Diabetes, Body Size, and Risk of Endometrial Cancer

Abstract

Data from a population-based case-control study of Wisconsin women were used to evaluate the relation of diabetes to the risk of endometrial cancer on the basis of body mass index (BMI). Cases (n=723) were identified from a statewide tumor registry; controls (n=2,291) were selected randomly from population lists. Diabetes status, weight, height, and other factors were ascertained by telephone interview. Subjects were categorized as not overweight (BMI, <29.1), overweight (BMI, 29.1-31.9), or obese (BMI, >31.9) according to the BMI distribution of middle-aged white women in the Second National Health and Nutrition Examination Survey. Joint associations between diabetes status, BMI, and endometrial cancer were evaluated using unconditional logistic regression models that controlled for age, parity, use of hormone replacement therapy, education, and smoking. Compared with persons without diabetes, those with diabetes had an adjusted odds ratio of 1.86 (95% confidence interval (CI) 1.37-2.52) for endometrial cancer. This association was modified by BMI (p interaction=0.04). Compared with nonoverweight nondiabetic subjects, nonoverweight and overweight women who reported diabetes had nonsignificant elevated risks of endometrial cancer (nonoverweight, odds ratio (OR)=1.10, CI 0.66-1.86; overweight, OR=1.58, CI 0.81-3.05). In contrast, elevated risk estimates were observed for obese diabetic women (OR=2.95, CI 1.60-5.46). These data contradict earlier reports and suggest that diabetes confers no additional risk of endometrial cancer in women who are neither overweight nor obese.

Diabetes and endometrial cancer: effect modification by body weight, physical activity and hypertension

“…The association was partly, but not totally, explained by overweight. As in other epidemiological studies (Shoff and Newcomb, 1998;SalazarMartinez et al, 2000;Anderson et al, 2001;Friberg et al, 2007), the association with diabetes was stronger for obese women, suggesting a supramultiplicative effect between diabetes and obesity in endometrial cancer risk.…”

“…Diabetes shows a supramultiplicative effect with body mass index, but not with physical activity or hypertension. An increased risk of endometrial cancer in diabetic women has often been reported (Parazzini et al, 1991(Parazzini et al, , 1999Brinton et al, 1992;La Vecchia et al, 1994;Shoff and Newcomb, 1998;Salazar-Martinez et al, 2000;Weiderpass et al, 2000;Anderson et al, 2001;Sharma et al, 2001;Cook et al, 2006;Friberg et al, 2007). Overweight and obesity are major risk factors for both conditions since they are related to increased endogenous oestrogen levels (Parazzini et al, 1991;Calle et al, 2003;Cook et al, 2006).…”

Birth characteristics and adult cancer incidence: Swedish cohort of over 11,000 men and women

“…Low birth weight is associated with increased risks of obesity and insulin resistance syndrome, 22 which are in turn associated with polycystic ovarian syndrome, all of which are well-established risk factors for endometrial cancer. 23 In the absence of many comparable studies of birth size, comparisons can instead be made with studies examining adult height, as birth weight and length for GA are both good predictors of final adult height. 24 Our findings would be in agreement with other studies that have reported increased risks in taller adults of pancreatic, 25 colorectal, 26,27 breast 28 and overall 29,30 cancer risk.…”

Diabetes mellitus and risk of endometrial cancer: a meta-analysis

“…The major modifiable determinants of type 2 diabetes, hyperinsulinaemia and insulin resistance are obesity [4,5] and low physical activity [6], both of which have also been shown to be risk factors for endometrial cancer [6][7][8]. A number of studies have reported a positive association between diabetes and incidence of [9][10][11][12][13][14][15][16][17][18][19][20] or mortality from [21] endometrial cancer. Many studies did not distinguish between type 1 and type 2 diabetes.…”