RRs associated with obesity range from 2 to 10. Some studies show that upper-body and central weight confer a higher risk than peripheral body weight, even after consideration of BMI.[63,64,65] However, other studies have failed to confirm such an association. Several studies have observed a stronger association between endometrial cancer and obesity near the time of diagnosis compared with obesity earlier in life.[66,67,68,69]
Endometrial cancer primarily affects postmenopausal women, with a median age at diagnosis of 60 years.
Women with inherited conditions such as Lynch syndrome, Cowden syndrome, and polycystic ovary syndrome have an increased risk of endometrial cancer. (Refer to the PDQ summaries on Genetics of Breast and Ovarian Cancer and Genetics of Colorectal Cancer for more information.)
Interventions of Unproven or Disproven Effect on Risk
While it is known that obesity is associated with increased endometrial cancer risk, only one study examines the potential benefit of intentional weight loss. In the Iowa Women's Health Study of 21,707 postmenopausal women , participants completed a self-report questionnaire, about intentional weight loss between ages 18 and 39 years, between ages 40 and 54 years, and after age 55 years. Multivariate models adjusting for age, BMI, and BMI2 found no association between endometrial cancer incidence and intentional weight loss of at least 20 lbs (RR = 0.93; 95% CI, 0.60–1.44). The obvious limitation of this study is the reliance on retrospective self-reported data.
Fruits, vegetables, and vitamins
The association between dietary factors, particularly fruit and vegetable intake, and endometrial cancer has been evaluated primarily in case-control studies. A systematic review of the evidence was undertaken as part of the World Cancer Research Fund's Food, Nutrition, Physical Activity and Cancer: A Global Perspective (2006) report. A pooled OR from ten case-control studies for high versus low vegetable intake was 0.71 (95% CI, 0.55–0.91). This association was similar to that reported previously in a report for the International Agency for Research on Cancer, which was based on results from five case-control studies. Neither report observed evidence of an association between fruit intake and endometrial cancer.
There is case-control evidence suggesting that regular consumption of soy products reduces the risk of endometrial cancer.[73,74]
A consortium of seven prospective cohort studies examined the association between serum vitamin D levels and the development of endometrial cancer. After controlling for BMI, there was no evidence of an association between circulating vitamin D and risk of endometrial cancer.
Multivitamin use has little or no influence on the risk of common cancers, including endometrial cancer, or on total mortality in postmenopausal women.
- American Cancer Society.: Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society, 2013. Available online. Last accessed March 13, 2013.
- American Cancer Society.: Detailed Guide: Endometrial Cancer: What are the Risk Factors for Endometrial Cancer? Atlanta, Ga: American Cancer Society, 2005. Available online. Last accessed February 15, 2013.
- Howlader N, Noone AM, Krapcho M, et al., eds.: SEER Cancer Statistics Review, 1975-2008. Bethesda, Md: National Cancer Institute, 2011. Also available online. Last accessed March 13, 2013.
- Jick H, Walker AM, Rothman KJ: The epidemic of endometrial cancer: a commentary. Am J Public Health 70 (3): 264-7, 1980.
- Watson P, Vasen HF, Mecklin JP, et al.: The risk of endometrial cancer in hereditary nonpolyposis colorectal cancer. Am J Med 96 (6): 516-20, 1994.
- Aarnio M, Mecklin JP, Aaltonen LA, et al.: Life-time risk of different cancers in hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Int J Cancer 64 (6): 430-3, 1995.
- Setiawan VW, Pike MC, Kolonel LN, et al.: Racial/ethnic differences in endometrial cancer risk: the multiethnic cohort study. Am J Epidemiol 165 (3): 262-70, 2007.
- Madison T, Schottenfeld D, James SA, et al.: Endometrial cancer: socioeconomic status and racial/ethnic differences in stage at diagnosis, treatment, and survival. Am J Public Health 94 (12): 2104-11, 2004.
- Combination oral contraceptive use and the risk of endometrial cancer. The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. JAMA 257 (6): 796-800, 1987.
- Ramcharan S, Pellegrin FA, Ray R, et al.: The Walnut Creek Contraceptive Drug Study: A Prospective Study of the Side Effects of Oral Contraceptives. Vol 3. Bethesda, Md: US Government Printing Office, 1981, NIH Pub. No 81-564.
- Beral V, Hannaford P, Kay C: Oral contraceptive use and malignancies of the genital tract. Results from the Royal College of General Practitioners' Oral Contraception Study. Lancet 2 (8624): 1331-5, 1988.
- Schlesselman JJ: Risk of endometrial cancer in relation to use of combined oral contraceptives. A practitioner's guide to meta-analysis. Hum Reprod 12 (9): 1851-63, 1997.
- Weiderpass E, Adami HO, Baron JA, et al.: Use of oral contraceptives and endometrial cancer risk (Sweden). Cancer Causes Control 10 (4): 277-84, 1999.
- Moradi T, Nyrén O, Bergström R, et al.: Risk for endometrial cancer in relation to occupational physical activity: a nationwide cohort study in Sweden. Int J Cancer 76 (5): 665-70, 1998.
- Terry P, Baron JA, Weiderpass E, et al.: Lifestyle and endometrial cancer risk: a cohort study from the Swedish Twin Registry. Int J Cancer 82 (1): 38-42, 1999.
- Goodman MT, Hankin JH, Wilkens LR, et al.: Diet, body size, physical activity, and the risk of endometrial cancer. Cancer Res 57 (22): 5077-85, 1997.
- Hirose K, Tajima K, Hamajima N, et al.: Subsite (cervix/endometrium)-specific risk and protective factors in uterus cancer. Jpn J Cancer Res 87 (9): 1001-9, 1996.
- Kalandidi A, Tzonou A, Lipworth L, et al.: A case-control study of endometrial cancer in relation to reproductive, somatometric, and life-style variables. Oncology 53 (5): 354-9, 1996 Sep-Oct.
- Levi F, La Vecchia C, Negri E, et al.: Selected physical activities and the risk of endometrial cancer. Br J Cancer 67 (4): 846-51, 1993.
- Moradi T, Weiderpass E, Signorello LB, et al.: Physical activity and postmenopausal endometrial cancer risk (Sweden). Cancer Causes Control 11 (9): 829-37, 2000.
- Olson SH, Vena JE, Dorn JP, et al.: Exercise, occupational activity, and risk of endometrial cancer. Ann Epidemiol 7 (1): 46-53, 1997.
- Shu XO, Hatch MC, Zheng W, et al.: Physical activity and risk of endometrial cancer. Epidemiology 4 (4): 342-9, 1993.
- Sturgeon SR, Brinton LA, Berman ML, et al.: Past and present physical activity and endometrial cancer risk. Br J Cancer 68 (3): 584-9, 1993.
- Zheng W, Shu XO, McLaughlin JK, et al.: Occupational physical activity and the incidence of cancer of the breast, corpus uteri, and ovary in Shanghai. Cancer 71 (11): 3620-4, 1993.
- Schouten LJ, Goldbohm RA, van den Brandt PA: Anthropometry, physical activity, and endometrial cancer risk: results from the Netherlands Cohort Study. J Natl Cancer Inst 96 (21): 1635-8, 2004.
- Littman AJ, Voigt LF, Beresford SA, et al.: Recreational physical activity and endometrial cancer risk. Am J Epidemiol 154 (10): 924-33, 2001.
- Colbert LH, Lacey JV Jr, Schairer C, et al.: Physical activity and risk of endometrial cancer in a prospective cohort study (United States). Cancer Causes Control 14 (6): 559-67, 2003.
- Cauley JA, Gutai JP, Kuller LH, et al.: The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol 129 (6): 1120-31, 1989.
- Salazar-Martinez E, Lazcano-Ponce EC, Gonzalez Lira-Lira G, et al.: Reproductive factors of ovarian and endometrial cancer risk in a high fertility population in Mexico. Cancer Res 59 (15): 3658-62, 1999.
- Newcomb PA, Trentham-Dietz A: Breast feeding practices in relation to endometrial cancer risk, USA. Cancer Causes Control 11 (7): 663-7, 2000.
- Dossus L, Allen N, Kaaks R, et al.: Reproductive risk factors and endometrial cancer: the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 127 (2): 442-51, 2010.
- Zeleniuch-Jacquotte A, Akhmedkhanov A, Kato I, et al.: Postmenopausal endogenous oestrogens and risk of endometrial cancer: results of a prospective study. Br J Cancer 84 (7): 975-81, 2001.
- Lukanova A, Lundin E, Micheli A, et al.: Circulating levels of sex steroid hormones and risk of endometrial cancer in postmenopausal women. Int J Cancer 108 (3): 425-32, 2004.
- Smith DC, Prentice R, Thompson DJ, et al.: Association of exogenous estrogen and endometrial carcinoma. N Engl J Med 293 (23): 1164-7, 1975.
- Mack TM, Pike MC, Henderson BE, et al.: Estrogens and endometrial cancer in a retirement community. N Engl J Med 294 (23): 1262-7, 1976.
- Ziel HK, Finkle WD: Increased risk of endometrial carcinoma among users of conjugated estrogens. N Engl J Med 293 (23): 1167-70, 1975.
- Walker AM, Jick H: Cancer of the corpus uteri: increasing incidence in the United States, 1970--1975. Am J Epidemiol 110 (1): 47-51, 1979.
- Gray LA Sr, Christopherson WM, Hoover RN: Estrogens and endometrial carcinoma. Obstet Gynecol 49 (4): 385-9, 1977.
- McDonald TW, Annegers JF, O'Fallon WM, et al.: Exogenous estrogen and endometrial carcinoma: case-control and incidence study. Am J Obstet Gynecol 127 (6): 572-80, 1977.
- Antunes CM, Strolley PD, Rosenshein NB, et al.: Endometrial cancer and estrogen use. Report of a large case-control study. N Engl J Med 300 (1): 9-13, 1979.
- Shapiro S, Kelly JP, Rosenberg L, et al.: Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens. N Engl J Med 313 (16): 969-72, 1985.
- Austin DF, Roe KM: The decreasing incidence of endometrial cancer: public health implications. Am J Public Health 72 (1): 65-8, 1982.
- Gusberg SB: Precursors of corpus carcinoma estrogens and adenomatous hyperplasia. Am J Obstet Gynecol 54(6): 905-927, 1947.
- Gusberg SB: Hormone-dependence of endometrial cancer. Obstet Gynecol 30 (2): 287-93, 1967.
- Bonte J: Medroxyprogesterone in the management of primary and recurrent or metastatic uterine adenocarcinoma. Acta Obstet Gynecol Scand Suppl 19: 21-4, 1972.
- Kistner RW: Histological effects of progestins on hyperplasia and carcinoma in situ of the endometrium. Cancer 12(6): 1106-1122, 1959.
- Whitehead MI: The effects of oestrogens and progestogens on the postmenopausal endometrium. Maturitas 1 (2): 87-98, 1978.
- Hammond CB, Jelovsek FR, Lee KL, et al.: Effects of long-term estrogen replacement therapy. II. Neoplasia. Am J Obstet Gynecol 133 (5): 537-47, 1979.
- Effects of hormone replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA 275 (5): 370-5, 1996.
- Persson I, Weiderpass E, Bergkvist L, et al.: Risks of breast and endometrial cancer after estrogen and estrogen-progestin replacement. Cancer Causes Control 10 (4): 253-60, 1999.
- Killackey MA, Hakes TB, Pierce VK: Endometrial adenocarcinoma in breast cancer patients receiving antiestrogens. Cancer Treat Rep 69 (2): 237-8, 1985.
- Fornander T, Rutqvist LE, Cedermark B, et al.: Adjuvant tamoxifen in early breast cancer: occurrence of new primary cancers. Lancet 1 (8630): 117-20, 1989.
- Rutqvist LE, Mattsson A: Cardiac and thromboembolic morbidity among postmenopausal women with early-stage breast cancer in a randomized trial of adjuvant tamoxifen. The Stockholm Breast Cancer Study Group. J Natl Cancer Inst 85 (17): 1398-406, 1993.
- Andersson M, Storm HH, Mouridsen HT: Incidence of new primary cancers after adjuvant tamoxifen therapy and radiotherapy for early breast cancer. J Natl Cancer Inst 83 (14): 1013-7, 1991.
- Fisher B, Costantino JP, Redmond CK, et al.: Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 86 (7): 527-37, 1994.
- Fisher B, Costantino JP, Wickerham DL, et al.: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90 (18): 1371-88, 1998.
- Cummings SR, Eckert S, Krueger KA, et al.: The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA 281 (23): 2189-97, 1999.
- DeMichele A, Troxel AB, Berlin JA, et al.: Impact of raloxifene or tamoxifen use on endometrial cancer risk: a population-based case-control study. J Clin Oncol 26 (25): 4151-9, 2008.
- Enriori CL, Reforzo-Membrives J: Peripheral aromatization as a risk factor for breast and endometrial cancer in postmenopausal women: a review. Gynecol Oncol 17 (1): 1-21, 1984.
- Davidson BJ, Gambone JC, Lagasse LD, et al.: Free estradiol in postmenopausal women with and without endometrial cancer. J Clin Endocrinol Metab 52 (3): 404-8, 1981.
- Troisi R, Potischman N, Hoover RN, et al.: Insulin and endometrial cancer. Am J Epidemiol 146 (6): 476-82, 1997.
- Bergström A, Pisani P, Tenet V, et al.: Overweight as an avoidable cause of cancer in Europe. Int J Cancer 91 (3): 421-30, 2001.
- Swanson CA, Potischman N, Wilbanks GD, et al.: Relation of endometrial cancer risk to past and contemporary body size and body fat distribution. Cancer Epidemiol Biomarkers Prev 2 (4): 321-7, 1993 Jul-Aug.
- Elliott EA, Matanoski GM, Rosenshein NB, et al.: Body fat patterning in women with endometrial cancer. Gynecol Oncol 39 (3): 253-8, 1990.
- Schapira DV, Kumar NB, Lyman GH, et al.: Upper-body fat distribution and endometrial cancer risk. JAMA 266 (13): 1808-11, 1991.
- Olson SH, Trevisan M, Marshall JR, et al.: Body mass index, weight gain, and risk of endometrial cancer. Nutr Cancer 23 (2): 141-9, 1995.
- Weiderpass E, Persson I, Adami HO, et al.: Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 11 (2): 185-92, 2000.
- Le Marchand L, Wilkens LR, Mi MP: Early-age body size, adult weight gain and endometrial cancer risk. Int J Cancer 48 (6): 807-11, 1991.
- Shu XO, Brinton LA, Zheng W, et al.: Relation of obesity and body fat distribution to endometrial cancer in Shanghai, China. Cancer Res 52 (14): 3865-70, 1992.
- Parker ED, Folsom AR: Intentional weight loss and incidence of obesity-related cancers: the Iowa Women's Health Study. Int J Obes Relat Metab Disord 27 (12): 1447-52, 2003.
- International Agency for Research On Cancer.: IARC Handbooks of Cancer Prevention. Volume 8: Fruit and Vegetables. Lyon, France: International Agency for Research On Cancer, 2003.
- Bandera EV, Kushi LH, Gifkins DM, et al.: WCRF Systematic Literature Review: The Association Between Food, Nutrition, and Physical Activity and the Risk of Endometrial Cancer and Underlying Mechanisms. Washington, DC: World Cancer Research Fund, American Institute for Cancer Research, 2006.
- Horn-Ross PL, John EM, Canchola AJ, et al.: Phytoestrogen intake and endometrial cancer risk. J Natl Cancer Inst 95 (15): 1158-64, 2003.
- Xu WH, Zheng W, Xiang YB, et al.: Soya food intake and risk of endometrial cancer among Chinese women in Shanghai: population based case-control study. BMJ 328 (7451): 1285, 2004.
- Zeleniuch-Jacquotte A, Gallicchio L, Hartmuller V, et al.: Circulating 25-hydroxyvitamin D and risk of endometrial cancer: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol 172 (1): 36-46, 2010.
- Neuhouser ML, Wassertheil-Smoller S, Thomson C, et al.: Multivitamin use and risk of cancer and cardiovascular disease in the Women's Health Initiative cohorts. Arch Intern Med 169 (3): 294-304, 2009.