A Second Chance

Second chance road sign

Sheila Hoffman(¥) struggled with her weight for many years. Her weight really got out of control after her marriage when she was 28 years old. “He was abusive,” she said, “when you live with a person like that you just stop caring about yourself.” Unable to have children as well, she dealt many years with depression.

Years later, her husband died suddenly of a heart attack. She was now 53 years old and widowed.

“How did you feel about it after he died?” I asked curiously and a bit reluctantly. “After he died? Yeah, I was really sad….but part of me was relieved. I felt like maybe I can now start living my life on my own terms” she said timidly. Then looking up with slight smirk, she said “ I even thought about losing all this weight and exercising….but I gained too much weight and I found it impossible to lose the weight and keep it off”. She paused as if pondering a thought, “I think I just became too helpless of a person.”

But her excess weight gain also caused health problems. She had also developed high blood pressure, and Type 2 Diabetes. Her weight gain caused severe joint problems in both knees, and she had to undergo two knee replacement surgeries so she could somewhat walk normally and comfortably again. All the while, she continued to work in a hospital medical records department handling billing claims. It was a desk job that she had been employed for years.

All though she was in menopause—not having had a period in years—one day she started noticing she was bleeding again. Concerned, she went to her gynecologist who recommended her to undergo an office biopsy of the inside lining of the uterus. Three days later, she got the call from her doctor. “I remember that day vividly. It was a Friday, and I was in my car leaving work. He called my cell and told me it was cancer…it was endometrial cancer.”

As an oncologist who cares for women with gynecologic malignancies, Sheila’s symptoms and her risk factors (obesity, high blood pressure, Type 2 Diabetes) are classic for this kind of cancer. In fact, a woman who walks into my office with abnormal vaginal bleeding, obesity, high blood pressure, and Type 2 Diabetes is assumed to have endometrial cancer until proven otherwise.

Sheila Hoffman’s cancer is highly related to obesity. Since 2007, we are seeing a rise of endometrial cancers in the U.S. Many experts attribute this to our rising obesity rates. In fact, if the current trends continue, by 2030, we will see 55% more endometrial cancers than we do today.

The rapid increase in obesity and its disease burden (i.e., cardiovascular disease, chronic illness, cancers) have not only been a public health issue here in America but also globally. For the first time, more than 10% of earth’s population is obese.

Although we often hear that obesity is on the rise in both children and adults, what many may not realize is that it is women who have the highest rates of obesity. Moreover, the discrepancy between men and women is widening.

Where women extend the gap of obesity between men starts at age 50- the age most women go through menopause. During menopause, women gain body fat due to the drop in estrogen hormone in the body. During menopause, women also typically start to accumulate more body fat around their belly. This increasing amount of belly fat is a risk factor to develop insulin resistance leading to Type 2 Diabetes and cardiovascular disease like high blood pressure.

Last year, research published in the New England Journal of Medicine confirmed that there is now sufficient evidence to link 13 types of cancers related to excess body weight. Three of the 13 cancers occur only in women—breast cancer, endometrial cancer, and ovarian cancer. What is more alarming is that you don’t have to be obese to increase your cancer risk. The risk of these cancers increases with simply just being overweight (BMI > 25). Of course, the higher the BMI, the higher the risk of these diseases.

We also know that obesity leads to worse outcomes in women diagnosed with these cancers. Obese women with breast cancer and ovarian cancer have worse cancer prognosis than average weight women.

Last year, I did Sheila’s hysterectomy and staging (I removed some lymph nodes and her ovaries). Fortunately, it was caught early, and she had a stage I endometrial cancer. Her type of cancer was a slow growing tumor and did not invade very deep into the uterus muscle. So she didn’t need any chemotherapy and radiation.

Although her cancer is likely cured, I still tried to encourage her to lose weight. She was still at risk for heart disease, stroke, diabetes complications, and other obesity-related cancers like breast cancer, colon cancer, kidney cancer, etc.

She joined Weight Watchers and started going to the group meetings. She also started doing more gardening and yard work to be physically active. “When I got that cancer diagnosis, and I found out it was also related to my weight like my diabetes and blood pressure, I was so angry at myself. But when I figured out after surgery that the cancer is likely cured and I wouldn’t need any chemotherapy and radiation, I promised myself to change because this was a sign of a second chance in my life.” Now one year later, she is down 25 lbs and still doing her best to live a healthier life.

(¥): Sheila Hoffman’s name is changed for her privacy