Recent unintentional weight loss linked to increase in short-term cancer risk
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Key takeaways:
- Recent weight loss correlated with increased cancer risk within the next 12 months.
- Most common form of cancer among individuals at risk are those of the upper gastrointestinal tract.
Health care professionals who experienced recent weight loss had a significantly higher risk for a cancer diagnosis during the subsequent 12 months, results of a prospective cohort analysis revealed.
The findings suggest an association between recent weight loss and increased short-term cancer risk, according to data published in JAMA.
Cancers of the upper gastrointestinal tract occurred most frequently among individuals with recent weight loss, according to study investigators.
“We wanted to assess whether cancers caused weight loss prior to diagnosis and what cancer types did this,” Brian M. Wolpin, MD, MPH, Robert T. and Judith B. Hale chair in pancreatic cancer at Dana-Farber Cancer Institute and professor of medicine at Harvard Medical School, told Healio.
“We also wanted to assess whether weight loss was intentional or unintentional based on changes in physical activity and diet,” he added. “The goal of this work was to help clinicians understand when recent weight loss should be of concern for cancer and what cancers would be most likely when recent unintentional weight loss develops.
Background and methodology
Rates of cancer among patients with recent weight loss in the subsequent 12 months are unclear when compared with individuals without recent weight loss. As a result, study investigators conducted two separate prospective cohort analyses of men and women to determine the rates of subsequent cancer diagnosis over 12 months among health care professionals with weight loss during the prior 2 years compared with those without recent weight loss.
Data included women 40 years or older (n = 111,912) from the Nurses’ Health Study who received follow-up from June 1978 to June 30, 2016, and men 40 years or older (n = 45,562) from the Health Professionals Follow-Up Study who received follow-up from January 1988 to Jan. 31, 2016.
Researchers calculated recent weight change from the participants weight, reported biennially; they categorized intentionality of weight loss as “high” if both physical activity and diet quality increased, “medium” if one increased, and “low” if neither increased.
They then determined rates of cancer diagnosis during the 12 months after weight loss to serve as the study’s primary outcome measurement.
Results
The pooled cohort analysis totaled 157,474 study participants (median age, 62 years; 71.1% women; 95.2% white).
Researchers identified 15,809 incident cancer cases during 1.64 million person-years (PY) of follow-up, for an incident rate of 964 cases/100,000 PY.
In the 12 months following weight change, researchers observed 1,362 cases/100,000 PY among participants with recent weight loss of greater than 10% of body weight, compared with 869 cases /100,000 PY among participants without recent weight loss, for a difference between groups of 493 cases/100,000 PY (95% CI, 391-594).
Among individuals noted as having “low intentionality” of weight loss, researchers observed 2,687 cases/100,000 PY for those with weight loss of greater than 10% of body weight, compared with 1,220 cases/100,000 PY for those without recent weight loss, for a difference between groups of 1,467 cases/100,00 PY (95% CI, 799-2,135).
Cancers of the upper gastrointestinal tract — esophageal cancer, stomach cancer, liver cancer, biliary tract cancer, pancreatic cancer — occurred most commonly among individuals with recent weight loss; researchers noted 173 cases/100,000 PY for those with weight loss of greater than 10% body weight, compared with 36 cases/100,000 PY for those without recent weight loss, for a difference between groups of 137 cases/100,000 PY (95% CI, 101-172).
Researchers noted several study limitations, including that individuals self-reported body weights, which had not been verified, and no evaluation of the timeframe in which individuals lost weight occurred outside of the immediate 12-month period.
Next steps
Individuals who self-report recent weight loss of more than 10% of prior body weight are at an increased risk for a cancer diagnosis during the following 12 months, according to data from this study.
“We found that cancer did cause weight loss prior to diagnosis in some patients, particularly for patients who developed upper GI tract, colorectal, lung and hematologic cancers,” Wolpin said.
“The risk for a cancer diagnosis after recent weight loss was stronger when the weight loss was unintentional,” he added. “Notably, weight loss could be seen prior to diagnosis of localized cancer and advanced cancer, suggesting that weight loss occurs with both early and late-stage cancers.”
Wolpin said additional studies are needed to further understand how best to monitor individuals experiencing sudden weight loss. However, the study’s results still raise worthwhile points for both individuals and health care professionals.
“For the public: When people experience weight loss and are not trying to lose weight by increasing physical activity and modifying their diet, they should consult their doctor so that further evaluations can be considered if warranted,” Wolpin told Healio. “For doctors: Recent unintentional weight loss is associated with a higher risk for cancer diagnosis in the next 12 months, particularly for upper gastrointestinal tract, colorectal, lung and hematologic cancers.
“Future studies will be needed to examine approaches to clinical evaluation of patients with recent unintentional weight loss,” he added.
For more information:
Brian M. Wolpin, MD, MPH, can be reached at Dana-Farber Cancer Institute, Department of Medical Oncology, 450 Brookline Ave., Boston, MA 02215; email: brian_wolpin@dfci.harvard.edu. a
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