When the Diagnosis Arrives by App: Why Most Patients Still Want a Human Voice
Key Takeaways:
- In a UT Southwestern survey of more than 2,400 people diagnosed with cancer, 75% said they would prefer to receive the news directly from their physician – in person or by telemedicine – rather than through an electronic patient portal.
- More than half of those who first learned of their diagnosis via the portal were alone at the time, often without support from a clinician or family member.
- Researchers are calling for a more personalised approach, including better portal notification settings, tiered or delayed release of sensitive findings, and plain-language summaries of radiology and pathology reports.
A digital convenience with an emotional cost
Electronic patient portals have transformed how quickly people can see their own test results. For routine bloodwork or a clear scan, near-instant access is a welcome convenience. But the same speed raises a difficult question for clinicians: how should a new cancer diagnosis be communicated when a patient can open the result on a phone before anyone has had the chance to talk it through?
That tension has grown sharper since 2021, when a provision of the 21st Century Cures Act came into force in the United States. The regulation requires that patients have timely, unrestricted access to their electronic health information – which, in practice, means a growing number of people are discovering a new or recurrent cancer diagnosis through their portal, sometimes with no clinician present to interpret it or answer the questions that immediately follow.
What the UT Southwestern survey found
A new survey carried out at UT Southwestern Medical Center suggests that, for most people facing a cancer diagnosis, faster is not better. The findings, published in JAMA Network Open, show that 75% of respondents would prefer to learn about a cancer diagnosis directly from their physician, whether in person or through a telemedicine appointment.
The 2025 survey gathered responses from more than 2,400 people who were diagnosed with cancer at the Harold C. Simmons Comprehensive Cancer Center between 2019 and 2023, giving the researchers a substantial real-world picture of how patients want sensitive results delivered.
According to the study’s lead author, Sheena Bhalla, M.D., Assistant Professor of Internal Medicine in the Division of Hematology and Oncology and a medical oncologist at the Simmons Cancer Center, the broad enthusiasm for digital access does not extend neatly to oncology. “While most patients in the general population appreciate rapid electronic access to test results, the situation for patients with cancer is much more nuanced,” she said. “Learning about a cancer diagnosis without the ability to immediately ask questions or discuss next steps with a trusted clinician can add to the significant stress, uncertainty, and fear that patients experience.”
Preferences are not one-size-fits-all
The survey also revealed that there is no single right way to share a result. Preferences varied according to people’s prior experiences, how frequently they used their portal, and their demographic characteristics. Men, for instance, were more likely than women to prefer learning of a diagnosis through the portal.
For senior author David Gerber, M.D., Professor of Internal Medicine in the Division of Hematology and Oncology and of Epidemiology in the Peter O’Donnell Jr. School of Public Health, and co-Director of the Simmons Cancer Center Office of Education and Training, that variation is precisely the point. “These findings highlight the need for a more personalized, tailored approach to communicating sensitive and life-changing results,” he said. “Moving beyond a one-size-fits-all approach can help clinicians provide a more thoughtful, compassionate patient experience.”
The hidden consequence: facing the news alone
Perhaps the most striking insight concerns the circumstances in which people are receiving these results. Among those who learned of their diagnosis through the portal, more than half reported that they were alone when they read it.
Dr Bhalla described this as one of the most troubling side effects of real-time access. “That’s one of the most unintended consequences of real-time access,” she said. “Patients are often alone without support from their physician or family at one of their most vulnerable moments.”
Possible solutions for clinicians and health systems
The researchers are clear that the answer is not to roll back access, but to design around it more thoughtfully. They point to several potential measures, including raising awareness among both clinicians and patients of the portal notification settings already available; developing tiered or delayed-release approaches for particularly sensitive findings; and integrating supportive digital tools such as plain-language summaries for radiology and pathology reports.
Policy is beginning to catch up. Since the Cures Act took effect, three states – including Texas – have enacted laws permitting the delayed portal release of cancer-related and other sensitive results, giving care teams a window to reach out before a patient is left to interpret difficult news on their own.
Looking ahead
For the study’s authors, the work is a starting point rather than a conclusion. “Further study and increased interdisciplinary collaboration among oncology clinicians, health services researchers, and digital health experts can help us better understand how patients receive and react to cancer diagnoses,” Dr Bhalla said. “Our goal is to increase awareness of this issue and help drive innovative approaches to patient-centered communication.”
Source: UT Southwestern Medical Center
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Turning Records into Foresight: Machine Learning to Anticipate Need in Cancer Survivorship Care
Key Takeaways:
- Sylvester researchers used machine learning on records and patient-reported data from over 25,000 people who have survived cancer to predict who is most at risk.
- Adding patients’ own reports nearly doubled the models’ accuracy, with the top 10 per cent of risk capturing about half of later events.
- The work signals a shift towards proactive, personalised survivorship care, though it is not yet meant to change practice.
A new phase of care
For a growing number of people who have survived cancer, ringing the bell at the end of primary treatment marks the start of a complex new phase of care – one that is often less structured and far harder to predict. Even once therapy has concluded, people may continue to experience lingering physical symptoms, emotional distress or other unexpected medical needs. These can lead to visits to the emergency department or urgent care, to hospital admissions, and to a worsening burden of symptoms over time.
A new study from Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, suggests that the key to anticipating these outcomes may lie in examining electronic health records and patient-reported data systematically, using novel artificial intelligence (AI) technologies.
Published in JCO – Clinical Cancer Informatics, the study demonstrates how machine learning models, when applied to clinical data and patient-reported outcomes (PROs), can help identify survivors at increased risk of unplanned healthcare use and of an elevated symptom burden during survivorship. By transforming medical records and patient-reported data into predictive signals, the research offers a potential route towards more proactive, personalised survivorship care.
Cancer survivorship care is a dynamic, ongoing process rather than a single phase of care, explained Frank J. Penedo, Ph.D., Sylvester associate director for population sciences, director of Sylvester’s Survivorship and Supportive Care Institute and the study’s senior author.
“For many patients, new or evolving challenges arise after treatment ends, just as routine clinical contact often tapers off, raising a critical question. How can we identify those at higher risk earlier, before these concerns intensify and become harder to address?” Dr Penedo said.
Listening to people’s own experiences
Patient-reported outcomes capture experiences that traditional clinical data often miss or assess only infrequently. These include emotional well-being, fatigue, functional limitations and other practical needs that may interfere with adequate survivorship care. Over the past decade, PROs have become an increasingly important component of cancer care. Yet translating large volumes of patient-reported data, and integrating them with vast amounts of medical record data to produce actionable insights – particularly across whole populations of survivors – has remained a persistent challenge.
Led by Akina Natori, M.D., M.S.P.H., a Sylvester oncologist and assistant professor in the Division of Medical Oncology at the Miller School, the study reframed PROs. Rather than treating them as retrospective descriptions of what a person has already experienced, the team used them as prospective indicators of future need.
“PROs tell us how patients are actually feeling and functioning,” said Dr Natori, first author of the study. “We wanted to know whether those self-reported experiences, in combination with clinical data such as cancer and treatment type, could help us identify which survivors might be at higher risk for significant symptom burden or unplanned health care use down the line.”
Unplanned healthcare use can include emergency department visits or hospital admissions that arise outside scheduled follow-up. Such events often signal unmet needs or gaps in survivorship and supportive care. Being able to forecast that risk could allow care teams to step in earlier, with targeted symptom management, psychosocial support or closer monitoring.
Applying machine learning to survivorship data
To explore that possibility, the research team analysed data from more than 25,000 people who have survived cancer, followed over three years, using machine learning to detect patterns that traditional statistical methods can miss. The advantage of these approaches is their ability to weigh many factors at once – clinical history, treatments, symptoms, emotional well-being and patterns of healthcare use – and to find the subtle interactions that signal which people are heading towards trouble.
The answers turned out to depend on what was being predicted. For acute events such as emergency room visits and hospital admissions, recent clinical activity was the strongest signal: what was happening with a person over the last few months mattered more than where they had started. For symptom burden, longer-term trends told a clearer story. Crucially, adding patient-reported outcomes nearly doubled how well the models performed compared with clinical data alone. When the researchers flagged the highest-risk 10 per cent of people, that group accounted for roughly half of all subsequent healthcare events and elevated symptom episodes.
Building models that clinicians can trust
“This type of risk stratification problem is well-suited for machine learning,” said Jerry R. Bonnell, Ph.D., a postdoctoral associate at the University of Miami’s Frost Institute for Data Science and Computing. “The challenge is developing models that are not only accurate, but also interpretable and meaningful for clinicians making real-world decisions.”
That emphasis on interpretability shaped the study’s design. Rather than treating the models as opaque, “black box” systems, the team built them to show their reasoning. This surfaced which factors were driving a given person’s risk score, and how those factors shifted over time. The goal is a tool that gives clinicians not just a number, but a starting point for conversation: about who needs closer follow-up, what they may need, and when to step in before a problem escalates.
An interdisciplinary approach
The project drew together expertise from clinical oncology, psychosocial oncology, population sciences and data science, reflecting the multifaceted nature of survivorship care. Contributors included Vasileios Stathias, Ph.D., assistant director for data science at Sylvester, alongside collaborators across the University of Miami.
“Survivorship sits at the intersection of biology, behavior and health systems,” Dr Stathias said. “By combining patient-reported and clinical data with advanced analytics, we can begin to see patterns that might otherwise remain invisible and that can inform more proactive care strategies.”
Additional authors included:
- Sara Fleszar Pavlovic, Ph.D., a Miller School research assistant professor of medical oncology
- Mitsunori Ogihara, Ph.D., programme director of UM’s Big Data Analytics and Data Mining program
- Andrew Wang, A.B.
- Ravi Vadapalli, Ph.D., director of advanced computing for the Frost Institute for Data Science and Computing
- Blanca Silvia Noriega Esquives, M.D., Ph.D., a Sylvester postdoctoral associate
- Tracy Crane, Ph.D., RDN, co-leader of the Cancer Control Program and director of lifestyle medicine, prevention and digital health at Sylvester
Implications for cancer survivorship care
While the authors emphasised that the findings are not intended to change clinical practice immediately, they highlighted the broader implications of the work. As populations of people living beyond cancer continue to grow, health systems face mounting pressure to deliver long-term care that is precise, proactive and sustainable.
“This is about shifting from reactive to proactive survivorship care,” Dr Penedo said. “If we can identify patients who are more likely to struggle, we can begin to align supportive resources earlier and more effectively.”
The team also noted the potential impact of predictive models that combine clinical and PRO-based data on healthcare access. Because PROs reflect patient voices directly, they may help surface unmet needs that are less likely to be captured through routine clinical encounters alone.
Looking ahead
Future research will focus on continuing to refine and validate these models across broader populations of survivors, and on exploring how risk stratification driven by electronic health record and PRO data could be integrated into survivorship standards of care.
“The expertise of our multidisciplinary team provides a unique opportunity to create a data ecosystem that facilitates the implementation of AI-powered analytics to guide proactive and precision care to reduce the burden of cancer on patients and health systems. This study is among several initiatives that are working towards this goal,” said Dr Penedo.
“Our long-term goal is to ensure that survivorship care keeps pace with advances in treatment,” said Dr Natori. “That means using data not only to describe outcomes, but to anticipate them, so we can more proactively support patients in the years after cancer.”
Source: University of Miami Miller School of Medicine
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Obesity Identified as Key Driver of Rising Cancer Rates in Younger Adults
Key Takeaways:
- A major new study has found that overweight and obesity are likely to be significant contributors to rising cancer rates among younger adults in England.
- Researchers found that many traditional behavioural cancer risk factors – including smoking, alcohol consumption and physical inactivity – have remained stable or improved over the past two decades, making them unlikely to fully explain the increase in early-onset cancers.
- Although excess weight appears to play an important role, researchers say it cannot entirely account for the rise in cancers such as bowel cancer, suggesting that additional biological, environmental and early-life factors may also be involved.
Study highlights growing concern over early-onset cancer
Being overweight or living with obesity may be a key driver behind rising cancer rates in younger adults in England, according to a major new study led by researchers at The Institute of Cancer Research, London, and Imperial College London.
The analysis, published in BMJ Oncology, examined trends in cancer incidence alongside changes in known behavioural cancer risk factors over nearly two decades. Researchers found that while rates of several cancers among younger adults have continued to increase, many established lifestyle-related risk factors have either improved or remained stable during the same period.
These findings led researchers to conclude that obesity is likely to be one of the most important contributors to the increase in cancer incidence among younger generations in England.
At the same time, the researchers stressed that rising body mass index (BMI) alone does not fully explain the growing number of cancer cases, indicating that additional factors may also be contributing to the trend.
Researchers analysed cancer trends across England
The research team used national cancer registry data from England covering the years 2001 to 2019. The study was conducted by scientists from the Cancer Epidemiology and Prevention Research Unit (CEPRU) at both The Institute of Cancer Research (ICR) and Imperial College London.
Researchers examined incidence trends across:
- 22 cancer types in women
- 21 cancer types in men
From this analysis, they identified 11 cancers that are increasing among adults aged between 20 and 49 years and are associated with known behavioural risk factors.
All of the cancers identified – except oral cancer – are recognised as being linked to excess weight.
For most cancer types, increases seen in younger adults mirrored trends observed in adults aged over 50, where the overall disease burden remains considerably higher. However, bowel cancer and ovarian cancer stood out as notable exceptions because rates were increasing only among younger age groups.
Most traditional risk factors have improved
The study examined trends in several well-established behavioural cancer risk factors, including:
- Smoking
- Alcohol use
- Overweight and obesity
- Physical inactivity
- Red and processed meat consumption
- Low fibre intake
Together, these risk factors accounted for an estimated 40–50 per cent of bowel, endometrial, oral and liver cancer cases in 2019.
However, researchers found that trends for most of these risk factors have either remained stable or improved over time, making them unlikely to substantially explain the recent rise in cancer incidence among younger adults.
According to the analysis:
- Smoking among younger adults has fallen by approximately two per cent annually over the past two decades.
- Alcohol consumption has largely stabilised or declined.
- Physical inactivity has decreased.
- Consumption of red and processed meat has reduced.
- Fibre intake, while still below recommended levels, has gradually improved.
In contrast, rates of overweight and obesity have steadily increased since 1995.
The largest increases in obesity were observed among younger women, where obesity prevalence rose by approximately 2.6 per cent relative increase per year.
Obesity linked to rising bowel cancer rates
The researchers found evidence linking rising BMI to increasing bowel cancer rates among younger adults.
Among younger women, bowel cancer rates associated with BMI rose from 0.9 to 1.6 cases per 100,000 people. In comparison, bowel cancer rates not attributable to BMI increased from 6.4 to 9.6 cases per 100,000 people.
Similar patterns were also observed in men.
However, the authors emphasised that the total number of BMI-linked bowel cancer cases remained lower than the number of cases not linked to BMI. This suggests that although obesity is an important contributor, it cannot fully explain the scale of the increase in bowel cancer among younger adults.
Additional causes may be contributing
The study points to the likelihood that multiple interacting factors are contributing to rising cancer rates in younger generations.
Several suspected contributors have previously been proposed, including:
- Ultra-processed foods
- Antibiotic use
- Air pollution
However, researchers noted that many of these exposures have also shown relatively stable or declining trends in the UK, complicating efforts to identify the main drivers of early-onset cancers.
The authors also highlighted emerging evidence suggesting that obesity-related mechanisms not fully captured by BMI may influence cancer risk. These include:
- Metabolic dysfunction
- Chronic inflammation
- Alterations in the gut microbiome
Further research is needed to determine whether these mechanisms directly contribute to the development of bowel cancer and other cancers in younger adults.
Experts say more research is urgently needed
The researchers called for large-scale, long-term studies capable of tracking exposures across the entire life course in order to better understand what is driving rising rates of early-onset cancers.
Professor Marc Gunter, Co-Director of the Cancer Epidemiology and Prevention Research Unit at Imperial College London, said:
“The changes we’re seeing in cancer incidence, particularly the rates of some cancers in younger adults, don’t have a single cause or a simple answer. They reflect a complex mix of generational effects, gaps in long-term exposure data, and shifts in diagnosis and detection, and show how much more scientists still need to understand about when and how cancer develops across the life course. While rising rates in younger adults are concerning, it remains crucial not to lose sight of cancer trends in older adults, where the absolute burden of disease is still far greater.”
Professor Montserrat García-Closas, Co-Director of the Cancer Epidemiology and Prevention Research Unit and Group Leader in Integrative Cancer Epidemiology at The Institute of Cancer Research, London, said the findings indicate that behavioural changes alone cannot explain current trends.
She said:
“Our findings show that while cancer rates are rising in younger adults, the trends are unlikely to be explained by changes in most known behavioural risk factors. Smoking, alcohol and other behaviours have been stable or improving for two decades, yet early-onset cancers continue to increase – particularly bowel cancer.
“Excess weight is an important contributor, although it cannot fully account for the scale of the rise in bowel and other cancers. This tells us that multiple factors – including early-life exposures – may be acting together. Understanding these patterns is essential for identifying what is truly driving cancer risk in today’s generations. We now need deeper research, better measurement and continued surveillance to uncover the causes behind these worrying trends.
“However, we cannot wait to act. Tackling obesity across all ages, particularly in children and young people, through stronger public health policies and wider access to effective interventions, could slow the rise in cancer and prevent many cancers – and must become a national priority.”
Calls for stronger prevention and public health action
The findings have prompted renewed calls for stronger public health measures aimed at preventing obesity and improving cancer prevention strategies across all age groups.
Professor Kristian Helin, CEO of The Institute of Cancer Research, London, said the study highlights an urgent public health challenge requiring coordinated action across research, prevention and policy.
He said:
“This work highlights a growing public health challenge and the need for urgent action across research, prevention and policy. Although rising cancer rates in younger adults are concerning, the burden remains overwhelmingly higher in older people, which means prevention efforts must span all ages.
“This study makes clear that traditional lifestyle risks alone cannot explain current trends – pointing to the importance of investigating other exposures such as the potential role of the microbiome, while strengthening strategies to address obesity and other established risks. To protect future generations, we must invest in understanding the causes of cancer at all ages and ensure that early diagnosis, screening and prevention strategies keep pace with a changing population.”
CCH insights:
The outcomes of this study are concerning but not entirely surprising, given that obesity rates in children and young people are still rising and obesity is a significant risk factor for many cancers. It adds further support for the call to treat obesity at the earliest opportunity, regardless of the age of the individual. The longer obesity goes untreated the greater the risk of individuals developing serious chronic diseases such as cancer, type 2 diabetes and heart disease.
Automated Weight Loss Programme Shows Promise for People Living with Cancer in Landmark Trial
Key Takeaways:
- A fully automated, web-based programme delivered clinically meaningful weight loss in people living with and beyond cancer, without any in-person support
- More than 43 percent of participants achieved at least 3 percent weight loss, with nearly one in three reaching 5 percent or more
- The intervention also improved a range of health outcomes, including diet quality, physical functioning, and cardiometabolic markers
A new model for post-cancer care
A large national randomised clinical trial has demonstrated that a fully automated, web-based weight loss intervention can deliver substantial health benefits for people living with and beyond cancer. The programme, developed by researchers at the University of Alabama at Birmingham, represents a significant shift in how post-cancer care may be delivered in the future.
Published in the Journal of the National Comprehensive Cancer Network, the study reported the highest level of weight loss ever achieved through a fully automated intervention in this population. The programme, known as the AMPLIFY Diet (AiM, PLan and act on LIFestYles), was designed to provide structured, evidence-based lifestyle support without requiring direct clinician involvement.
Addressing a major unmet need
A substantial proportion of people living with and beyond cancer are also living with overweight or obesity. In the United States, this figure is estimated to be around 70 percent. This places individuals at increased risk of cardiovascular disease, type 2 diabetes, functional decline, cancer recurrence, and the development of second primary cancers.
Despite this, access to specialist oncology dietitians remains limited. Traditional weight management programmes often rely on in-person consultations or regular coaching, which can be difficult to scale and may not be accessible to all patients.
The AMPLIFY Diet intervention was developed specifically to address these barriers by delivering personalised nutrition and behavioural support entirely online.
A fully automated intervention
The programme operates without live coaching, counselling calls, or face-to-face appointments. Instead, it uses a structured digital platform that includes weekly interactive sessions, goal-setting tools, progress monitoring, and automated personalised feedback.
Participants engage with the system independently, receiving guidance that is grounded in established behavioural and nutritional science. This approach allows for scalability while maintaining a consistent standard of care.
“This is a game changer for cancer survivorship care,” said Wendy Demark-Wahnefried, Ph.D., R.D., senior author and professor at UAB’s School of Health Professions and O’Neal Comprehensive Cancer Center. “We showed that a completely automated online program grounded in decades of behavioral and nutrition science can safely and effectively help cancer survivors lose weight and improve their health at scale.”
Study design and participant profile
Between 2020 and 2024, the study enrolled 349 participants aged between 50 and 82 years from 31 states across the United States. All participants were living with and beyond cancers associated with obesity.
The cohort included individuals with a range of cancer types, including breast, colorectal, prostate, endometrial, ovarian, thyroid, renal, and haematologic cancers. Participants were randomly assigned to either the AMPLIFY Diet programme or a control group receiving standard survivorship information.
Clinically meaningful weight loss outcomes
After six months, the results showed clear differences between the intervention and control groups.
More than 43 percent of participants in the AMPLIFY Diet group achieved weight loss of at least 3 percent of their body weight. In comparison, only 13 percent of those receiving usual care reached this threshold.
In addition, nearly one in three participants in the intervention group lost at least 5 percent of their body weight. This level of weight loss is widely associated with reductions in cardiovascular risk and improvements in cancer-related outcomes.
On average, weight loss in the intervention group was nearly five times greater than that observed in the control group.
Broader health improvements
The benefits of the programme extended beyond weight loss alone. Participants in the AMPLIFY Diet group experienced improvements across multiple domains of health and wellbeing.
These included reductions in waist circumference and overall caloric intake, as well as improvements in diet quality. Biochemical markers also shifted in a favourable direction, with lower circulating levels of leptin, a hormone associated with cancer progression and cardiometabolic disease.
Further gains were observed in blood pressure, physical functioning, and cognitive performance. Participants also reported improvements in depression and their ability to engage in social roles, suggesting a broader impact on quality of life.
Strong engagement without human support
One notable finding from the study was the level of participant engagement. Individuals completed an average of 60 percent of the weekly sessions, which is considerably higher than engagement rates typically reported in other digital lifestyle interventions.
This suggests that a well-designed automated system can maintain user engagement even in the absence of direct human interaction.
Implications for scalable care
Unlike many conventional weight management programmes, the AMPLIFY Diet intervention does not require ongoing staff involvement. This makes it particularly well suited for integration into healthcare systems, cancer centres, and community-based services.
The ability to deliver consistent, evidence-based care at scale may help address longstanding gaps in survivorship support, particularly in settings where specialist resources are limited.
The role of behavioural and nutritional care
The researchers emphasise that lifestyle-based interventions remain a cornerstone of care for people living with and beyond cancer, particularly as pharmacological approaches continue to evolve.
“Behavioral and nutritional interventions are essential,” Demark-Wahnefried said. “Diet quality, muscle preservation, cognition, and long-term sustainability of a healthful lifestyle and body weight are critical for cancer survivors, and even if weight loss medications eventually receive broadscale endorsement, they alone do not address all of these needs.”
Future directions
The research team is now focusing on expanding the reach of the AMPLIFY Diet programme across both clinical and non-clinical settings. The aim is to improve access to effective survivorship care while also contributing to broader cancer prevention efforts.
The study was funded by the National Institutes of Health and the American Cancer Society.
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Larger Organs, More Cells – New Study Clarifies How Obesity May Increase Cancer Risk
Key Takeaways:
- A new study suggests that larger organ size in people living with obesity increases cancer risk due to a higher number of cells
- Organ growth appears to be driven largely by an increase in cell number rather than simply larger cells
- Findings indicate that organ size may be a more precise predictor of cancer risk than BMI alone
A longstanding question in obesity and cancer
For many years, researchers have recognised a clear association between obesity and an increased risk of cancer, particularly in organs such as the liver, kidneys and pancreas. However, the biological mechanism underpinning this relationship has remained uncertain.
A research team from City of Hope and its Translational Genomics Research Institute, known as TGen, has now provided a clearer explanation. Their findings suggest that the relationship may be explained by a straightforward principle – larger bodies tend to have larger organs, and larger organs contain more cells.
This increase in cell number creates more opportunities for mutations and, consequently, cancer development.
Study design and key findings
The study, presented in Cancer Research, analysed data from 747 adults across a broad spectrum of body mass index (BMI), ranging from underweight at 18.5 kg/m² to severe obesity above 40 kg/m².
Researchers examined the pancreas, kidneys and liver, identifying a consistent pattern: as body weight increased, organ size increased proportionally.
For every 5-point rise in BMI:
- The liver increased in size by 12%
- The kidneys increased by 9%
- The pancreas increased by 7%
These findings demonstrate a measurable and progressive relationship between BMI and organ enlargement.
More cells, not just bigger cells
To better understand how organs grow, the research team analysed kidney tissue from autopsies and biopsy samples from living individuals. This allowed them to distinguish between two biological processes:
- Hypertrophy – where existing cells grow larger
- Hyperplasia – where the number of cells increases
First author Sophie Pénisson, PhD, explained the importance of this distinction:
“When an organ increases in size, the question is to know whether it’s because the cells in it become bigger or whether there are more of them [that are] the same size,” Pénisson said. “And the first case is we call hypertrophy, with bigger cells, and hyperplasia is when we have more cells.”
The results showed that approximately 60% of kidney growth was due to hyperplasia, meaning an increase in the number of cells, while the remainder was due to hypertrophy.
A simple but powerful explanation for cancer risk
These findings support the idea that a greater number of cells increases the likelihood of cancer simply by increasing the number of opportunities for mutations to occur.
Senior author Cristian Tomasetti, PhD, illustrated this concept with a simple analogy:
“Think of playing the lottery: The more tickets you buy, the greater your chances of winning,” Tomasetti said. “Similarly, the more cells in an organ, the more mutations and the greater the risk of one cell going awry during division and becoming cancerous.”
Importantly, this mechanism does not replace existing explanations such as inflammation or hormonal disruption. Instead, it works alongside them.
Pénisson elaborated on this interaction:
“If more cells is like having more raffle tickets, she said, ‘if on top of that, there is inflammation – it means you play more often. With greater frequency, again, you increase your risk of developing cancer.’”
Rethinking BMI as a predictor of risk
The study also raises important questions about the use of BMI as a measure of cancer risk.
Although BMI is widely used in clinical practice, the researchers observed considerable variation in organ size among individuals with similar BMI values. Some individuals within a “healthy” BMI range had organ sizes typically seen in severe obesity, while others with higher BMI did not.
The authors wrote:
“We…observe substantial interindividual variation in organ size among people with similar BMI: For example, some individuals in the healthy BMI range have organ sizes expected only in severe obesity, and vice versa. This large variability suggests that organ size itself may be a better predictor of cancer risk than BMI, a possibility we believe warrants further investigation.”
They further concluded:
“Taken together, these findings establish organ hyperplasia as a previously unrecognized contributor to obesity-related kidney, liver, and pancreatic cancer risk, complementing known mechanisms including inflammation, hormonal changes, and metabolic dysfunction.”
Pénisson reinforced this point:
“When an organ doubles in size, it is expected to roughly double its risk of developing cancer,” Pénisson said, noting that BMI does not distinguish between fat mass and lean tissue. “Our work suggests that, at least for some organs, their dimensions may predict cancer risk better than BMI.”
Can weight loss reverse the risk?
An important question arising from these findings is whether reducing body weight can reverse organ enlargement and lower cancer risk.
Tomasetti indicated that this is an active area of research:
“It’s actually something we are working on right now,” Tomasetti said. “But yes, preliminary data seem to indicate that essentially, you are reverting back according to the same process” that caused the weight gain.
He also referenced emerging evidence presented at the American Society of Clinical Oncology, suggesting a link between GLP-1 receptor agonists and reduced cancer risk, although further research is needed to confirm this relationship.
Implications for treatment and prevention
Given the global scale of obesity, affecting more than 2 billion people, these findings may have important implications for prevention strategies and treatment approaches.
Tomasetti suggested that therapies such as GLP-1 receptor agonists could play a broader role:
GLP-1 RAs “are something that should be given to people as a treatment option to reduce the cancer risk, among other things,” including heart disease.
While further research is needed, this study provides a clearer mechanistic link between obesity and cancer risk and highlights the potential importance of organ size as a clinical marker.
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Obesity-Linked Lipids Drive Aggressive Breast Cancer Growth in Mouse Models
Key Takeaways:
- New research from the University of Utah reveals that lipids – fat molecules elevated in people living with obesity – can accelerate tumour growth in aggressive forms of breast cancer.
- The findings suggest that lipid-lowering therapies may slow cancer progression and that high-fat diets such as ketogenic regimens may worsen outcomes in some patients.
- Researchers caution that weight loss without addressing lipid levels is insufficient protection against obesity-associated cancers like triple-negative breast cancer.
Lipids identified as key driver in obesity-related breast cancer
A new study from the University of Utah’s Huntsman Cancer Institute (HCI) has found that lipids, a hallmark of obesity, play a significant role in fuelling tumour growth in an aggressive form of breast cancer. The research, funded by the National Cancer Institute and conducted using preclinical mouse models, highlights how lipid metabolism may be a crucial therapeutic target for individuals living with obesity who have or have survived breast cancer.
The findings suggest that breast cancer patients and survivors with obesity could benefit from therapies that lower lipid levels. Conversely, high-fat dietary approaches, such as the ketogenic diet, may have unintended adverse effects by increasing lipid availability to cancer cells.
“The key here is that people have underestimated the importance of fats and lipids in the all-encompassing term that is obesity,” explained Dr Keren Hilgendorf, assistant professor of biochemistry and investigator at HCI. “But our study shows that breast cancer cells are really addicted to lipids, and the abundance of lipids in patients with obesity is one of the reasons that breast cancer is more prevalent and more aggressive in these patients.”
Focus on triple-negative breast cancer
The study focused on triple-negative breast cancer (TNBC) – a fast-growing and difficult-to-treat subtype that lacks receptors for oestrogen, progesterone, and HER2. TNBC is more common in women under 40 and in Black women, and it accounts for approximately 10 to 15 per cent of all breast cancer cases. This form of cancer is particularly prone to recurrence and metastasis.
A high level of lipids in the blood, known as hyperlipidaemia, is a frequent feature of obesity. Dr Hilgendorf and her colleagues, Dr Amandine Chaix and Dr Greg Ducker, both from HCI, examined how lipid levels influence tumour growth using specialised mouse models.
Lipid levels alone drive tumour growth
The researchers used two sets of models: one group of mice was fed high-fat diets, while another was genetically engineered to develop hyperlipidaemia without other typical markers of obesity, such as elevated blood glucose or insulin levels. In both cases, tumours grew faster when lipid levels were high.
“The idea is that lipids, which form the surface membrane of the cell, are like building blocks,” explained Dr Chaix, assistant professor of nutrition and integrative physiology. “If a cell receives the signal to proliferate and more building blocks are available, the tumour is going to grow more easily. We see that a high amount of lipids enables this proliferation.”
Importantly, when lipid levels were lowered – even in the presence of high glucose and insulin – breast cancer cell growth slowed down.
Potential implications for treatment and prevention
While the research was conducted in mice, the results point to potential therapeutic strategies for people with obesity and breast cancer.
“We think this has therapeutic implications, because if you could just lower the lipids – which we already know how to do in patients, for example, with lipid-lowering medication – that could be a way to decelerate breast cancer growth,” said Dr Hilgendorf. “If we can target these high levels of fat in the blood, the cancer sufferers, because the lipids are no longer feeding the cancer. But while our results in mice were striking, there are clear limitations in directly projecting these findings onto human patients. More research using human samples and patients will be necessary to confirm our hypotheses.”
Rethinking weight management in cancer care
These findings may also influence how clinicians guide people with obesity and breast cancer in managing their weight. While weight loss is commonly recommended to reduce recurrence risk, there is limited guidance on the best dietary approaches.
Some individuals turn to ketogenic diets, which are high in fat and low in carbohydrates, to induce ketosis – a state where the body uses fat rather than carbohydrates for energy. However, the new findings raise concerns about such diets in this patient group.
“For patients who are diagnosed with breast cancer and have an elevated BMI [body mass index], we would advise them to consult their physician and develop a weight-loss plan as part of their treatment,” said Dr Ducker, assistant professor of biochemistry. “If you have high cholesterol levels to start with, think about a weight-loss plan or potential pharmaceuticals that could lower your lipid levels. As our study shows, diets like keto that are very high in fat can have serious unintended side effects – even causing the tumour to grow.”
Beyond breast cancer: Broader implications
The research team believes that lipid-driven tumour growth may not be limited to breast cancer alone. Elevated lipid levels could also contribute to tumour progression in other cancers linked to obesity, such as ovarian or colorectal cancers.
The next stage of the research will investigate how anti-lipid drugs could improve the effectiveness of chemotherapy and explore the mechanisms through which lipids feed cancer cells.
Dr Chaix, Dr Ducker and Dr Hilgendorf emphasised that their results apply specifically to triple-negative breast cancer, and that ketogenic diets might still hold benefits for other forms of cancer. Nevertheless, their findings underscore the need for careful, evidence-based dietary guidance for people with obesity affected by cancer.
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