Analysis of Proportion of Cancer Cases Attributable to Excess Body Weight Across U.S. States


Key Points

  • The PAF of cases was approximately twice as high in women vs men.
  • PAFs by state ranged from 3.9% to 6.0% among men and 7.1% to 11.4% among women.

In a study reported in JAMA Oncology, Islami et al assessed the population attributable fraction (PAF)—the proportion of a given outcome attributable to a given risk factor—of incident cancer cases associated with excess body weight among individual U.S. states during 2011 to 2015. The estimates ranged from 3.9% to 6.0% among men and 7.1% to 11.4% among women.

In the study, sex-, age-, and state-specific adjusted prevalence estimates for 4 high body mass index categories (25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥ 40 kg/m2) and corresponding relative risks for cancer from large-scale pooled analyses or meta-analyses were used to compute the PAFs among adults 30 years or older in 2011 to 2015 for each U.S. state for esophageal adenocarcinoma; multiple myeloma; and cancers of the gastric cardia, colorectum, liver, gallbladder, pancreas, female breast, corpus uteri, ovary, kidney/renal pelvis, and thyroid.

Proportions of Cases Attributable to Excess Body Weight

Each year, approximately 37,670 cancer cases in men (4.7% of all cases excluding nonmelanoma skin cancers) and 74,690 cases in women (9.6% of all cases) aged ≥ 30 years were attributable to excess body weight from 2011 to 2015. Among both men and women, there was a ≥ 1.5-fold difference in proportions of cancers attributable to excess body weight between states with the highest and lowest PAFs.

Among men, PAFs ranged from 3.9% in Montana to 6.0% in Texas. The PAF among women was approximately twice that among men, ranging from 7.1% in Hawaii to 11.4% in the District of Columbia. Overall, the highest PAFs were observed primarily in southern and midwestern states, Alaska, and the District of Columbia.

The investigators concluded, “The proportion of cancers attributable to [excess body weight] varies among states, but [excess body weight] accounts for at least 1 in 17 of all incident cancers in each state. Broad implementation of known community- and individual-level interventions is needed to reduce access to and marketing of unhealthy foods and to promote and increase access to healthy foods and physical activity, as well as preventive care.”

Farhad Islami, MD, PhD, of the Surveillance and Health Services Research Department, American Cancer Society, is the corresponding author for the JAMA Oncology article. 

Disclosure: The study was supported by the Intramural Research Department of the American Cancer Society. The study authors’ full disclosures can be found at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.