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    Interpreting the epidemiological evidence linking obesity and cancer: A framework for population-attributable risk estimations in Europe.

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    Authors
    Renehan, Andrew G
    Soerjomataram, Isabelle
    Leitzmann, Michael F
    Affiliation
    Department of Surgery, The Christie NHS Foundation Trust, School of Cancer and Enabling Sciences, University of Manchester, UK. arenehan@picr.man.ac.uk
    Issue Date
    2010-09
    
    Metadata
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    Abstract
    Standard approaches to estimating population-attributable risk (PAR) include modelling estimates of exposure prevalence and relative risk. Here, we examine the associations between body mass index (BMI) and cancer risk and how effect modifications of these associations impact on PAR estimates. In 2008, sex- and population-specific risk estimates were determined for associations with BMI in a standardised meta-analysis for 20 cancer types. Since then, refinements of these estimates have emerged: (i) absence of menopausal hormonal therapy (MHT) is associated with elevated BMI associations in post-menopausal breast, endometrial and ovarian cancers; (ii) current smoking attenuates the BMI associations in oesophageal squamous cell carcinoma, lung and pancreatic cancers; (iii) prostate screening attenuates BMI associations when all prostate cancers are considered together; and (iv) BMI is differentially associated with different histological subtypes within the same cancer group. Using secondary analyses of the aforementioned meta-analysis, we show 2-3-fold shifts in PAR estimations for breast and endometrial cancers depending on the MHT usage in European countries. We also critically examine how to best handle exposures (in this example, BMI distributions) and relative risk estimates in PAR models, and argue in favour of a counterfactual approach based around BMI means. From these observations, we develop a research framework in which to optimally evaluate future trends in numbers of new cancers attributable to excess BMI. Overall, this framework gives conservative estimates for PAR - nonetheless, the numbers of avoidable cancers across Europe through avoidance of excess weight are substantial.
    Citation
    Interpreting the epidemiological evidence linking obesity and cancer: A framework for population-attributable risk estimations in Europe. 2010, 46 (14):2581-92 Eur J Cancer
    Journal
    European Journal of Cancer
    URI
    http://hdl.handle.net/10541/112865
    DOI
    10.1016/j.ejca.2010.07.052
    PubMed ID
    20843487
    Type
    Article
    Language
    en
    ISSN
    1879-0852
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ejca.2010.07.052
    Scopus Count
    Collections
    All Christie Publications
    Surgery

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