Award: Category Award (Obesity)
Hisham Hussan, MD
Section of Intestinal Neoplasia and Hereditary Polyposis, Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center
Introduction: Roughly 40% of U.S. adults were obese in 2016 with a marked increase in the prevalence of young-onset obesity (Age < 50). Sufficient evidence links obesity to esophageal (EC), gastric (GC), colorectal (CRC) and pancreatic (PC) cancers. However, limited data exist on age-specific temporal changes in the incidence of these obesity-related cancers and corresponding surgical resection rates in obese patients.
Methods: We queried the 2002-2013 Surveillance, Epidemiology and End Results (SEER) and National Inpatient Sample (NIS) databases to identify the incidence of EC, GC, CRC and PC as well as their respective surgeries in obese (BMI ≥ 30 kg/m2) and non-obese patients. Joinpoint regression analysis was used to calculate average annual percentage change (APC) over time across age groups (18-49, 50-64, 65-74 and 75+ years old).
Results: SEER 2002-2013 (Figure 1): Cancer incidence increased in young adults (age < 50) with CRC (+1.8% then +0.8% per year, p<0.05) and GC(+0.7% per year, p<0.05), while it decreased incrementally with age in older groups. The incidence of PC increased annually across all age groups while that of EC decreased.
Using NIS 2002-2013, we identified 91,116 (7.16%) obese and 1,181,127 (92.84%) non-obese patients that had cancer resection surgeries, mainly for CRC (93.1%) then GC (4.4%) . The number of obese patients undergoing CRC and GC resections increased in all age groups over time (Figure 2), with the steepest rise in the 18-49 group for CRC (APC +13.1%, p<0.001) and 75+ year old patients for GC (APC +15.3%, p<0.001). This trend was opposite to a general temporal decrease in cancer resections in non-obese patients with CRC and GC. EC and PC resections also increased incrementally in obese patients within age groups younger than 75 (APC> 25% per year in the 50-74 years old group for PC and 65-74 group for EC) as in Figure 3. Conversely, we find a less pronounced temporal rise in cancer resection rates in the same age groups for non-obese patients with PC and EC.
Discussion: We identify an alarming temporal increase in the incidence of young-onset colorectal, gastric and across all age groups with pancreatic cancers in 2002-2013. There was a corresponding pronounced increase in rates of obese patients undergoing cancer resections in all obesity-related cancers. These findings strengthen a contributing role of obesity in etiology as well as the increasing incidence of these cancers and call for more efforts targeting obesity.