Obesity-related Cancers in Mississippi, 2003-2019

Obesity is a modifiable risk factor that increases the risk of developing certain cancers. According to data from the Behavioral Risk Factor Surveillance System for 2020, 39.7% of Mississippi adults are obese. Mississippi has the highest obesity rate in the nation¹. Cancers that are associated with obesity include colorectal cancer, pancreatic cancer, post-menopausal breast cancer, uterine cancer, ovarian cancer, kidney cancer, adenocarcinoma of the esophagus, gastric cardia cancer, gallbladder cancer, liver cancer, thyroid cancer, multiple myeloma, and meningioma.³ Below are graphs of the trends in obesity-related cancers over the period 2003 to 2019 by race and sex with a description of the trends occurring in each group both for the full time period and for the most recent period between 2015 and 2019. All analysis was done using SEER*Stat software².

While colorectal cancer is associated with obesity, it is also associated with other modifiable risk factors, tobacco use (both colon and rectum cancers), alcohol use (both colon and rectum cancers) and lack of physical activity (only colon cancer). Black males had significantly higher rates of colorectal cancer than all other groups except for in years 2003 and 2004 where their rates were similar to those of white males. Colorectal cancer rates decreased significantly in all groups for the period between 2003 and 2019. Black females had a significant decrease of 1.86% annually, and black males had a significant decrease of 0.70% annually. White males had a significant decrease of 1.14% annually. Conversely, white females had a significant decrease between 2003 and 2011 of 2.24% and then experienced an observed increase of 0.83% annually between 2011 and 2019. This translate to an overall significant average annual decrease of 0.7% over the full time period for white females.

For the latest five-year period of 2015 to 2019, black males and black females had similar significant trends to those for the full time period from 2003 to 2019. For black males, the trend for the latest five year period was a decrease of 1.39% annually. For black females, the most recent trend observed was a decrease of 2.99% annually. White males experienced an observed decreasing trend between 2015 and 2019 of 0.74%. The trend for white females between 2015 and 2019 is similar to the trend between 2011 and 2019. The observed rate of increase for white females was 0.56%.

While pancreatic cancer is associated with obesity, it is also associated with another modifiable risk factor, tobacco use. Pancreatic cancer rates increased significantly between 2003 and 2019 for females, overall. White females experienced annual significant increase of 3.25% between 2003 and 2013 but then saw and observed 3.01% decrease between 2013 and 2019. The rate for black females increased a significant 1.65% annually. For males, the average annual percent change between 2003 and 2019 was an observed increase of 0.60%. Black males had a small observed increase of 0.05% annually. White males experienced a significant increase between 2003 and 2015 of 3.48% annually but then experienced an observed decrease annually between 2015 and 2019 of 6.29%.

For the latest five-year period of 2015-2019, the trends were decreasing for all groups except black females who saw an increasing trend. White males had a significant decrease of 6.16% annually. For black males, the most recent trend observed is a decrease of 6.99% annually, and for black females the observed trend for the most recent five years was a 1.78% increase annually. White females had an observed decrease of 2.47%.

Post-menopausal breast cancer is defined as breast cancer diagnosed in women ages 50 and older. Besides obesity, post-menopausal breast cancer is also associated with a lack of physical activity. Additionally, female breast cancer, regardless of age, is associated with another modifiable risk factor, alcohol use. The rates of post-menopausal breast cancer by race were very similar over time. The rates of post-menopausal breast cancer between 2003 and 2019 increased significantly by 0.96% annually. The annual percent change for white females was a significant 0.78% and for black females was a significant 1.39%. For the most recent five-year time from 2015 to 2019, white females experienced a significant annual increase of 1.51%. Black females also experienced an annual significant increase over the period of 2013 to 2019 of 2.35%.

While uterine cancer is associated with obesity, it is also associated with another modifiable risk factor, lack of physical activity. Uterine cancer rates increased significantly between 2003 and 2019. The annual percent change over that period of time was 1.94%. Black females experienced a significant increase of 1.73% annually, and white females experienced a significant increase of 1.94%. The trend over the latest five-year period from 2015 to 2019 for black females was an annual increase of 0.89% which was not statistically significant. For white females, there was a decrease of 1.55% annually in contrast to the increase over the full time period. Though black females have rates that are observed to be higher than white females for all years except 2013, these differences are only statistically significant for years 2004, 2008, 2011, 2014, 2016, and 2019.

Rates for ovarian cancer were similar between white females and black females for all years but 2005 and 2018 where white females had significantly higher rates. Both white and black females had significant decreases over the period from 2003-2019. White females experienced a 1.36% decrease annually, and black females experienced a 1.52% decrease annually. In the most recent five-year time period between 2015 and 2019, both groups experienced annual declines though the changes were not statistically significant. White female rates declined 1.37% annually, and black female rates were observed to decline at 7.66% annually.

While kidney cancer is associated with obesity, it is also associated with another modifiable risk factor, tobacco use. Rates of kidney cancer were similar between black males and white males for most years. Additionally, the rates for white females and black females were also similar to each other for all years except 2009 to 2011 and the most recent years of 2016, 2017, and 2019 where black females had significantly higher rates. White females consistently had rates that were significantly lower than the rates of both black males and white males. Black females had rates that were significantly lower than black males. Their rates were also significantly lower than white males for all years except 2009.

All groups showed an increasing trend for the period from 2003 to 2019, and those trends were statistically significant for all groups. The annual percent increase for white males was 2.75% and white females was 2.12%. For black females, the trend was an annual increase of 3.77%. For black males, the trend showed an increase of 2.18% annually.

For the latest five-year period of 2015 to 2019, white males, black males, and black females all showed an increasing trend, though these increases were not statistically significant. The annual increase for white males was 2.74% and for black males was 5.02%. The increase for black females was 2.67% annually. In contrast, white females experienced a decrease of 0.44% annually, though this decrease was not statistically significant.

Adenocarcinoma of the esophagus is one type of esophageal cancer that is associated with obesity. Additionally, all types of esophageal cancer may also be associated with other modifiable risk factors, tobacco and alcohol use. Because esophageal adenocarcinoma is a rare cancer, the statistics could not be broken out by race and sex. Overall, the trend for esophageal cancer for the period from 2003 to 2019 was significantly increasing at an annual rate of 1.68%. For the latest five-year period of 2015 to 2019, the trend was decreasing at an observed rate of 0.54% annually.

Cancer occurring in the cardia portion of the stomach is associated with obesity. The cardia portion of the stomach is the upper portion of the stomach that is closest to the esophagus. Cancers in any portion of the stomach are also associated with another modifiable risk factor, tobacco use. Similar to esophageal adenocarcinoma, gastric cardia cancer is a rare cancer, so the statistics could not be broken out by race and sex. Between 2003 and 2016, the rate of gastric cardia cancer increased significantly at an annual rate of 2.58%. In contrast, the rate decreased between 2016 and 2019 at an observed annual rate of 12.08%. The overall trend for the full time period from 2003 to 2019 is an average annual decrease of 0.30%. This type of cancer is most common in men. The overall decrease was largely being driven by a significant decrease in black males of 4.79% annually. For the latest five-year period of 2015 to 2019, the overall trend was a decrease of 7.16% annually, though this trend was not statistically significant.

While liver cancer is associated with obesity, it is also associated with other modifiable risk factors, tobacco and alcohol use. Males had significantly higher rates of liver cancer than females. The rates were similar between the races for each sex group. For white males, the incidence rate increased significantly between 2003 and 2017 at a rate of 4.63% annually. Between 2017 and 2019, the rate for white males decreased at an observed rate of 8.73% annually. The rate for white females showed an annual decrease of 10.02% from 2003 to 2007, but then showed a significant increasing trend from 2007 to 2019 with an annual increase of 5.18%. The annual percent increase for black males was 1.13% and for black females was 1.42%.

For the latest five-year period of 2015 to 2019, trends were decreasing for all groups but white females. For white males, the trend for the last five year period was a decrease of 0.67% annually, and for black males, the most recent trend observed was a decrease of 10.03% annually. For black females, the decrease was a statistically significant 5.03% annually. In contrast to the other groups, white females had an observed increase of 4.25% annually between 2015 and 2019.

Gallbladder cancer is a rare cancer, so the statistics could not be broken out by race and sex. Overall, the trend for gallbladder cancer for the period from 2003 to 2019 was decreasing annually at 0.46%. This change was not statistically significant. In contrast, for the latest five-year period of 2015 to 2019, the trend was an observed annual increase of 3.51%.

Due to the number of cases diagnosed annually in black males being very small, the rates of thyroid cancer could not be broken out by both race and sex. Females have significantly higher rates of thyroid cancer than males, and the white population has a significantly higher rate of thyroid cancer beginning in 2005. Over the time period between 2003 and 2019, the black population experienced fluctuating observed trends, but the average annual observed trend was a decrease of 2.21%. During the period from 2003 to 2013, the white population had a significant annual increase of 5.53%. However, during the period from 2013 to 2019, the white population had a significant annual decrease of 5.36%. For the entire period from 2003 to 2019, the white population had a significant average annual increase of 1.30%.

For the latest five-year period between 2015 and 2019, both groups saw significant decreasing trends. The rate for the white population decreased at an annual rate of 6.98%. The rate of decrease during this period for the black population was 11.37% annually.

For most time periods, black males and black females had significantly higher rates of multiple myeloma than both white males and white females. Black males and females had similar rates except in 2014, 2017, and 2019 when black males had significantly higher rates. White males had significantly higher rates of multiple myeloma than white females in 2003, from 2007 to 2017, and in 2019. For the period from 2003 to 2019, all groups had an observed annual increase in the rate of multiple myeloma. The rate of increase was statistically significant for black males at 3.14% annually and black females at 2.76% annually. White males also experienced an observed increase annually of 1.55%, and white females also had an observed annual increase of 0.52%.

Over the most recent five-year time period from 2015 to 2019, only black males experienced a significant annual increase. This increase was 13.37% annually. The other groups all experienced an annual increase in the rates of multiple myeloma over this five-year period, but these changes were not statistically significant. The observed annual increase for white males was 1.05%, and for white females was 3.52%. The observed increase for black females annually was 5.76%.

Meningiomas are brain tumors that grow on the surface of the brain and spinal cord. Most are benign. The Mississippi Cancer Registry did not begin collecting benign and borderline tumors of the brain and central nervous system until 2004. Prior to 2004, the cancer registry would have only collected malignant meningiomas which are very rare. The data represented here covers the time period beginning in 2004 instead of 2003 like for the other cancers in this report.

Females had significantly higher rates than males for most years. Within each sex group, the two race groups had similar rates for most years. Meningioma trends were significantly increasing for all groups. White males experienced a significant increase of 4.25% annually, and black males experienced a significant increase of 4.51% annually. The trend for black females was an increase of 3.63% annually. For white females between 2004 and 2007, the annual increase was a significant 12.13%. From 2007 to 2019, white females still experienced a significant increase of 2.15%, but this was much lower than the earlier time period. For the full time period between 2003 and 2019, white females had a significant average annual increase of 4.1%.

The observed trend for the latest five-year period between 2015 and 2019 was increasing for all groups, though these changes were not statistically significant. The annual increase for white males was 0.18% and for white females was 1.51%. The annual increase for black males was 5.88% and for black females was 5.03%.

Definitions

Age Adjusting: A statistical method that allows comparisons of populations that take into account age-distribution differences between the populations. The 2000 U.S. standard population is used and applied to all of the time periods being considered. This assures that the rates do not reflect differences in the age distribution of the population.

Annual Percent Change (APC): The average annual percent change over several years. It is used to measure the change in rates over time. Calculating the APC involves fitting a straight line to the natural logarithm of the data when it is displayed by calendar year.

Statistical Significance: This is a mathematical measure of the difference between groups. A difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone 95% of the time. Rate ratios were used to assess the statistical significance between groups.

Citations

¹Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2020. [accessed Apr 18, 2022]. URL: https://www.cdc.gov/brfss/brfssprevalence/index.html.

²Surveillance Research Program, National Cancer Institute SEER*Stat software (seer.cancer.gov/seerstat) version 8.3.9.1.

³Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. Obesity and Cancer [online]. 2021. [accessed Jun 13, 2022]. URL: https://www.cdc.gov/cancer/obesity/index.htm

Source of Data: SEER*Stat Database: MS0219. Created on 11/30/2021. Mississippi Cancer Registry 2021 Submission (2002-2019) to Centers for Disease Control and Prevention, National Program of Cancer Registries.

Acknowledgement

We acknowledge the Centers for Disease Control and Prevention for their financial support under a cooperative agreement awarded to the Mississippi Cancer Registry.