▎ WuXi AppTec content team editor
Endometrial cancer, also known as uterine body cancer, is one of the three common malignant tumors of the female reproductive tract (the other two are cervical cancer and ovarian cancer), and it is also the second most common gynecological cancer after cervical cancer, accounting for about 20%-30% of gynecological cancers, mostly occurring in women with perimenopause and postmenopausal.
In 2020, there were 417 000 new cases of endometrial cancer worldwide, resulting in 97,000 deaths in women. In China, according to data recently released by the National Cancer Center, there were 71,000 new cases of endometrial cancer in 2016, accounting for 3.89% of the number of cancers in women; it caused 17,000 deaths, accounting for 1.9% of female cancer deaths.
What is more worrying is that with the increase of the average life expectancy of the population and the change of living habits, the incidence of endometrial cancer has continued to rise and rejuvenate in the past 20 years.
So what risk factors can have an impact on the risk of endometrial cancer? According to a study published in the Journal of Biomedical Medicine by researchers from Cancer Research UK and other institutions, being overweight or obese almost doubles a woman's risk of endometrial cancer.
Image credit: 123RF
The researchers analyzed 121885 female participants, of whom 12,906 were endometrial cancer patients and 108979 were control populations without endometrial cancer.
Using Mendelian randomization analysis (better analysis of cause and effect), the researchers analyzed data on 140 single nucleotide polymorphism (SNP) gene variation using genetic information as an alternative indicator of body weight.
These SNPs are associated with 14 markers that may mediate an association between overweight or obesity and endometrial cancer risk, including:
9 metabolic factors: high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), serum total cholesterol, triglycerides, blood glucose, fasting insulin, insulin-like growth factor 1 (IGF-1), adiponectin and leptin;
3 endogenous sex hormones or substances that regulate their biological activity: total testosterone, bioavailable testosterone and sex hormone-binding globulin (SHBG);
2 inflammatory markers: interleukin-6 (IL-6) and C-reactive protein (CRP).
In addition, the researchers also collected basic health information such as height and weight of the participants, lifestyle information, and information on the staging and subtype of endometrial cancer.
Image credit: 123RF
After removing the influence of other factors, the researchers analyzed and found that overweight or obesity, as well as 3 molecular characteristics, were associated with an increased risk of endometrial cancer and its subtypes. Specifically:
For every 4.7 kg/m2 increase in body mass index (BMI), participants were associated with an 88 percent increased risk of endometrial cancer and an 89 percent and 67 percent increased risk of two subtypes of endometrial cancer, endometrioid and non-endometrioid cancer.
Elevated levels of total testosterone, bioavailable testosterone, and fasting insulin are also associated with an increased risk of endometrial cancer and its subtypes. There was no clear association between several other molecular features and the risk of endometrial cancer.
In addition, the findings also showed that about 15% and 11% of endometrial cancers associated with overweight or obesity were caused by elevated bioavailable testosterone and fasting insulin, respectively, and in endometrioid endometrial cancers, 15% and 16% were also associated with elevated levels of bioavailable testosterone and fasting insulin, respectively.
The researchers analyzed that overweight or obesity in weight gain will have an impact on metabolism, resulting in an increase in bioavailable testosterone and fasting insulin, which in turn increases the risk of endometrial cancer.
Image credit: 123RF
The study concludes by highlighting that being overweight or obese is the second largest modifiable risk factor for cancer after smoking. Globally, about 34% of endometrial cancer patients are caused by being overweight or obese. The rising incidence of endometrial cancer is closely linked to the rise in global obesity rates, so for women, maintaining a healthy lifestyle and carrying out diet and exercise interventions to maintain a healthy weight are the cornerstones of primary prevention of endometrial cancer.
According to the "Guidelines for the Diagnosis and Treatment of Endometrial Cancer (2022 Edition)" issued by the National Health Commission of China, in addition to being overweight or obese, the following factors will also increase the risk of endometrial cancer, which should be paid attention to:
Reproductive endocrine disorders: such as anovulatory menstrual abnormalities, anovulatory infertility, polycystic ovary syndrome, etc.
Hypertension, diabetes: People with diabetes or glucose intolerance have a 2.8-fold increased risk of endometrial cancer than normal; patients with hypertension increased by 1.8 times.
Early menarche versus late menopause: Women with late menopause mostly menstruate anovulatory in the later years, thus prolonging the time of estrogen stimulation without progesterone synergy and also increasing the risk of endometrial cancer.
Infertility: Infertility increases the risk of endometrial cancer, whereas in contrast, each pregnancy reduces the risk of endometrial cancer to some extent. In addition, the higher the age of the last pregnancy, the lower the probability of developing endometrial cancer.
Ovarian tumors: Some ovarian tumors, such as ovarian granulocytoma, follicular membrane celloma, etc., often produce higher levels of estrogen, causing menstrual irregularities, postmenopausal bleeding, endometrial hyperplasia and even endometrial cancer.
Exogenous estrogens: if treated with a single exogenous estrogen for more than 5 years, the risk of developing endometrial cancer increases by 10-30 times. Combination of estrogen-progesterone replacement therapy does not increase the risk of endometrial cancer.
Lifestyle: Some lifestyle factors are known to be associated with endometrial cancer, including eating habits, exercise, alcohol consumption, smoking, etc.
Image credit: 123RF
In order to reduce the occurrence of endometrial cancer, people with the above risk factors should manage these risk factors in time, standardize living habits, timely conduct endometrial biopsy or ultrasonography, and carry out hormone replacement therapy under the guidance of a doctor, thereby reducing the risk of endometrial cancer.
Resources
[1] Emma Hazelwood, et al.,(2022). Identifying molecular mediators of the relationship between body mass index and endometrial cancer risk: a Mendelian randomization analysis. BMC Medicine, DOI: 10.1186/s12916-022-02322-3.
[2] Excess weight almost doubles risk of womb cancer. Retrieved Apr 25 ,2022,from https://medicalxpress.com/news/2022-04-excess-weight-womb-cancer.html
[3] Guidelines for the diagnosis and treatment of endometrial cancer (2022 edition). Retrieved Jan 3 ,2022,from http://www.nhc.gov.cn/yzygj/s7659/202204/a0e67177df1f439898683e1333957c74/files/22a422760c924a91bf07faf1e66ad7de.pdf
Disclaimer: WuXi AppTec's content team focuses on the global biomedical health research process. This article is for informational purposes only and the views expressed herein do not represent the position of WuXi AppTec, nor do they represent WuXi AppTec's support for or opposition to the views expressed herein. This article is also not recommended for treatment options. For guidance on treatment options, please visit a regular hospital.
Copyright note: This article is from WuXi AppTec content team, welcome to forward to the circle of friends, refuse the media or institutions to reprint to other platforms in any form without authorization. Reprint authorization, please reply to "reprint" on the "Healthy Press" WeChat public account to obtain the reprint instructions.
If you have other cooperation needs, please contact [email protected]
Healthy Press Machine 丨 WuXi App AppTec team to create
WeChat : ey_global
▇ Follow us and grasp the health information of fresh and material
Share, like, watch, spread health knowledge