Quick, simple blood test for solid cancers looks feasible


The idea of a general, quick and simple blood test for a diverse range of cancers just came closer to reality with news of a new study published in Nature Medicine.

Researchers from Stanford University School of Medicine have devised an ultra-sensitive method for finding DNA from cancer tumors in the bloodstream.

Previous research has already shown circulating tumor DNA holds promise as a biomarker for cancer, but existing methods for detecting it are not sufficiently sensitive and do not cover a diverse range of cancers.

Ways to increase the sensitivity and coverage of such tests exist, but these are cumbersome and time-consuming, and need lots of steps to customize for individual patients, so they are not feasible for use in clinics.

The new approach promises to change that. It is highly sensitive and specific and should be broadly applicable to a range of cancers, say the researchers.

Their new test identified around half of patients with stage 1 lung cancer and all patients with stage 2 or higher disease. They also showed the circulation tumor DNA was highly correlated with tumor volume estimated using CT and PET scans.

This suggests an approach based on CAPP-Seq could monitor tumors at a fraction of the cost of present methods that rely on imaging studies.

Team faced two major hurdles

In developing the test, they faced two major hurdles, as Maximilian Diehn, co-senior author and assistant professor of radiation oncology, explains:

“First, the technique needs to be very sensitive to detect the very small amounts of tumor DNA present in the blood. Second, to be clinically useful it’s necessary to have a test that works off the shelf for the majority of patients with a given cancer.”

Co-senior author, Ash Alizadeh, assistant professor of medicine, explains why they are interested in developing a general way to detect and measure disease burden in solid cancers, and how they are approaching it:

“Blood cancers like leukemias can be easier to monitor than solid tumors through ease of access to the blood. By developing a general method for monitoring circulating tumor DNA, we’re in effect trying to transform solid tumors into liquid tumors that can be detected and tracked more easily.”

Cancer cells divide and die, even without treatment. When a cancer cell dies, the DNA in its nucleus escapes into the bloodstream. This is present in small concentrations; something like 1 in 1,000 or 10,000 bits of DNA in the blood can be from a dead cancer cell in a person with cancer.

Even in patients with advanced cancer, the vast majority of DNA circulating in their blood is from healthy, normal cells.

So a test that can quickly and non-invasively monitor the tiny concentrations of cancer cell DNA would be really useful to clinicians who need to estimate the size of the tumor, how it changes over time, and monitor a patient’s response to treatment.

New test boosts existing methods for analyzing DNA

The team found a way to do this by boosting existing methods for extracting, processing and analyzing the DNA. They called their approach CAPP-Seq (which is short for Cancer Personalized Profiling by deep Sequencing).

CAPP-Seq is sensitive enough to detect one molecule of tumor DNA among 10,000 DNA molecules from healthy cells in the blood.

In their study, they tested blood from patients with non-small-cell lung cancer (this includes most lung cancers, like adenocarcinomas, squamous cell carcinoma and large cell carcinoma). But they say the approach should also work with solid cancers that occur in other parts of the body.

And while they see the test one day being used to follow the progress of tumors in patients already diagnosed with cancer, the researchers say it also has potential as a cancer screening tool for healthy and at-risk populations.

Although the test is described as a general test for cancer, it by no means just looks for one pattern of DNA. Each cancer is genetically different in different patients, but there are certain sets of DNA mutations that are the same across patients with the same cancer.

So the challenge was to find which DNA sequences were the ones most likely to indicate the presence of a given cancer across a diverse range of patients.

Test looks for as many of the known mutations for a given cancer as possible

This is why the team decided to take a population-based approach. They looked in national databases that contain DNA sequences of tumors from thousands of patients, and identified the points on the cancer DNA that are different from normal DNA.

From this information, they were able to compile a fingerprint for each cancer type made up of all the DNA mutations recorded – these include insertions or deletions of short pieces of genetic material, plus where sequences of DNA have been shuffled around or even flipped over.

But while no patient will have all these mutations, nearly all of them will have at least one of them. This makes it possible to compile a test that looks for as many of the known mutations for a given cancer as possible. But it only has to find one of them to strike a positive.

The next stage of the study was to examine the genome of the 407 patients with non-small-cell lung cancer recruited for the study.

Prof. Alizadeh explains how, using an approach called bioinformatics, they looked for regions in the genome enriched for cancer-associated mutations:

“We looked for which genes are most commonly altered, and used computational approaches to identify what we call the genetic architecture of the cancer. That allowed us to identify the part of the genome that would be best to identify and track the disease.”

They identified 139 genes that only represent 0.004% of the human genome but are recurrently mutated in non-small-cell lung cancer.

“By sequencing only those regions of the genome that are highly enriched for cancer mutations, we’re able to keep costs down and identify multiple mutations per patient,” Prof. Diehn says.

Other approaches tend to look for single, well-known mutations that occur frequently, but not necessarily in every patient, with a particular cancer. Because it looks for more than one mutation, the CAPP-Seq approach is more sensitive and gives researchers more flexibility in how to track the cancer over time.

Prof. Diehn explains that there are currently no reliable biomarkers for lung cancer, a cancer that claims the most lives. He says they are “very excited” about the study results because “a personalized, clinically useful biomarker could revolutionize how we detect and manage this devastating disease.”

The team is now working on ways to quickly home in on patient-specific mutations and methods to suppress background noise in a sample so they can identify even very tiny amounts of cancer DNA that might be in it.

CAPP-Seq may also have possibilities as a prognostic tool

The researchers say CAPP-Seq may also have potential as a prognostic tool. When they tested one patient thought to have been successfully treated for lung cancer, they found low levels of circulating tumor DNA. The cancer came back in that patient, and they died.

Conversely, scans of another patient who was treated for early stage disease showed a mass that was thought to indicate disease was still present. But CAPP-Seq found no circulating tumor DNA in that patient’s blood, and they remained disease-free for the rest of the study period.

And in a third patient, CAPP-Seq found a mutation that makes non-small-cell lung cancer resistant to the drug that is commonly used to treat it.

Prof. Diehn says this suggests another use for the approach – to monitor how the tumor progresses and look out for the emergence of treatment resistance early on, giving enough time to switch therapy to target the resistant cells.

“It’s also possible we could use CAPP-Seq to identify subsets of early stage patients who could benefit most from additional treatment after surgery or radiation, such as chemotherapy or immunotherapy,” he adds.

Funds from a number of sources helped finance the study, including the Department of Defense and the National Institutes of Health.

Meanwhile, Medical News Today recently learned how another US study led by The Scripps Research Institute (TSRI) found a new biomarker for head and neck cancer and non-small-cell lung cancer. That study focused on CCTα – an antigen that prompts the immune system to make specific antibodies – and concluded it was a better predictor of patient outcomes than expression of ERCC1, which is involved in DNA repair.

Written by Catharine Paddock PhD



MRI Improves Detection of Higher Risk Prostate Cancer



Magnetic resonance imaging (MRI) andMRI-guided prostate biopsy can greatly reduce the detection of low-risk prostate tumors while increasing detection of intermediate- and high-risk tumors, according to the findings of a recent study.

Leslie C. Thompson, MBBS, FRACS, a consultant urologist at The Wesley Hospital and Wesley Research Institute in Brisbane, Australia, and colleagues compared multiparametric MRI (mpMRI) followed by MRI-guided biopsy (MRGB) with transrectal ultrasound-guided biopsy (TRUSGB) in the detection of prostate cancer (PCa) in 223 biopsy-naïve men referred by urologists with a high or concerning PSA level.

Of these, 142 (63.7%) had PCa. TRUSGB detected 126 cases of PCa in 223 men (56.5%), including 47 (37.3%) classified as low risk and 79 (62.7%) classified as intermediate or high risk. MRGB detected 99 cases of PCa in 142 men (69.7%) with equivocal or suspicious mpMRI findings. Of these, 6 (6.1%) were low risk and 93 (93.9%) were intermediate or high risk. MRGB detected intermediate- or high-risk tumors in 29 men that were either missed or misclassified as low risk by TRUSGB, Dr. Thompson’s team reported online ahead of print in European Urology.

The MRGB pathway decreased the need for biopsy by 51%, decreased the diagnosis of low-risk PCa by 89.4%, and increased detection of intermediate- or high-risk PCa by 17.7%, the researchers reported.

All men in the study underwent mpMRI. Patients returned for prostate biopsy at a second visit. Patients with equivocal or intermediate- or high-risk lesions underwent MRGB followed within 30 minutes by TRUSGB performed by a urologist blinded to the mpMRI findings and MRGB procedure. A 12-core TRUSGB was performed in a standard paired sextant pattern. Patients with normal mpMRI scans had TRUSGB only.

The study’s most important finding, Dr. Thompson told Renal & Urology News, is that the MRI-based diagnostic pathway “almost eliminates the diagnosis of low-risk cancer. This relieves a huge psychological, investigative, and treatment burden on men that have been told they have ‘insignificant’ cancer, because they and their doctors only hear one word: ‘cancer.’”

He continued: “It has become clear to me that the reason that both urological groups and government task forces have not been able to produce sustainable guidelines for PSA testing over the last 20 years is that they have been, unknowingly, addressing the wrong question, over and over again.

The PSA test, in retrospect, is not the problem: It is merely a non-specific ‘alarm bell’ that something is wrong with the prostate. The problem, in retrospect, seems to be the current biopsy protocols where we take large numbers of random biopsies from the prostate.”

With respect to implementing mpMRI and MRGB in prostate cancer workups, Dr. Thompson stated that collaboration between urologists and radiologists is paramount. Urologists are expert in prostate anatomy, surgery, and diseases, whereas radiologists are expert in imaging.

Urologists will have to learn about MRI as well as how to recognize good image quality. They also will have to insist on good image quality from their radiologists, he said.




More intensive radiotherapy is better than less for localised prostate cancer


A radiotherapy regime involving higher doses of radiation is a better option than having lower doses for men with localisedprostate cancer, the 10-year results of the largest trial of its kind have shown.

Having 37 rounds, or fractions, of radiotherapy at 74 Gray (Gy) – compared with 32 fractions at 64 Gy – controlled the disease more effectively and reduced the chance that men would need follow-up hormone-deprivation therapy, which can have long-term side-effects.

The findings, published in The Lancet Oncology, come from the major RT01 phase III trial. The trial was led by Professor Dearnaley at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, and was funded and conducted by the Medical Research Council Clinical Trials Unit at UCL. The study also involved several leading clinical research centres in the UK, New Zealand and Australia.

The study also demonstrated the overall effectiveness of radiotherapy for men with localised disease. Almost three quarters of men treated with either the more or less intensive radiotherapy regimes were still alive after 10 years.

Set up in 1998, the trial split 843 men with localised prostate cancer into two groups to compare the two doses of radiotherapy. Some 421 men had the less and 422 the more intensive treatment regimes. Both groups also had standard hormone-deprivation treatment alongside their radiotherapy.

The five-year results of the trial have previously shown the benefits of dose-escalated radiotherapy, and played an influential role in changing NICE guidance to recommend it in prostate cancer. Dose escalation is now the norm for localised prostate cancer in the UK.

The new 10-year results further strengthen the evidence for choosing dose-escalation radiotherapy, as well as showing the long-term benefits of the treatment.

After 10 years, 55 per cent of men on the 37-fraction regime, compared with 43 per cent of men on the 32-fraction regime, had survived without their disease progressing into a more hazardous form, as measured by the standard prostate-specific antigen (PSA) test. In each half of the study, 71 per cent of men were alive after 10 years and only 11 per cent had died from prostate cancer.

Men who received the higher dose were more likely to have side-effects associated with radiotherapy, but few men had severe side-effects. Receiving the higher dose reduced the need for follow-up hormone treatment, which also carries a risk of side-effects.

The trial did not show that men given dose-escalated radiotherapy live longer, but both groups of men lived much longer than expected. Almost three quarters of all the men in the study were still alive after 10 years, and of the 236 men who had died since treatment, only 91 had died of prostate cancer.

Study leader Professor David Dearnaley, Professor of Uro-Oncology at The Institute of Cancer Research, London, and Honorary Consultant at the Royal Marsden NHS Foundation Trust, said:

“Our study has proved that treating men with localised prostate cancer using higher doses of radiotherapy is more effective than a less intensive regime. The dose-escalated regime is safe in the long term, and reduces the chances that a cancer will return and men will require further hormone-deprivation treatment. The side-effects of hormone treatment do need to be balanced against those of the extra radiotherapy doses, but overall our study has shown men are better off after having the escalated regime, as is now the norm in the UK.

“Another key finding to come out of our study is that radiotherapy in general is both a safe and an effective treatment for localised prostate cancer. Almost three quarters of men treated with either the more or less intensive radiotherapy regimes are still alive after 10 years, and of the men who have died, less than half actually died from prostate cancer.

“Further refinements in radiotherapy techniques since our trial began have made treatment even safer and are very important as men with localised prostate cancer have such favourable long-term survival prospects.”

Matthew Sydes, Senior Scientist and Statistician at the MRC Clinical Trials Unit at UCL, said:

“The RT01 trial has already changed how men with localised prostate cancer are treated. The current NICE guidelines recommend the use of the higher dose of radiotherapy, based on the five-year results of RT01. The trial also helped to develop guidelines on how to limit the radiation that organs near the tumour receive, and helped hospitals across the UK to introduce quality-assured conformal radiotherapy. It is now contributing to biological studies to help better understand the disease and the side-effects of radiotherapy.”


Picture courtesy of newsatjama.


Prostate Cancer Linked to Metabolic Syndrome



Metabolic syndrome (MetS) is independently associated with an increased likelihood of a prostate cancer (PCa)diagnosis, but any individual component of the syndrome is not, a new study suggests.

Bimal Bhindi, MD, of the University of Toronto, and colleagues studied 2,235 men without a prior PCa diagnosis undergoing prostate biopsy. Of these, 494 (22.1%) had MetS, which was defined as the presence of any three of the following components: obesity, hypertension, impaired fasting glucose or diabetes, low high-density lipoprotein-cholesterol, and hypertriglyceridemia.

Having three or more components of MetS versus no component was associated with a 54% increased odds of a PCa diagnosis, a 56% increased odds of clinically significant PCa, and a 56% increased odds of intermediate- or high-grade PCa, Dr. Bhindi’s group reported online ahead of print in European Urology.

In analyses stratified by obesity, the association between MetS and a PCa diagnosis was slightly stronger among obese versus non-obese subjects. After adjusting for obesity, the risk associated with MetS was not attenuated, “suggesting that obesity is not driving this association.”

“Our findings suggest that men with MetS may require a lower threshold for performing biopsy,” the authors concluded. “MetS may be worth considering for potential inclusion in PCa risk calculators in future studies.”




Bladder cancer subtypes genetically similar to breast cancer subtypes

UrologyResearchers at the UNC School of Medicine conducted a comprehensive genetic analysis of invasive bladder cancertumors to discover that the disease shares genetic similarities with two forms of breast cancer. The finding is significant because a greater understanding of the genetic basis of cancers, such as breast cancers, has in the recent past led to the development of new therapies and diagnostic aids.

Bladder cancer, which is the fourth most common malignancy in men and ninth in women in the United States, claimed more than 15,000 lives last year.

The analysis of 262 bladder cancer tumors, published online in the Proceedings of the National Academy of Sciences, revealed that the invasive form of the disease can be classified into two distinct genetic subtypes – basal-like and luminal – which were shown to be highly similar to the basal and luminal subtypes of breast cancer first described by Charles Perou, PhD, the May Goldman Shaw Distinguished Professor of Molecular Oncology at UNC Lineberger.

“It will be particularly interesting to see whether the bladder subtypes, like the breast subtypes, are useful in stratification for therapy,” said lead author William Kim, MD, a researcher at the UNC Lineberger Comprehensive Cancer Center and associate professor in the departments of genetics and medicine at UNC.

Mapping genetic signaling pathways of breast cancer subtypes has led to the development of drugs to treat patients and diagnostic aids that help physicians determine the best course of therapy for patients. Because the identified bladder cancer subtypes share many of the same genetic signaling pathways of breast cancer, researchers hope that the identification of the genetic subtypes can lead to similar advances.

“Currently there are no approved targeted therapies for bladder cancer,” said lead author Jeffrey Damrauer, graduate student in the Curriculum of Genetics and Molecular Biology at the UNC School of Medicine. “Our hope is that the identification of these subtypes will aid in the discovery of targetable pathways that will advance bladder cancer treatment.”

The study also revealed a possible answer to why women diagnosed with bladder cancer have overall poorer outcomes compared to males. Analysis showed that female patients had a significantly higher incidence of the deadlier basal-like tumors. But researchers said that more research is needed before a definite link between the subtype and survival rate can be confirmed.

Dr. Kim’s lab has developed a gene map – BASE47 – that proved successful as a prognostic aid when applied to the tumor samples in the study. The PAM50 genetic test, a similar genetic map developed in the Perou lab, was recently approved as a clinical diagnostic tool by the FDA.


Picture courtesy of www.supportourribbons.com

Non-Medical Treatments for Kidney Stones: What Nephrologists Need to Know


Urology_January1The surgical treatment of urolithiasis has undergone a marked evolution over the past 30 years  Surgical treatments have evolved from maximally invasive open stone surgery to minimally invasive techniques including ureteroscopy (URS), extracorporeal shock wave lithotripsy (ESWL), and percutaneous nephrolithotomy (PCNL). 

As technology in fiber optics, miniaturization, and imaging has evolved alongside improvements in lithotripsy (laser, ultrasonic, and hydraulic), rendering patients stone free with minimal morbidity has become the standard of care. All are outpatient procedures except PCNL.

In acute clinical situations, intervention is indicated in those patients presenting with urosepsis, renal failure, bilateral obstruction, or intractable pain. In most cases, a stent composed of a flexible polymer is placed from the kidney to the bladder within the lumen of the ureter, using cystoscopy and fluoroscopy, to bypass the obstruction. Manipulation of stones in the setting of infection is contraindicated, as high-pressure irrigation and lithotripsy will induce bacteremia and urosepsis. Therefore, infected stones are left in place and treated electively after stenting.  In cases where acute intervention is indicated and infection has been excluded, URS can be performed.

In non-acute clinical situations, the treatment modality is based on stone size, location, number, density, body habitus, and patient preference. Treatment goals are rendering the patient stone free with the minimum amount of morbidity.

ESWL delivers a shock wave through the skin and surrounding tissues to focus on the stone and subsequently fragment it. The shock wave is delivered with image guidance, either fluoroscopy or ultrasound, though most use fluoroscopic guidance, presenting a challenge for stones that are radiolucent.

Classic ESWL generators use electrohydraulic energy to pulverize the stone  These machines offer the greatest efficacy but least amount of control of both pulse focus and energy delivery. More modern lithotripters use electromagnetic generators that emit cone-shaped shock waves that concentrate on the stone but spread onto a greater surface area of the skin, causing less pain. Both of these generators require general anesthesia, due to the pain with increasing shockwave energy.

General anesthesia also allows for timed breathing, limiting excursion of the kidney during shock wave delivery that decreases damage to surrounding tissue and maximizes energy focused on stones. Other modern low-intensity lithotripters, such as piezoelectric lithotripters, developed for their tolerance in awake patients, have had limited efficacy.

Complications of ESWL include perinephric hematomas, with an incidence of 0.6% with electrohydraulic generators and 3%-12% with electromagnetic generators.1,2 Surrounding tissue damage may also occur, but is generally self-limited.

A classic complication of ESWL is known as steinstrasse (German for “stone street”) impaction of small stone fragments in the ureter created during lithotripsy causing obstruction. This can occur with any type of lithotripsy, but is most common with ESWL as the stone fragments are not removed.

URS can be used for both ureteral and kidney stones. The ureter is accessed via a small-caliber endoscope. Distal stones can be visualized and treated with semirigid ureteroscopes, whereas stones above the distal third of the ureter are usually treated using a flexible ureteroscope. When using a flexible ureteroscope, a ureteral access sheath is usually placed so that the scope can be removed and replaced easily during treatment.

Ureteroscopes have small working ports that allow for a single small Holmium laser fiber up to 200 microns for pulverization or a small wire basket used to remove stone fragments. URS complication rates are low and include ureteral stricture, ureteral perforation, ureteral avulsion, and ureteral intussusception. After URS, a ureteral stent is generally left in place for varying amounts of time to avoid post procedural edema causing obstruction.

PCNL is reserved for larger and more complex kidney stone burdens and has almost completely replaced open stone surgery in this indication. Access to the collecting system is obtained either by interventional radiology prior to surgery or by the urologist intraoperatively with fluoroscopic guidance through a percutaneous tract directed through the flank.

This tract is then dilated and a sheath is placed to allow direct access to the collecting system with a nephroscope. The large caliber of this access sheath allows for powerful ultrasonic and hydraulic lithotripters and tools to grasp and remove large stone fragments. While still minimally invasive, this procedure does incur greater risks than ESWL and URS, including hemorrhage and renal pelvis perforation. Multiple tracts are placed for complex collecting system anatomy.

Should a postoperative scan reveal residual stone burden, the same tract can be used for a second look PCNL. Use of open stone surgery, including anatrophic nephrolithotomy, is now only reserved for patients in whom PCNL has failed or rendered impossible because of patient anatomy.

Stones located in the kidney that are larger than 2 cm (cumulative stone burden) and staghorn calculi should be treated with PCNL. Lower pole kidney stones have low stone-free rates with ESWL and URS, regardless of size because fragments do not easily pass down the ureter. With URS, small stones can be moved from the lower kidney to the upper kidney, making URS the choice for small lower pole stones.

Stones smaller than 1cm not located in the lower pole can usually be treated effectively with ESWL. Stones 1-2 cm that are not in the lower pole, less than 1000 Hounsfield units (HFU) on computed tomography scans, and with a short skin to stone distance (less than 10 cm) also can be effectively treated with ESWL. Harder 1-2 cm stones (greater than 1000 HFU) can be treated with URS/laser lithotripsy.

Stones in the ureter are generally treated with URS. ESWL can be used for stones at the most upper portions of the ureter. PCNL for ureteral stones is reserved for very large stones at the ureteropelvic junction or proximal ureter. While ESWL is often the treatment modality preferred by patients as it is the least invasive, ureteral stone free rates are higher with ureteroscopic lithotripsy, especially as stone density and size increases. For this reason ureteroscopy is considered the gold standard for ureteral stones.

Dr. Conti is a urology resident and Dr. Chung is Assistant Professor of Urology, Director of Robotic and Minimally Invasive Urologic Surgery, Stanford University School of Medicine.

  1. Dhar NB, Thornton J, Karafa MT, Streem SB. A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. J Urol2004;172 (6 Pt 1):2271-2274.
  2. Chaussy C, Schmiedt E. Extracorporeal shock wave lithotripsy (ESWL) for kidney stones. An alternative to surgery? Urol. Radiol 1984;6:80-87.



Prostate Cancer Linked to Adipose Tissue

Urology_December1Radiographic imaging of adipose tissue pointed to a risk for malignancies not normally associated with obesity, such as prostate cancer (PCa).

Greater body mass index (BMI) has been shown to be associated with an increased risk for many types of cancer, particularly cancers of the breast, endometrium, esophagus, pancreas, colon and rectum, kidney, thyroid, and gallbladder. BMI, however, does not provide information on the distribution of adipose tissue. Knowledge of cancer risk in relation to specific adipose tissue deposits may be of particular importance in old age, when such tissue tends to be redistributed throughout the body, according to a study group led by Rachel A. Murphy, PhD, a researcher at the National Institute on Aging in Bethesda, Md.

Dr. Murphy and her colleagues examined radiographic measures of adiposity and incident cancer (excluding nonmelanoma skin cancer) in a prospective study of older adults, describing their work inApplied Physiology, Nutrition, and MetabolismThe participants were aged 70-79 years at baseline and were followed for incident cancer for 13 years. None had prevalent cancer (a cancer diagnosis within the previous three years) at study enrollment.

The final analytical sample included 1,902 individuals (mean age 74 years, 47% male, 57% white) without incident cancer, and 617 with incident cancer, including 268 women (19.2/1,000 person-years) and 349 men (33.1/1,000 person-years). The predominant incident cancers to develop were PCa (126 cases), lung cancer (110 cases), colon and rectal cancers (82 cases), and breast cancer (74 cases). Incident cancers most often developed in men, in current or former smokers, and those who smoked for longer durations.

During a mean and median follow-up of 10.3 years and 12.4 years, respectively, obesity-related cancer developed in 142 women (10.0/1,000 person-years) and 82 men (7.03/1,000 person-years). Total adipose tissue as measured by dual-energy x-ray absorptiometry and visceral adipose tissue as measured by computed tomography were positively associated with cancer risk among women, but were not associated with cancer risk in men.

Total adipose tissue was positively associated with obesity-related cancer risk among women, whereas visceral adipose tissue was positively associated with obesity-related cancer risk among men, even after adjustment for BMI.

Dr. Murphy’s group stated that their results suggests adiposity may carry risk for cancers beyond those identified as obesity-related by the National Cancer Institute and further suggest a possible sex differential with respect to adiposity and cancer risk. Incident cancers among men tended to be nonobesity-related cancers, and women tended to develop obesity-related cancers.