“Cancer risk after breast proton therapy considering physiological and radiobiological uncertainties” by Raptis et al. (Physica Medica 76 (2020) 1–6)

The paper by Raptis et al. concludes that proton therapy has an advantage over photon therapy with respect to the induction of a second cancer. Furthermore, the authors conclude that physiological movements and radiobiological parameters do not affect the general trend of lower risk associated with proton therapy. The work is based on a modeling framework which is different from most previously used models on the same subject. This invited commentary puts the findings of the paper in context with other published modeling studies on second cancer risk after proton and photon radiation therapy for breast cancer.     

How Creditable are Cancer Risk Estimates from the S.W. Taiwan Database for Arsenic in Drinking Water?

A database of cancer mortality and arsenic concentrations in village wells in an arseniasis-endemic area of southwestern Taiwan has been the predominant source of information for risk assessments of U.S. Environmental Protection Agency and two National Research Council reports on arsenic and drinking water. A limitation of the data, however, is that exposure is ecological, that is, cancer mortality cannot be matched with arsenic exposure on an individual basis, just grouped by village. The resultant potential for bias is examined by comparing dose-response analyses of villages divided into two groups, those with well concentrations in a narrow range and the remainder. The narrow range group suggests a flat or downward change in risk in the low dose range, whereas the other group indicates increasing risk. More disturbingly, however, the dose-response data are highly dispersed for both groups and the dose-response curve predicts background bladder/lung cancer levels much higher than a southwestern Taiwan comparison population. This may be due to a large variability between villages of the study area in bladder/lung cancer not directly attributable to arsenic. Including the comparison population in the dose-response analysis artificially anchors the dose-response curve at a background level inconsistent with the study population and likely just biases the slope factor upward.     

Sensitivity Analysis of U.S. EPA's Estimates of Skin Cancer Risk from Inorganic Arsenic in Drinking Water

The current U.S. Environmental Protection Agency's (USEPA's) risk analysis on the Integrated Risk Information System (IRIS) for arsenic in drinking water is based on an epidemiological study of skin cancer in Taiwan. Assumptions used in the USEPA application of the multistage-Weibull model for risk estimation were varied to assess the effect on predicted risk of skin cancer to the U.S. population at arsenic concentrations of 1 to 50?µg/L in drinking water. Among the assumptions tested, the only notable change in risk estimates was a reduction when the arsenic concentration used as representative for Taiwan villages in the low range (<300?µg/L) was increased to the 75th percentile (245?µg/L) in place of the mean used in the USEPA analysis (170?µg/L), but the representative value for Taiwan villages in the high range (≥600?µg/L) was not increased simultaneously to the 75th percentile. Additionally, a simulation study was conducted using records of arsenic measurements in wells from the same period and region of Taiwan as the original study. The exposure-response curve estimated from 60 villages (60 data points) differed only marginally from the outcome when data were summarized into four data points (as in the USEPA skin cancer analysis). Briefly discussed are differences between the study area of Taiwan and the U.S. in nutritional status and consumption of inorganic arsenic in food that might bias predicted U.S. skin cancer risks.     

Understanding Food Scares: The Role of Ambiguity Aversion and Analogical Reasoning

Why do individuals exhibit similar reactions to manifestly different food scares? This article examines the hypothesis of analogical reasoning, a cognitive shortcut whereby individuals anchor their risk judgements in other similar previous risky events present in their memories explains together with known determinants of risks perceptions such as risk attitudes and ambiguity aversion. Considering the distribution of risk perceptions related to three food scares that people in Europe remember, namely dioxins, genetically modified food (GMF), and bovine spongiform encephalopathy (BSE). Furthermore, the article explores whether intrinsic individual attitudes toward risk (risk aversion) or a common human reaction to lack of information, namely ambiguity aversion, are associated with perceptions of risk. The findings suggest that perceptions of the three food scares appear to be statically distributed in almost the same way, consistently with the presence of analogical reasoning. Results show that although risk perceptions were affected by a degree of ambiguity aversion, the intensity of risk perceptions is mainly explained by individual-specific risk attitudes.     

Through the Eyes of Children: Perceptions of Environmental Change in Tropical Forests

This study seeks to understand children''s perceptions of their present and future environments in the highly biodiverse and rapidly changing landscapes of Kalimantan, Indonesian Borneo. We analyzed drawings by children (target age 10–15 years) from 22 villages, which show how children perceive the present conditions of forests and wildlife surrounding their villages and how they expect conditions to change over the next 15 years. Analyses of picture elements and their relationships to current landscape variables indicate that children have a sophisticated understanding of their environment and how different environmental factors interact, either positively or negatively. Children appear to have landscape-dependent environmental perceptions, showing awareness of past environmental conditions and many aspects of recent trends, and translating these into predictions for future environmental conditions. The further removed their present landscape is from the originally forested one, the more environmental change they expect in the future, particularly declines in forest cover, rivers, animal diversity and increases in temperature and natural disasters. This suggests that loss of past perceptions and associated “shifting environmental baselines” do not feature strongly among children on Borneo, at least not for the perceptions we investigated here. Our findings that children have negative expectations of their future environmental conditions have important political implications. More than other generations, children have a stake in ensuring that future environmental conditions support their long-term well-being. Understanding what drives environmental views among children, and how they consider trade-offs between economic development and social and environmental change, should inform optimal policies on land use. Our study illuminates part of the complex interplay between perceptions of land cover and land use change. Capturing the views of children through artistic expressions provides a potentially powerful tool to influence public and political opinions, as well as a valuable approach for developing localized education and nature conservation programs.     

A Bayesian scoring rule on clustered event data for familial risk assessment – An example from colorectal cancer screening

Colorectal cancer screening is well established. The identification of high risk populations is the key to implement effective risk‐adjusted screening. Good statistical approaches for risk prediction do not exist. The family's colorectal cancer history is used for identification of high risk families and usually assessed by a questionnaire. This paper introduces a prediction algorithm to designate a family for colorectal cancer risk and discusses its statistical properties. The new algorithm uses Bayesian reasoning and a detailed family history illustrated by a pedigree and a Lexis diagram. The algorithm is able to integrate different hereditary mechanisms that define complex latent class or random factor structures. They are generic and do not reflect specific genetic models. This is comparable to strategies in complex segregation analysis. Furthermore, the algorithm can integrate different statistical penetrance models for right censored event data. Computational challenges related to the handling of the likelihood are discussed. Simulation studies assess the predictive quality of the new algorithm in terms of ROC curves and corresponding AUCs. The algorithm is applied to data of a recent study on familial colorectal cancer risk. Its predictive performance is compared to that of a questionnaire currently used in screening for familial colorectal cancer. The results of the proposed algorithm are robust against different inheritance models. Using the simplest hereditary mechanism, the simulation study provides evidence that the algorithm improves detection of families with high cancer risk in comparison to the currently used questionnaire. The applicability of the algorithm goes beyond the field of colorectal cancer.     

农户对气候变化的感知与生计适应——基于中部与东部村庄的调查对比

相对于城市居民,气候变化对农户的影响更为直接与强烈,而农户对气候变化的感知是其采取适应策略的重要前提。目前,相关领域的宏观研究成果比较丰富,以家庭为单位的典型调查分析相对缺乏,基于不同地域农户对比的微观实证研究则更未见于报道。选择中部内陆河南省与东部沿海福建省典型农区的一个村庄作为研究样地,采用参与式农村评估法(Participatory Rural Appraisal,PRA),基于中部和东部村庄144份与153份有效问卷数据,从家庭尺度探讨内陆与沿海农户对气候变化及其影响的感知与生计适应的结构性差异。结果显示:农户对气温与降水的变化感知直接且强烈,能较一致地回顾气候变暖的强度与时期,中部农户对降水变化的感知度较强;接近一半的农户将气候变暖归因于人类因素,至于人类活动内容(如工业排放、汽车增加、个人与家庭、农业污染、农村建设等)对气候变化变暖影响的认知,中部与东部农户则存在显著性差异;农户对气候变化影响的感知不如预期深刻;农户对气候变化的生计适应趋于多样化,包括外出打工、改变种植方式、修建基础设施与多样化经营等。     

Review: Dairy foods,red meat and processed meat in the diet: implications for health at key life stages

Social and health care provision have led to substantial increases in life expectancy. In the UK this has become higher than 80 years with an even greater proportional increase in those aged 85 years and over. The different life stages give rise to important nutritional challenges and recent reductions in milk consumption have led to sub-optimal intakes of calcium by teenage females in particular when bone growth is at its maximum and of iodine during pregnancy needed to ensure that supply/production of thyroid hormones to the foetus is adequate. Many young and pre-menopausal women have considerably sub-optimal intakes of iron which are likely to be associated with reduced consumption of red meat. A clear concern is the low intakes of calcium especially as a high proportion of the population is of sub-optimal vitamin D status. This may already have had serious consequences in terms of bone development which may not be apparent until later life, particularly in post-menopausal women. This review aims to examine the role of dairy foods and red meat at key life stages in terms of their ability to reduce or increase chronic disease risk. It is clear that milk and dairy foods are key sources of important nutrients such as calcium and iodine and the concentration of some key nutrients, notably iodine can be influenced by the method of primary milk production, in particular, the iodine intake of the dairy cow. Recent meta-analyses show no evidence of increased risk of cardiovascular diseases from high consumption of milk and dairy foods but increasing evidence of a reduction in the risk of type 2 diabetes associated with fermented dairy foods, yoghurt in particular. The recently updated reports from the World Cancer Research Fund International/American Institute for Cancer Research on the associations between dairy foods, red meat and processed meat and various cancers provide further confidence that total dairy products and milk, are associated with a reduced risk of colorectal cancer and high intakes of milk/dairy are not associated with increased risk of breast cancer. Earlier evidence of a significant increase in the risk of colorectal cancer from consumption of red and particularly processed meat has been reinforced by the inclusion of more recent studies. It is essential that nutrition and health-related functionality of foods are included in evaluations of sustainable food production.     

Melatonin is an appropriate candidate for breast cancer treatment: Based on known molecular mechanisms

Breast cancer is the most prevalent cancer and one of the most important causes of death in women throughout the world. Breast cancer risk factors include smoking, alcohol consumption, personal and family history, hypertension, and hormone therapy, long-term use of nonsteroidal anti-inflammatory drugs and tobacco usage. Surgery, chemotherapy, radiotherapy, immunotherapy, and neoadjuvant therapy are the current means for breast cancer treatment. Despite hormonal agents and chemotherapy, which have beneficial effects on lowering breast cancer death rate, the reaction of different people to these treatments is still a challenging point. Melatonin (N-acetyl-5-methoxy tryptamine) is a methoxy indole compound that is mainly secreted by the pineal gland at night; it is as an antioxidant, anti-inflammatory, and oncostatic agent. On the basis of recent studies, melatonin has antitumor properties on different cancer types and it may suppress cancer development in vitro and as well as in animal models. It is suggested that melatonin inhibits the development of breast cancer by various mechanisms. This paper summarizes the roles of melatonin in breast cancer treatment from the aspect of its molecular actions.     

Polytomous disease mapping to detect uncommon risk factors for related diseases

A statistical model for jointly analysing the spatial variation of incidences of three (or more) diseases, with common and uncommon risk factors, is introduced. Deaths for different diseases are described by a logit model for multinomial responses (multinomial logit or polytomous logit model). For each area and confounding strata population (i.e. age-class, sex, race) the probabilities of death for each cause (the response probabilities) are estimated. A specic disease, the one having a common risk factor only, acts as the baseline category. The log odds are decomposed additively into shared (common to diseases different by the reference disease) and specic structured spatial variability terms, unstructured unshared spatial terms and confounders terms (such as age, race and sex) to adjust the crude observed data for their effects. Disease specic spatially structured effects are estimated; these are considered as latent variables denoting disease-specic risk factors. The model is presented with reference to a specic application. We considered the mortality data (from 1990 to 1994) relative to oral cavity, larynx and lung cancers in 13 age groups of males, in the 287 municipalities of Region of Tuscany (Italy). All these pathologies share smoking as a common risk factor; furthermore, two of them (oral cavity and larynx cancer) share alcohol consumption as a risk factor. All studies suggest that smoking and alcohol consumption are the major known risk factors for oral cavity and larynx cancers; nevertheless, in this paper, we investigate the possibility of other different risk factors for these diseases, or even the presence of an interaction effect (between smoking and alcohol risk factors) but with different spatial patterns for oral and larynx cancer. For each municipality and age-class the probabilities of death for each cause (the response probabilities) are estimated. Lung cancer acts as the baseline category. The log odds are decomposed additively into shared (common to oral cavity and larynx diseases) and specic structured spatial variability terms, unstructured unshared spatial terms and an age-group term. It turns out that oral cavity and larynx cancer have different spatial patterns for residual risk factors which are not the typical ones such as smoking habits and alcohol consumption. But, possibly, these patterns are due to different spatial interactions between smoking habits and alcohol consumption for the first and the second disease.     

Attitudes toward genetic testing for cancer risk after genetic counseling and decision support: a qualitative comparison between hereditary cancer types

This study aimed to qualitatively assess individuals' attitudes toward genetic testing for cancer risk after genetic counseling and decision support. As part of a larger study, 78 women considering genetic testing for hereditary breast/ovarian cancer (HBOC) risk and 22 individuals considering genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC) completed an open-ended table of their perceived pros and cons of genetic testing. The most frequently reported pros were "to help manage my risk of developing cancer," "to help my family," and "to know my cancer risk." With regards to risk management, the HBOC group perceived genetic testing as most helpful in informing their general risk management practices, while the HN-PCC group focused on the potential to clarify their need for bowel cancer screening, suggesting that patients' perceptions of the benefits of genetic testing may differ across cancer syndromes. Individuals in both groups expressed concern about the potential psychological impact of genetic testing. We also found that some affected individuals may not fully comprehend the meaning of their potential test results. Eliciting patients' perceived pros and cons during genetic counseling is likely to be a valuable tool for improving patient care. This data also provides an improved evidence base for the development of patient education tools.     

Patterns of bushmeat hunting and perceptions of disease risk among central African communities

There is a great need to determine the factors that influence the hunting, butchering and eating of bushmeat to better manage the important social, public health and conservation consequences of these activities. In particular, the hunting and butchering of wild animals can lead to the transmission of diseases that have potentially serious consequences for exposed people and their communities. Comprehension of these risks may lead to decreased levels of these activities. To investigate these issues, 3971 questionnaires were completed to examine the determinants of the hunting, butchering and eating of wild animals and perceptions of disease risk in 17 rural central African villages. A high proportion of individuals reported perceiving a risk of disease infection with bushmeat contact. Individuals who perceived risk were significantly less likely to butcher wild animals than those who perceived no risk. However, perception of risk was not associated with hunting and eating bushmeat (activities that, compared with butchering, involve less contact with raw blood and body fluids). This suggests that some individuals may act on perceived risk to avoid higher risk activity. These findings reinforce the notion that conservation programs in rural villages in central Africa should include health-risk education. This has the potential to reduce the levels of use of wild animals, particularly of certain endangered species (e.g. many non-human primates) that pose a particular risk to human health. However, as the use of wild game is likely to continue, people should be encouraged to undertake hunting and butchering more safely for their own and their community's health.     

Genetic polymorphism of manganese superoxide dismutase (MnSOD) and breast cancer susceptibility

Within mitochondria, manganese superoxide dismutase (MnSOD) provides a major defence against oxidative damage by reactive oxygen species (ROS). An alanine-9valine (Ala-9Val) polymorphism in the mitochondrial targeting sequence of MnSOD has been described and has recently been associated with risk of human breast cancer. Our present case-control study was performed to explore the association between MnSOD genetic polymorphism and individual susceptibility to breast cancer. Ala-9Val polymorphism in the signal sequence of the protein for MnSOD was determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay in a study population. There was no significant difference in risk for breast cancer development between patients positive and negative for the MnSOD Ala allele with adjusted odds ratio (OR): 0.86 (95% confidence interval (CI(0.43 to 1.72). When MnSOD Ala was combined with either cytochrome P450 1B1 CYP1B1*1 and catechol O-methyltransferase COMT-L (V158M) genotypes, the risk for developing breast cancer was significantly increased in patients with a body mass index (BMI) greater than 24 kg m(-2) (OR: 1.42 (95%CI=1.04-1.93)).     

The Effect of Wildlife Conservation on Local Perceptions of Risk and Behavioral Response

In this study, we examine the effect of Tarangire National Park (TNP) on local perceptions of risk and how these perceptions may influence behavioral responses. Data were collected during 2004–2005 through household surveys and participatory risk mapping (PRM) in eight villages east of TNP. By identifying and rank-ordering respondents’ perceived risks, PRM enhances understanding of the nature and variation of risks faced within a population by distinguishing between the incidence and severity of subjective risk perceptions. Results indicate that proximity to the park has a strong effect on the type and severity of perceived risks. Within villages close to the park, however, behavioral response to perceived risks varies considerably. This study contributes to an appreciation of how behavioral response to environmental and socioeconomic factors is mediated by human perception.

Cancer and non-cancer health risk assessment associated with exposure to non-methane hydrocarbons among roadside vendors in Delhi,India

Abstract

This study estimates the cancer and non-cancer health risk among the roadside vendors in Delhi, the capital city of India. Air samples of selected NMHCs and their derivatives were collected from four different sites (one traffic intersection, one industrial, and two residential) in Delhi and were analyzed on Gas Chromatograph (GC) to obtain their atmospheric concentrations. At each site, a survey among the roadside vendors was also conducted to obtain information about their bodyweight and exposure to outdoor ambient air. The study reveals that hazard quotient of 1,3-butadiene is greater than one at all the sites, with its maximum value occurring at the industrial site. The major contributors to the workplace cancer risk (WCR) are found to be 1,3-butadiene and chloroform. The overall WCR is observed to be the highest (9.4?×?10^?4) at the traffic intersection site, followed by the industrial site (7.0?×?10^?4). Cancer incidence data and the population data are also used to estimate the growth of cancer risk in Delhi from 2009 to 2016. Comparison of the WCR values of the four sites with the cancer risk estimated from the cancer incidence data shows that NMHCs and their derivatives are significant contributors to the overall cancer risk in Delhi. Our results suggest that NMHCs and their derivatives need to be given due consideration in the National Cancer Control Programme of India.     

An investigation of the relationship between SULT1A1 Arg213His polymorphism and lung cancer susceptibility in a Turkish population

Human sulfotransferase 1A1 (SULT1A1), the most expressed isoform of the phenol SULT1 subfamily, is an important member of sulfotransferase superfamily. A transition, G to A at position 638, in SULT1A1 gene, results in Arg²¹³His change. This single nucleotide polymorphism reduces the activity and thermostability of SULT1A1 enzyme. Thus, in the present study the relationship between SULT1A1 Arg²¹³His polymorphism and lung cancer was investigated. One hundred and six case and 271 control samples were studied using PCR‐RFLP. There was no significant difference in genotype and allele distribution between lung cancer and control populations (p = 0.07; p = 0.06, respectively). Compared with the SULT1A1*1/SULT1A1*1 genotype the variant SULT1A1 genotype (SULT1A1*1/SULT1A1*2 or SULT1A1*2/SULT1A1*2) was associated with a significantly increased lung cancer risk in cases (p = 0.027). In male populations, there was no significant difference between case and controls (p = 0.313). In female populations, however, this difference was found to be significant (p = 0.04). In smoker and non‐smoker populations, no significant relationship was evident between lung cancer and control population (p = 0.170, p = 0.065, respectively). Statistical analyses of histological types of lung cancer in comparison with the control individuals indicated a significant difference between SULT1A1 Arg²¹³His polymorphism and SCC (p = 0.027) and other types of cancer (p = 0.037), except SMCC (p = 0.854). Copyright © 2009 John Wiley & Sons, Ltd.     

Brain metastasis in lung cancer: Building a molecular and systems-level understanding to improve outcomes

Lung cancer is a clinically difficult disease with rising disease burden around the world. Unfortunately, most lung cancers present at a clinically advanced stage. Of these cancers, many also present with brain metastasis which complicates the clinical picture. This review summarizes current knowledge on the molecular basis of lung cancer brain metastases. We start from the clinical perspective, aiming to provide a clinical context for a significant problem that requires much deeper scientific investigation. We review new research governing the metastatic process, including tumor cell signaling, establishment of a receptive tumor niches in the brain and evaluate potential new therapeutic options that take advantage of these new scientific advances.Lung cancer remains the largest single cause of cancer mortality in the United States (Siegel et al., 2015). This continues to be the clinical picture despite significant advances in therapy, including the advent of targeted molecular therapies and newly adopted immunotherapies for certain subtypes of lung cancer. In the vast majority of cases, lung cancer presents as advanced disease; in many instances, this advanced disease state is intimately associated with micro and macrometastatic disease (Goldberg et al., 2015). For both non-small cell lung cancer and small cell lung cancer patients, the predominant metastatic site is the brain, with up to 68% of patients with mediastinal lymph node metastasis eventually demonstrating brain metastasis (Wang et al., 2009).The frequency (incidence) of brain metastasis is highest in lung cancers, relative to other common epithelial malignancies (Schouten et al., 2002). Other studies have attempted to predict the risk of brain metastasis in the setting of previously non-metastatic disease. One of the largest studies to do this, analyzing historical data from 1973 to 2011 using the SEER database revealed a 9% risk of patients with previously non-metastatic NSCLC developing brain metastasis over the course of their disease, while 18% of small cell lung cancer patients without previous metastasis went on to develop brain metastasis as their disease progressed (Goncalves et al., 2016).The reasons underlying this predilection for the central nervous system, as well as the recent increase in the frequency of brain metastasis identified in patients remain important questions for both clinicians and basic scientists. More than ever, the question of how brain metastasis develop and how they can be treated and managed requires the involvement of interdisciplinary teams—and more importantly—scientists who are capable of thinking like clinicians and clinicians who are capable of thinking like scientists. This review aims to present a translational perspective on brain metastasis. We will investigate the scope of the problem of brain metastasis and the current management of the metastatic disease process in lung cancer. From this clinical starting point, we will investigate the literature surrounding the molecular underpinnings of lung tumor metastasis and seek to understand the process from a biological perspective to generate new hypotheses.     

Cancer risk after breast proton therapy considering physiological and radiobiological uncertainties

BackgroundThe reduced normal tissue dose burden from protons can reduce the risk of second cancer for breast cancer patients. Breathing motion and the impact of variable relative biological effectiveness (RBE) are however concerns for proton dose distributions. This study aimed to quantify the impact of these factors on risk predictions from proton and photon therapy.Materials and methodsTwelve patients were planned in free breathing with protons and photons to deliver 50 Gy (RBE) in 25 fractions (assuming RBE = 1.1 for protons) to the left breast. Second cancer risk was evaluated with several models for the lungs, contralateral breast, heart and esophagus as organs at risk (OARs). Plans were recalculated on CT-datasets acquired in extreme phases to account for breathing motion. Proton plans were also recalculated assuming variable RBE for a range of radiobiological parameters.ResultsThe OARs received substantially lower doses from protons compared to photons. The highest risks were for the lungs (average second cancer risks of 0.31% and 0.12% from photon and proton plans, respectively). The reduced risk with protons was maintained, even when breathing and/or RBE variation were taken into account. Furthermore, while the total risks from the photon plans were seen to increase with the integral dose, no such correlation was observed for the proton plans.ConclusionsProtons have an advantage over the photons with respect to the induction of cancer. Uncertainties in physiological movements and radiobiological parameters affected the absolute risk estimates, but not the general trend of lower risk associated with proton therapy.     

Sexual functioning of testicular cancer survivors and their partners – A review of literature

BackgroundTesticular cancer (TC) is the most common cancer in the 25–40 age group, with peak morbidity at around 30 years of age. It is a period of highest productivity, when sexual sphere is an important aspect of life. The disease, invasive treatment and its consequences interfere with this sphere.AimThe aim of this paper was to review the most recent studies on the sexual functioning of patients treated for testicular cancer and their partners published in English language scientific journals in the period of 1989–2010.ResultsNumerous studies report that men cured from testicular cancer are at risk of sexual disorders. Agents of psychological nature play an important role in the occurrence and persistence of sexual dysfunctions. Being in permanent relationship is a protective factor, while single persons are marked with particular predisposition to such dysfunctions. Sexual and marital satisfaction of TC survivors and their partners are mutually correlated.ConclusionWith a growing number of TC survivors, a thorough investigation is required into their sexuality, both in an individual and dyadic dimension, so as to improve the quality of life of the affected young men, who take on their new social and professional roles in the period of highest reproductiveness.     

Tissue‐Specificity and Ethnic Diversity in Obesity‐Related Risk of Cancer May Be Explained by Variability in Insulin Response and Insulin Signaling Pathways

Obesity is a predisposing risk factor for several chronic diseases. The link between obesity and cancer appears to be particularly complex. Notably only the risk for development of specific cancers appear to be affected. Moreover, the obesity‐related risk of cancer is very different across ethnic groups. African‐Americans appear particularly prone, whereas Hispanics appear to be relatively protected. Obesity is associated with increased levels of circulating insulin. These levels of elevated insulin may serve to promote proliferation of fat cells to accommodate the elevated nutrient flux. However, elevated levels of insulin may be a major mediating factor influencing cancer risk. This hypothesis alone cannot explain the complexity of the phenomenon. We suggest here that the different insulin responses to obesity of different ethnic groups may explain their different risk profiles. Moreover, we speculate that tissue‐specific variations in the insulin signaling pathways may underlie their differential susceptibility to tumorigenesis in the face of elevated obesity. Elevated cancer risk may be an unwanted side effect of insulin responding to elevated nutrient flux in the obese which it serves to proliferate fat cells that provide a location for storage of ingested fat, which consequently prevents ectopic fat storage. Hence, while Hispanics may be protected from cancer risk in obesity because of their lower insulin response, they have an elevated risk of fatty liver disease. Reduction of insulin levels in obesity as a strategy to reduce cancer risk may pose additional problems unless it is combined also with interventions that aim to limit nutrient influx.