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Obesity and inactivity fuel global cancer epidemic
Debbie Josefson BMJ 2001;322;945doi:10.1136/bmj.322.7292.945
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News
Obesity and inactivity fuel global cancer epidemic
Debbie Josefson, San Francisco
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Obesity and lack of exercise contribute to up to a third of cancers of the colon, breast, kidney, and digestive tract, says a new report from the World Health Organization. The study was prompted by concerns that obesity and its attendant health risks constitute a growing global epidemic. The Centers for Disease Control and Prevention (CDC) estimate that obesity causes 300 000 deaths in the United States annually, a number exceeded only by deaths related to tobacco. Half of European adults and 61% of Americans are overweight. Moreover, the proliferation of Western diets and sedentary lifestyles in developing countries poses a threat to people who were previously at low risk of obesity. Obesity consumes 8% of the US healthcare budget and an estimated $100bn (£71.4bn) in direct and indirect costs. It is well known that obesity increases the risk of cardiovascular diseases, but its role in oncogenesis is less understood. Several studies have shown that obesity increases the risk for cancers of the colon, breast, endometrium,
kidney, and oesophagus (adenocarcinoma). The mechanism of increased cancer risk in obese populations is unclear, but nutritional and dietary factors may have a role. Changes in metabolism and hormonal activity may also be implicated, particularly in hormone responsive cancers such as breast, prostate, and endometrial carcinomas. Oestrogens serve as growth factors for both breast and endometrial cancers and fat cells serve as a source for androstenedione, which is converted into estrogens. Evidence exists that weight gain increases cancer risk, but the converse proposition—that weight loss would reduce risk of the disease—has not been confirmed. The WHO panel said that despite the lack of direct evidence, hormonal changes produced by weight loss seem likely to reduce risks of some cancers, especially breast and uterine cancer. The researchers urged a multipronged approach to combat the obesity epidemic, involving federal and local governments, educational systems, families, and individuals. Governments and schools
Inactivity and Western diets can cause many common cancers 16475
should be encouraged to fund programs to promote physical activity, and urban planning should be designed to be conducive to a healthy lifestyle. “‘Obesity cannot be prevented or managed, nor physical activity promoted, solely at the level of the individual governments, the food industry, international
agencies, the media, communities, and individuals all need to work together to modify the environment so that it is less conducive to weight gain,” the WHO panel concluded.
The WHO report is at www.iarc.fr/pageroot/UNITS/Che moprevention2.html
Stresses on women doctors may cause higher suicide risk
Roger Dobson Abergavenny
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Suicide rates among women NHS doctors in the United Kingdom are twice that of the general female population, new research has found. It also found differences in suicide rates between medical specialties, with anaesthetists, community health doctors, GPs, and psychiatrists of both sexes having significantly higher rates than doctors in general hospital medicine.
Researchers say that the high risk in women doctors particularly needs to be carefully monitored and that that stresses facing women doctors may be one explanation for the suicide rate. “The excess risk of suicide in female doctors highlights the need to tackle stress and mental health problems in doctors more effectively. The increased risk is of particular concern in the light of the steadily increas-
ing number and proportion of women in the medical workforce,” says a report of the research in Journal of Epidemiology and Community Health (2001;55:296-300). It adds, “The greater tendency of women to commit suicide by self poisoning—a pattern that is even more pronounced in female doctors than in the general population—might be part of the explanation for the increased risk in female doctors who would be very aware of what drugs are dangerous in overdose.” The study was based on deaths of doctors between 1979 and 1995 where there was a suicide or open verdict at
inquest. Almost a third of the 329 deaths were excluded—86 doctors had retired and 20 were not on the General Medical Council’s register. The Oxford researchers also established that the rate among male doctors was two thirds that of the general male population, and the report notes: “This is in marked contrast with the general population, in which rates are considerably higher in men than women.” “The excess risk of suicide associated with general practice is of concern in the light of recent reports of stress and dissatisfaction among GPs,” the report says.
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