Obesity and Diabetes Increase Risk of Endometrial Cancer
Researchers from Norway have reported that obesity and diabetes increase the risk of developing endometrial cancer while smoking decreases the risk. The details of this study appeared in an early online publication in the British Journal of Cancer on March 25.1
Endometrial cancer is the most common invasive gynecologic cancer in women, with 36,100 new cases each year. This incidence would be higher if it were not for the relatively large number of hysterectomies performed for non-cancerous reasons. It is estimated that approximately 6,500 women will die of uterine cancer in the United States each year. The lifetime risk of developing uterine cancer for an American woman is 2%.
There has been an increase in the incidence of, but not mortality from, endometrial cancer since the mid 1970s, which has been attributed to the use of hormone replacement therapy for treatment of menopausal symptoms. Factors associated with an increased risk of developing endometrial cancer include obesity, a high-fat diet, and a prolonged exposure to the female hormone, estrogen. Women who begin to menstruate early in life, experience a late menopause, and/or have no children have the longest exposure to estrogen, and are thus at the highest risk. Completion of at least one pregnancy appears to lower the risk of uterine cancer by 50%. The risk also decreases in proportion to the number of induced abortions. Women who take oral contraceptives also appear to have a reduction in the incidence of uterine cancer. A recent study has also suggested that lack of sun exposure and low vitamin D levels can increase the incidence of endometrial cancer.
Obesity has been associated with an increased incidence of several cancers including endometrial cancer, but the exact extent of risk of various cancers associated with obesity is poorly documented in the literature.
The current study involved 36,761 Norwegian women who were evaluated over a 16-year period. Two-hundred twenty-two cases of endometrial cancer occurred in this group of women. A normal body mass index (BMI) was defined as 10-24 kg/m2. Women who had a low BMI (<20 kg/m2) had a 50% reduction in the risk of developing endometrial cancer compared with those with a normal BMI. Women who had a BMI of 35-39 kg/m2 had a fourfold increase in the risk of developing endometrial cancer while women with a BMI of >40 kg/k2 had a sixfold increase. Women with known diabetes had a threefold increase in the risk of endometrial cancer, while smokers had a 50% reduction in risk compared with non-smokers.
Comment: These are ominous data for the U.S. population where obesity has reached epidemic proportions.
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