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Eating disorders and the risk of developing cancer : a systematic review

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Abstract
Purpose Evidence concerning eating disorders as risk toward developing cancer is sparse. Energy restriction might be cancer protective, while malnutrition, vomiting, laxative and substance use might stimulate cancer development. We examined whether individuals with an eating disorder (not restricted to anorexia nervosa) had a different risk of developing cancer. Methods A systematic search on Medline and Embase until 28th April 2020 identified relevant human original research publications, including all populations and all cancer types. Results From 990 records, 6 case reports and 9 cohorts were included. Some cohorts found a decreased breast (3/5 studies) or cervical (1/2) cancer risk, while an increased esophageal (2/3), liver (1/1), brain (1/1 in men) and respiratory (2/4) cancer risk, but other cancer risks were non-significant, and an increased mortality overall (1/2), from breast (1/1), female genital (1/1) and skin (1/1) cancer in eating disorder patients. The case reports further described esophageal cancer and leukemia. No clear statistical differences in cancer risk were found depending on eating disorder type, perhaps due to the small sample size (n = 1783 for other than anorexia nervosa). Conclusions The literature on eating disorders and cancer risk is sparse with many gaps. Hormonal changes, sexual activity, nutritional status, vomiting and concomitant tobacco/alcohol abuse may explain increased/decreased cancer risk. Future large studies (now 1-366 cancer cases) that also include men (now 4.7%), bulimia nervosa (now 3.8%) and several cancer sites (now mainly breast cancer) are needed and should foresee longer follow-up time (now 5.4-15.2 years) and extensive confounder adjustment (now only age and sex).
Keywords
Clinical Psychology, Psychiatry and Mental health, Neoplasms, Systematic review, Anorexia nervosa, Bulimia nervosa, Observational studies, SQUAMOUS-CELL CARCINOMA, BODY-MASS INDEX, ANOREXIA-NERVOSA, BULIMIA-NERVOSA, BREAST-CANCER, CALORIC RESTRICTION, BARRETTS-ESOPHAGUS, PREVALENCE, MORTALITY, EPIDEMIOLOGY

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Citation

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MLA
Michels, Nathalie, et al. “Eating Disorders and the Risk of Developing Cancer : A Systematic Review.” EATING AND WEIGHT DISORDERS - STUDIES ON ANOREXIA BULIMIA AND OBESITY, vol. 26, 2021, pp. 1021–35, doi:10.1007/s40519-020-01020-4.
APA
Michels, N., De Backer, F., Dimakopoulou, M., Mane, K., Indave, I., & Huybrechts, I. (2021). Eating disorders and the risk of developing cancer : a systematic review. EATING AND WEIGHT DISORDERS - STUDIES ON ANOREXIA BULIMIA AND OBESITY, 26, 1021–1035. https://doi.org/10.1007/s40519-020-01020-4
Chicago author-date
Michels, Nathalie, Fien De Backer, Myrto Dimakopoulou, Katerina Mane, Iciar Indave, and Inge Huybrechts. 2021. “Eating Disorders and the Risk of Developing Cancer : A Systematic Review.” EATING AND WEIGHT DISORDERS - STUDIES ON ANOREXIA BULIMIA AND OBESITY 26: 1021–35. https://doi.org/10.1007/s40519-020-01020-4.
Chicago author-date (all authors)
Michels, Nathalie, Fien De Backer, Myrto Dimakopoulou, Katerina Mane, Iciar Indave, and Inge Huybrechts. 2021. “Eating Disorders and the Risk of Developing Cancer : A Systematic Review.” EATING AND WEIGHT DISORDERS - STUDIES ON ANOREXIA BULIMIA AND OBESITY 26: 1021–1035. doi:10.1007/s40519-020-01020-4.
Vancouver
1.
Michels N, De Backer F, Dimakopoulou M, Mane K, Indave I, Huybrechts I. Eating disorders and the risk of developing cancer : a systematic review. EATING AND WEIGHT DISORDERS - STUDIES ON ANOREXIA BULIMIA AND OBESITY. 2021;26:1021–35.
IEEE
[1]
N. Michels, F. De Backer, M. Dimakopoulou, K. Mane, I. Indave, and I. Huybrechts, “Eating disorders and the risk of developing cancer : a systematic review,” EATING AND WEIGHT DISORDERS - STUDIES ON ANOREXIA BULIMIA AND OBESITY, vol. 26, pp. 1021–1035, 2021.
@article{8680867,
  abstract     = {{Purpose Evidence concerning eating disorders as risk toward developing cancer is sparse. Energy restriction might be cancer protective, while malnutrition, vomiting, laxative and substance use might stimulate cancer development. We examined whether individuals with an eating disorder (not restricted to anorexia nervosa) had a different risk of developing cancer. Methods A systematic search on Medline and Embase until 28th April 2020 identified relevant human original research publications, including all populations and all cancer types. Results From 990 records, 6 case reports and 9 cohorts were included. Some cohorts found a decreased breast (3/5 studies) or cervical (1/2) cancer risk, while an increased esophageal (2/3), liver (1/1), brain (1/1 in men) and respiratory (2/4) cancer risk, but other cancer risks were non-significant, and an increased mortality overall (1/2), from breast (1/1), female genital (1/1) and skin (1/1) cancer in eating disorder patients. The case reports further described esophageal cancer and leukemia. No clear statistical differences in cancer risk were found depending on eating disorder type, perhaps due to the small sample size (n = 1783 for other than anorexia nervosa). Conclusions The literature on eating disorders and cancer risk is sparse with many gaps. Hormonal changes, sexual activity, nutritional status, vomiting and concomitant tobacco/alcohol abuse may explain increased/decreased cancer risk. Future large studies (now 1-366 cancer cases) that also include men (now 4.7%), bulimia nervosa (now 3.8%) and several cancer sites (now mainly breast cancer) are needed and should foresee longer follow-up time (now 5.4-15.2 years) and extensive confounder adjustment (now only age and sex).}},
  author       = {{Michels, Nathalie and De Backer, Fien and Dimakopoulou, Myrto and Mane, Katerina and Indave, Iciar and Huybrechts, Inge}},
  issn         = {{1124-4909}},
  journal      = {{EATING AND WEIGHT DISORDERS - STUDIES ON ANOREXIA BULIMIA AND OBESITY}},
  keywords     = {{Clinical Psychology,Psychiatry and Mental health,Neoplasms,Systematic review,Anorexia nervosa,Bulimia nervosa,Observational studies,SQUAMOUS-CELL CARCINOMA,BODY-MASS INDEX,ANOREXIA-NERVOSA,BULIMIA-NERVOSA,BREAST-CANCER,CALORIC RESTRICTION,BARRETTS-ESOPHAGUS,PREVALENCE,MORTALITY,EPIDEMIOLOGY}},
  language     = {{eng}},
  pages        = {{1021--1035}},
  title        = {{Eating disorders and the risk of developing cancer : a systematic review}},
  url          = {{http://dx.doi.org/10.1007/s40519-020-01020-4}},
  volume       = {{26}},
  year         = {{2021}},
}

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