Adiposity and cancer: epidemiology, mechanisms and future perspectives

Excess adiposity is a major modifiable risk factor for at least 19 cancer types, and the burden of obesity-related cancer is expected to rise substantially in the coming decades. A comprehensive understanding of underlying mechanisms and precise risk associations will be critical to inform targeted prevention strategies and reduce this burden. In this Review, we examine key biological mechanisms linking adiposity and cancer, including sex hormones, hyperinsulinaemia and chronic inflammation, alongside emerging insights from omics technologies, and tumour subtype-specific associations. We also highlight priorities for future research, including imaging-based adiposity measures, integration of multi-omics approaches and expanded data collection in lower-income settings and understudied populations. Finally, we consider the potential implications of emerging obesity pharmacotherapies, which may facilitate substantial weight loss at scale.