualization of the cervix?”

The pressure effect of obesity may lead to sampling errors, he explained: “Some Pap tests may not be done because direct visualization is not possible.”

Dizon also pointed out that the database study did not indicate what type of practitioner did the screening – i.e., a busy family doctor with 15 minutes per patient who does maybe one a week, or a gynecologist who does five or six a day? – and that variable can lead to sampling errors.

Clarke and colleagues noted that obesity-related screening or imaging problems have also emerged in prostate cancer, resulting in underdiagnosis, and have also been noted in radiology reports.

As for cause and effect, previous studies on the association of obesity and increased cervical cancer incidence and mortality have not been consistent, and most studies have lacked screening information or have not analyzed precancer endpoints separately, the researchers noted. And they stressed that while HPV vaccination is promising, screening will remain a preventive mainstay.

MedPage Today has reported on previous findings that obesity is a barrier to screening for cervical and breast cancers.

Clarke et al said that in light of the worldwide obesity epidemic, the findings highlight the need for greater awareness and the development of specific clinical recommendations for screening overweight and obese women.

“Whether existing equipment (e.g., speculum size) and procedures are adequate for visualization and sampling of the cervix in overweight and obese women requires further evaluation,” they wrote.

Dizon said that better tools will always be helpful, “but the important issue is that we need to provide good primary care for all Americans regardless of body size. And if you needed another reason why healthy eating habits, lifestyle, and activity should be stressed more within the U.S. general population, this may actually be it: If you have a higher BMI, we may not be able to give the proper surveillance to potentially catch cancer before it becomes invasive.”

The researchers noted that the study was limited by an inability to relate specific false-negative co-test and/or colposcopy results to cancer diagnosis, since the exact timing of cancer development versus detection was not always known. In addition, BMI data were missing for about 13% of the cohort. Furthermore, since women tend to gain weight over time, using 5-year median BMI at enrollment may have led to misclassification, thereby potentially underestimating a true association between obesity and cancer. Finally, there was no information about patient comorbidities.

The study was supported by the Intramural Research Program of the National Cancer Institute.

Clarke reported having no conflicts of interest. Two co-authors reported financial relationships with Teva, Bayer HealthCare, Roche, and Becton Dickinson.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner


last updated

Tagged with:

About author

Related Articles