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Researchers from some of the top cancer centers in the U.S. gathered in Richmond on March 16 to share ideas and discuss research that is furthering our understanding of the role of obesity in cancer risk. Scientists, students and community leaders were among the more than 115 people in attendance at VCU Massey Cancer Center’s second annual Gordon Ginder Innovations in Cancer Symposium.

In recent decades, many chronic conditions have been associated with obesity, including hypertension, cardiovascular disease and diabetes. Obesity has also been linked to 13 types of cancer, including post-menopausal breast cancer, colorectal, kidney and pancreatic cancer. Massey is committed to advancing obesity control in its catchment area and beyond as one of the significant behavioral drivers of our cancer burden.

Bernard Fuemmeler, Ph.D., M.P.H., associate director of population sciences and the Gordon D. Ginder, M.D., Chair in Cancer Research at Massey, served as the day’s host, welcoming guests to a day of learning from leading experts about the exciting, multidisciplinary scientific research happening at the intersection of obesity and cancer.

Representing a community perspective, Robert Noriega, a health educator at the Healthy Living and Learning Center at the Petersburg Public Library, spoke of his experience working to bring healthier options to the convenience stores in Petersburg. “It’s hard to be healthy, and it’s expensive, too,” he said, noting that the two Petersburg grocery stores are not easily accessible to most residents, and the more prevalent convenience stores offer less healthy food at lower prices.

Referencing the upcoming presentations, Noriega said, “We haven’t completely connected the dots with the data that links obesity to cancer and other health complications. We can’t control a lot of risk factors for cancer – getting older, our sex, the role genetics play in cancer diagnosis – but we can make better food choices and be more physically active.”

Stephen D. Hursting, Ph.D., M.P.H., professor in the Department of Nutrition and the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, explored the data we do have linking obesity and cancer, and raised several unanswered questions that will help scientists develop mechanism-based interventions for breaking those links.

“We need to pivot as a research community from the question of whether obesity is a risk factor to the question of, what are we going to do about it?” Hursting said. He explored study results examining the efficacy of weight loss via bariatric surgery or calorie restriction on the impact of cancer risk and emphasized an important gap in the number and quality of weight-loss studies that can show whether the risk of obesity-related cancers is reversed with weight loss.

Hursting also noted that based on research to date, both bariatric surgery and calorie restriction interventions reversed obesity-associated transcriptional and epigenetic changes, which is key as we seek to target the immune-suppression effects of obesity.

Disparities-informed research

As several presenters noted, disparities in cancer diagnoses and outcomes may be influenced by higher rates of obesity in racial and ethnic minority groups. Kristina Tatum, Psy.D., a Massey postdoctoral research scholar who also works in the Department of Pediatrics at the VCU School of Medicine, noted that Black women in particular have the highest rates of obesity relative to their counterparts.

Victoria L. Bae-Jump, M.D., Ph.D., director of the Endometrial Cancer Center of Excellence at UNC Lineberger Comprehensive Cancer Center, discussed racial disparities in obesity-driven endometrial cancer — including the genetic factors and social determinants of health associated with them — and her research team’s efforts to better understand and develop potential strategies to effectively reduce these health inequities.

“Endometrial cancer harbors one of the worse cancer disparities for Black women than any other cancer,” Bae-Jump said. “Critical to addressing this disparity is to define the molecular alterations in the endometrial cancers of Black women in the context of other biologic and non- biologic factors that may drive more aggressive behavior of disease.”

Obesity, diabetes and insulin resistance are well-known risk factors for endometrial cancer, and Black women suffer a significantly higher mortality from the disease than white women, Bae-Jump said.

Additionally, Bae-Jump highlighted that environmental effects can cause changes in gut health, and the gut microbiome is directly related to the efficacy of various cancer treatments and patient outcomes. Her research identified that microbiome compositions were different in Black and white patients with endometrial and uterine tumors, and were noticeably affected by obesity status.

Tiffany Carson, Ph.D. M.P.H., an associate member and the inaugural George Edgecomb Scholar in the Department of Health Outcomes and Behavior in the Division of Population Sciences at Moffitt Cancer Center, also highlighted racial and ethnic variation in obesity-related cancers. Reviewing the effects of two major weight-loss intervention studies — Diabetes Prevention Program and the Look AHEAD trial — Carson noted that though both produce clinically meaningful weight loss, they don’t necessarily perform the same across populations. In both studies, Black women showed the least amount of weight loss at six months or one year.

Carson and her research team have launched the RESET study to address the elevated stress levels experienced by Black women. “It’s well documented that Black women tend to report higher prevalence of chronic stress compared to white women and to men,” said Carson. “We’re hoping to determine whether adding a culturally-tailored stress-management program to an evidence-based weight-loss intervention produces greater weight loss than the standard intervention in this population.”

In a pilot study, women receiving the enhanced intervention lost twice as much weight as the lifestyle intervention alone.

Lifestyle interventions across the life span

Marian Fitzgibbon, Ph.D., associate director of the Population Health, Behavior and Outcomes Program at the University of Illinois Cancer Center, presented on the role of obesity and lifestyle behaviors in cancer risk and prevention.

Lifestyle factors such as alcohol, unhealthy diets, smoking and a lack of physical activity are directly linked to an increased risk of cancer.

Fitzgibbon studies weight control, dietary and lifestyle intervention strategies, including the implementation of physical exercise programs in public schools to determine their effectiveness on increasing childhood activity. She also examines how the home food environment impacts the diet of young children, particularly in African American and Hispanic/Latino households.

“When there’s healthy food in the home, people are eating healthier foods,” Fitzgibbon said. “We need to be more intentional toward the underpinnings of people’s food intake.”

Karen Basen-Engquist, Ph.D., the director of the Center for Energy Balance in Cancer Prevention and Survivorship at The University of Texas MD Anderson Cancer Center, addressed healthy living in cancer survivorship and the need to better reach underserved communities.

Due to improvements in cancer prevention, screening and treatment methods, there are approximately 18 million cancer survivors in the U.S. today. However, cancer survivors are at an increased risk for functional decline, and consequently an increased risk for disability, chronic diseases and falling, among other issues, Basen-Engquist said.

Basen-Engquist oversees the implementation of lifestyle physical activity intervention approaches for cancer survivors, which have been shown to result in improvements in quality of life and physical functioning for survivors who participate. Her work also focuses on trying to expand access to these interventions for cancer survivors who live in rural communities.

“We need to think of cancer treatment as including exercise in addition to chemotherapy” and other treatments routinely included in patient care, Basen-Engquist said.

Partnering with the community

To close out the event, all the day’s speakers were joined on stage by Fuemmeler and David Turner, Ph.D., member of the Cancer Prevention and Control research program at Massey. The panelists discussed future directions of obesity-related cancer research, including how best to partner with communities to understand their research needs and how they want to be involved.

“Another important part of the conversation is building and establishing trust over time,” said Carson. “That involves going back to the community and telling them what you’ve learned, and letting them benefit from the work you conduct because they are community partners with you.”

In his parting words to the assembled group, Robert A. Winn, M.D., Massey director and Lipman Chair in Oncology, honored Gordon Ginder, M.D., his predecessor and the symposium’s namesake, who was also in attendance: “The best way to recognize Dr. Ginder is through our shared love of science. Bringing this issue of obesity, metabolism, cancer and the microbiome to bear was incredibly enlightening.”

Written by: Annie Harris and Blake Belden