1. Obesity and Cancer: The Link

2. The Panel’s Recommendation

3. Obesity and Cancer: The Evidence AICR/WCRF is continually updating the evidence Breast cancer update released in 2009 - 2007 expert report based on 873 studies - Update included additional 81 studies - Findings strengthened previous conclusions that women can reduce risk by maintaining low body fat, being physically active, drinking no alcohol and breastfeeding their children. Updates of colon and prostate cancer are now underway.

4. Obesity and Cancer: Mechanisms Adipose tissue is an active endocrine organ Mechanisms by which adipose tissue may influence cancer risk - Production of sex steroid hormones (e.g., estrogen, androgen) - Effects on insulin sensitivity and production of insulin-like growth factors - Actions on other hormones in adipose tissue (e.g., leptin, adiponectin) - Increases in oxidative stress and chronic low-grade inflammation that affect the body’s immune response

5. Developing the Preventability Estimates Several sources of data were used: –Current estimates of cancer incidence in the US and the actual number of cancer cancers –Survey data on the prevalence of rates of different levels of overweight/obesity in the US population –Estimates of the risk of developing specific cancers associated with these levels of overweight, based on key studies in the literature These data are combined to compute a population attributable fraction (PAF), and the estimated numbers of preventable cancers

6. Obesity and Cancer: Conclusions A healthy diet can help sustain a healthy weight and lower risk of cancers regular physical activity protects against the buildup of excess body fat and against cancer, independently

7. Lifestyle Habits and Breast Cancer Survival Higher BMI and lower physical activity are associated with a reduced risk of breast and colon cancer specific survival. Current cancer therapies do not address the association of obesity and sedentary lifestyle effects on prognosis. Obesity and physical inactivity are common before and after a breast cancer diagnosis.

8. Mortality from Cancer According to BMI for U.S. Women in the Cancer Prevention Study II Calle, E. et al. N Engl J Med 2003;348:1625-1638

9. Weight and Survival in Early-Stage Breast Cancer BMI (kg/m 2 ) Estimated Relative Risk of Adverse Event 20304050 0 5 10 15 25354555 Distant Recurrence, p=0.0005 Death, p=0.0007 Goodwin et al, JCO 2002

10. Nurses’ Health Study: Physical activity after breast cancer diagnosis MET-Hrs/week *p=0.05, # p<0.004 MET-hr/wk Holmes M et al JAMA 2005 P =.05 HR P=.004P =.003

11. The HEAL Study: Physical Activity after Diagnosis Hazard Ratio for Death MET-hr/wk Irwin ML et al JCO, 2008. P =.04P =.46

12. Benefits of Increasing Post-Diagnosis PA Need to encourage cancer survivors to maintain (if active prior to diagnosis) or increase physical activity after diagnosis.Need to encourage cancer survivors to maintain (if active prior to diagnosis) or increase physical activity after diagnosis. Physical activity is associated with numerous benefitsPhysical activity is associated with numerous benefits –Decreasing adverse side effects of surgery and treatment –Improving quality of life and fatigue –Improving fitness, functional capacity, and body composition –Decreasing serum hormones and growth factors –Improving cancer-specific survival and all cause survival

13. 2009 Cancer Risk Awareness

14. OBESITY Percentage of Americans who Believe it to be a Cause of Cancer Year

15. Percentage of Americans Who Rate It Their #1 Health Concern

16. Percentage of Americans Who Consider It “Highly Preventable”