Eating disorders and the risk of developing cancer: a systematic review
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REVIEW
Eating disorders and the risk of developing cancer: a systematic review Nathalie Michels1 · Fien De Backer1 · Myrto Dimakopoulou2 · Katerina Mane2 · Iciar Indave2 · Inge Huybrechts1,2 Received: 3 July 2020 / Accepted: 11 September 2020 © Springer Nature Switzerland AG 2020
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). Level of evidence Level I, systematic review. Keywords Neoplasms · Systematic review · Anorexia nervosa · Bulimia nervosa · Observational studies
Introduction An eating disorder is a psychological disorder characterized by a pathological way of eating affecting the body and the mind, resulting in an impaired physical and psychosocial functioning. Most well-known subtypes are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). AN is a psychological disorder characterized by a restriction of energy intake and an extreme weight
Nathalie Michels and Fien De Backer shared first authorship. * Nathalie Michels [email protected] 1
Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000 Gent, Belgium
International Agency for Research on Cancer, Lyon, France
2
loss, induced and sustained by the patient. It is mostly, but not exclusively, seen in adolescent girls, but boys and men may also be affected [1]. BN is a syndrome character
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