Obesity and Endometrial Cancer

Abstract

Endometrial cancer is the sixth most common cancer in women worldwide and the most common gynecologic malignancy in the developed world. This chapter explores the current epidemiologic evidence on the association between obesity and endometrial cancer risk and mortality. Using body mass index (BMI) as a measure of obesity, we found that obesity (defined as BMI > 30 and < 35 kg/m) was associated with a 2.6-fold increase in endometrial cancer risk, while severe obesity (BMI > 35 kg/m) was associated with a 4.7-fold increase compared to normal-weight women (BMI < 25 kg/m). Increased central adiposity also increased endometrial cancer risk by 1.5- to twofold. Among both healthy and endometrial cancer patient populations, obesity was associated with a roughly twofold increase in endometrial cancer-specific mortality. This risk reduction was also observed for obesity and all-cause mortality among endometrial cancer patients. In the few studies that assessed risk associated with weight change, an increased endometrial cancer risk with weight gain and weight cycling was observed, whereas some evidence for a protective effect of weight loss was found. Furthermore, early-life obesity was associated with a moderately increased risk of endometrial cancer later in life. There are several mechanisms whereby obesity is hypothesized to increase endometrial cancer risk, including increased endogenous sex steroid hormones, insulin resistance, chronic inflammation and adipokines. Further research should focus on histological subtypes or molecular phenotypes of endometrial tumors and population subgroups that could be at an increased risk of obesity-associated endometrial cancer. Additionally, studies on weight gain, loss or cycling and weight loss interventions can provide mechanistic insight into the obesity-endometrial cancer association. Sufficient evidence exists to recommend avoiding obesity to reduce endometrial cancer risk.

Obesity and Risk of Cancer: An Introductory Overview

“…This is primarily due to the limited long-term success of weight loss strategies among obese individuals. There is limited evidence suggesting that obesity may also be associated with poor prognosis among patients with colorectal cancer, breast cancer, endometrial cancer, ovarian cancer and pancreatic cancer [33,37,46,51,44]. Taken together, these findings support efforts to prevent weight gain on an individual level as well as on a population level.…”

“…Thus, a recent statement by the IARC added thyroid cancer, multiple myeloma, and meningioma to this list [30]. For some cancer types there is also some evidence that weight gain during adulthood increases cancer risk, e.g., colorectal cancer, postmenopausal breast cancer, endometrial cancer, and liver cancer [33,37,46,49]. However, for most cancers it is an open question as to whether vulnerability to weight gain in relation to cancer risk depends on specific life periods.…”

“…Thus, obesity is associated with a 2.6-fold higher risk of endometrial cancer compared to normal weight [46]. Similarly, weight gain during adulthood is associated with a higher risk [46].…”

“…Thus, obesity is associated with a 2.6-fold higher risk of endometrial cancer compared to normal weight [46]. Similarly, weight gain during adulthood is associated with a higher risk [46]. Potential mechanisms for the observed association primarily include endogenous sex steroid hormones, but also insulin resistance, chronic inflammation and adipokines.…”

“…Potential mechanisms for the observed association primarily include endogenous sex steroid hormones, but also insulin resistance, chronic inflammation and adipokines. There are only a few studies that have investigated whether the association of obesity with survival among women with endometrial cancer, and these studies suggest that obesity is related to poorer survival [46].…”