Obesity linked strongly with 11 cancers including digestive, endometrial and breast cancer.

Results of a recent umbrella review published online in BMJ have provided strong evidence to support the association between excess body weight and 11 cancers that include G.I tract, endometrial and postmenopausal breast malignancies.

“The association is now clear; it’s time to get serious about prevention, “write Professors Yikyung Park and Graham A Colditz in an accompanying editorial.

An Umbrella review is the reviews of existing systematic reviews and only considers the highest level of evidence to be included, namely systematic reviews and meta-analysis.[1] Hence, the findings from this umbrella review is the strongest evidence put forth so far linking obesity and cancer.

The study by Kyrgiou et al. initially selected 204 individual meta-analyses from 49 papers and further narrowed it down to 95 meta-analysis based on validity and association provided by the studies. 76% of the meta-analyses provided varied level of evidence for association between obesity and cancer.

  

The literature search was performed for meta-analysis and reviews that investigated association between adiposity indices and risk of developing or dying from any cancer. Adiposity indices included in the study were body mass index, waist circumference, hip circumference, waist to hip ratio, weight, weight gain, and weight loss from bariatric surgery.  Obesity was defined as a body mass index (BMI) >30 kg/m2.

The nine obesity related cancers with strong evidence were endometrial cancer (premenopausal women), breast cancer (postmenopausal), kidney cancer, multiple myeloma, esophageal adenocarcinoma, colon and rectal cancer (in men), biliary tract system and pancreatic cancer. The risk of ovarian and stomach cancer increases as the weight increases with maximum risk in obese vs. normal weight individuals.

The BMI was measured as a continuous variable.

With every 5 units increase in BMI, the risk of developing rectal cancer increased by 9% in men and that of developing biliary tract cancers increased by 56%.

For each 5 kg of weight gain in adulthood the risk of postmenopausal breast cancer increased by 11% even if the women have never used HRT, similarly for .1 increases in waist to hip ratio the risk of endometrial cancer increased by 21%.

Obesity has become a major public health problem in last four decades with the incidence being doubled among women and tripled among men. And preventing adult weight gain can bring down the risk of these cancers.

The authors also stressed the importance of primary care physicians in medical practice because they are the primary point of contact with the patients. They said “Given the critical role of healthcare providers in obesity screening and prevention, clinicians, particularly those in primary care, can be a powerful force to lower the burden of obesity related cancers, as well as the many other chronic diseases linked to obesity such as diabetes, heart disease, and stroke.”

Although more prospective studies are needed to confirm the association, personalized primary preventive strategies could be designed in subjects at ‘ high risk’ for cancers.  

Link to  full article here.

Link to Editorial here

---

[1] https://www.ncbi.nlm.nih.gov/pubmed/26360830 accessed March 2, 2017

Incentives now, harsh punishments then: A spin on China’s one child policy.

After nearly 4 decades of harsh punishments that included fines and forced abortions to abide by the ‘one child policy’, China is now offering incentives for parents that chose to have a second child.

This announcement was made on Saturday during a meeting of the China Social Welfare Academy, by Wang Peian, the vice-minister of the National Health and Family Planning Commission (NHFPC).

She said "To have a second child is the right of each family in China but affordability has become a bottleneck that undermines the decision."

A poll conducted by NHFPC in 2015 showed that 60% of people survey were reluctant to have second child because of financial constraints.

China birthrate is lowest in the world and it is home to 114 million people over the age of 65 years, with 90 million more expecting to retire in next 30 years. This is going to create a large vacuum of young people in labor force till the newborns are old enough to work.

The one child policy was implemented in 1979 after a massive population explosion with average 6 births per woman of reproductive age group.

The policy brought down the rate to 1.5 birth per woman for the last 20 years. 

China overturned it's one child policy in October 2015, the birth rate has increased since than but not in pace with the aging population. 

Sources:

China Daily

CNN

New Single Handed IUD Inserter for LILETTA released easing IUD insertion.

Courtesy: Liletta.com

Allergan a leading global pharmaceutical company, and Medicines360, a nonprofit global women's health pharmaceutical company, recently launched the new LILETTA® (levonorgestrel-releasing intrauterine system) 52 mg IUD single-handed inserter (intrauterine device), for use by women to prevent pregnancy for up to three years. The system needs to be replaced after 3 years if continuous protection is desired.                                                                                                    

The launch and availability of the single-handed inserter came in the wake of U.S. Food and Drug Administration (FDA) approval received in January 2016.

The FDA approved it after the results of the largest hormonal IUD trial, ACCESS IUS (A Comprehensive Contraceptive Efficacy & Safety Study of an IUS). The study enrolled 1751 women to have LILETTA inserted. It was shown to be safe with a cumulative three-year efficacy rate of 99.45 percent. It was effective in broad range of women irrespective of ethnicity, BMI and parity. The study included women aged 16-45 years with 58% nulliparous and 42% multiparous.

It can be inserted as an office procedure and the success rate with the single-handed inserter is 99.2%. The new single handed inserter has a bendable tube which adapts to the anatomy of the uterus. Two color coded blue and green sliders help to load the Intra Uterine System(IUS) during insertion and open the arms at the time of release. The device can be reset if not loaded properly.

Courtesy: Liletta.com

Allergan and Medicines360 have launched a comprehensive product demonstration programme in private and public sector.

The contraindications, risk factors and complications are similar to other levonorgestrel-releasing intrauterine system IUS.

Jessica Grossman, MD, CEO of Medicines360 said “We are excited to bring to market the new LILETTA inserter and anticipate that the single-handed process may lead to broader use by healthcare providers, thereby increasing the number of women who have access to this effective contraceptive.” She further added “Specifically, the new LILETTA inserter includes an ergonomic design allowing for single-handed insertion that can be used with either hand; a bendable tube to accommodate the anatomy of the patient during insertion; and the ability to reload the device if needed before insertion.”

The cost of Liletta for an uninsured patient is $50.