Obesity-associated cancers may be on the rise in Puerto Rico

Carola T. Sánchez-Díaz, MS, PhD, assistant investigator in the Division of Cancer Control and Population Sciences at the University of Puerto Rico Comprehensive Cancer Center.

By THE STAR STAFF

The incidence of obesity-associated cancers in Puerto Rico rose significantly between 2000 and 2022, according to research presented at the 18th AACR Conference on the Science of Cancer Health Disparities, held last week.

Individuals with obesity have a much higher cancer risk, from a 10% increase to a seven-fold increase in risk across multiple types of cancers, compared with individuals who do not have obesity, explained presenter Carola T. Sánchez-Díaz, MS, PhD, assistant investigator in the Division of Cancer Control and Population Sciences at the University of Puerto Rico Comprehensive Cancer Center (UPRCCC). Obesity-associated cancers, as defined by the U.S. Centers for Disease Control and Prevention (CDC), include esophageal cancer, upper stomach cancer, colorectal cancer, liver cancer, gallbladder cancer, pancreatic cancer, multiple myeloma, postmenopausal female breast cancer, uterine cancer, ovarian cancer, kidney cancer, meningioma, and thyroid cancer.

In 2023, the overall obesity prevalence in the United States and its territories was about 20%. In Puerto Rico, however, obesity prevalence exceeded 36%, making it one of the jurisdictions with the highest rates in the nation.

The study led by Sánchez-Díaz evaluated the incidence and trends of obesity-related cancers in Puerto Rico between 2000 and 2022, drawing on data from the Puerto Rico Central Cancer Registry. Looking ahead, Sánchez-Díaz explained that the island’s unique social and environmental context—including economic crises, infrastructure failures, natural disasters like Hurricane Maria and earthquakes, and the COVID-19 pandemic—may have played a role in shaping lifestyle behaviors. These disruptions can restrict access to cancer screening, health care, nutritious foods, and safe spaces for physical activity, all of which heighten obesity risk. With Puerto Rico already facing high rates of obesity, her team and collaborators at the UPRCCC are now seeking to determine whether these factors are contributing to the disproportionate rise in obesity-associated cancers observed on the island.

From 2000 to 2022, the incidence of obesity-related cancers increased significantly, with an average annual percentage change (AAPC) of 1.4%, while non-obesity-related cancers remained stable.

From 2000 to 2022, women under 50 had the highest increase in obesity-related cancers, with an AAPC of 4.9% and 4.6% among those 30 to 39 and 40 to 49 years old, respectively. “It is most concerning to find that women under 50 are experiencing the most significant increases in obesity-related cancers,” said Sánchez-Díaz.

Sánchez-Díaz explained that among men under 40, the largest increases were for thyroid cancer (AAPC: 7.5%), kidney cancer (AAPC: 4.4%), and colorectal cancer (AAPC: 4.0%). Women under 40 showed the highest increases in thyroid cancer (AAPC: 6.1%), colorectal cancer (AAPC: 5.0%), and uterine cancer (AAPC: 4.9%). In addition, women aged 40 to 49 experienced significant increases in pancreatic, kidney, and ovarian cancers, while men in the same age group showed increases in multiple myeloma.

The study found that between 2018 and 2022, a total of 35,468 cases of obesity-associated cancers were reported, corresponding to an overall age-adjusted incidence rate of 213.18 per 100,000 population. The overall age-adjusted incidence rate from 2000 to 2017 was 193.66 per 100,000 population, which may show the effect of natural disasters like Hurricane Maria and the COVID-19 pandemic on obesity-associated cancer incidence. However, further research is needed to fully assess the impact of these events.

She explained the need to understand the unique challenges Puerto Ricans face and to develop public policies that support healthier living and highlighting that cancer screening is essential for early detection, especially for these younger age groups. “Our purpose is to show that Puerto Rico has a unique context and history that cannot be generalized from U.S. mainland data,” Sánchez-Díaz added.

Limitations of the study include the restriction of 2017 data to January through June due to population shifts following Hurricane Maria. Additionally, data from 2020 were excluded from trend analyses because of COVID-19-related disruptions. Individual-level data on body mass index, behaviors, and health care access were not available, limiting the ability to directly attribute observed trends to obesity.

The study was supported by a federal grant from the CDC-National Program of Cancer Registries to the Puerto Rico Central Cancer Registry at the UPRCCC.