Reproductive, menstrual, and medical risk factors for endometrial cancer: Results from a case-control study

Brinton, Louise A.; Berman, Michael L.; Mortel, Rodrigue; Twiggs, Leo B.; Barrett, Rolland J.; Wilbanks, George D.; Lannom, Linda; Hoover, Robert N.

doi:10.1016/s0002-9378(11)91709-8

Cited by 343 publications

(231 citation statements)

References 19 publications

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“…Inverse associations with later ages at a first birth have been demonstrated in some studies (Kvale et al, 1988;Albrektsen et al, 1995;Parslov et al, 2000;Wernli et al, 2006), although not in all of them (Lesko et al, 1991;Parazzini et al, 1991Parazzini et al, , 1998Shu et al, 1991;Brinton et al, 1992;McPherson et al, 1996;Lambe et al, 1999). More recently, studies have suggested that risk may decrease with later ages at a last birth (Kvale et al, 1988(Kvale et al, , 1991Lesko et al, 1991;Parazzini et al, 1991Parazzini et al, , 1998Lambe et al, 1999).…”

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Reproductive risk factors for endometrial cancer among Polish women

et al. 2007

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We conducted a population-based case -control study of reproductive factors in Warsaw and Ló qź, Poland, in 551 incident endometrial cancer cases and 1925 controls. The reproductive variable most strongly related to risk was multiparity, with subjects with three or more births having a 70% lower risk than the nulliparous women. The reduced risk was particularly strong below 55 years of age. Subjects with older ages at a first birth were also at reduced risk even after adjustment for number of births. Ages at last birth or intervals since last birth were not strongly related to risk. Spontaneous abortions were unrelated to risk, but induced abortions were associated with slight risk increases (odds ratios ¼ 1.28, 95% confidence intervals 0.8 -2.1 for 3 þ vs no abortions). The absence of effects on risk of later ages at, or short intervals since, a last birth fails to support the view that endometrial cancer is influenced by mechanical clearance of initiated cells. Alternative explanations for reproductive effects should be sought, including alterations in endogenous hormones.

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Reproductive risk factors for endometrial cancer among Polish women

et al. 2007

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“…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.…”

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confidence: 99%

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

et al. 2007

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Aims/hypothesis Diabetes has been associated with a statistically significantly increased risk of endometrial cancer in most, but not all studies. To provide a quantitative assessment of the association between diabetes and risk of endometrial cancer, we conducted a meta-analysis of casecontrol studies and cohort studies. Subjects and methods We identified studies by a literature search of PubMed and Embase through to January 2007 and by searching the reference lists of relevant articles. Summary relative risks (RRs) with 95% CIs were calculated using random-effects model. Results The analysis of diabetes (largely type 2) and endometrial cancer is based on 16 studies (three cohort and 13 case-control studies), including 96,003 participants and 7,596 cases of endometrial cancer. Twelve of the studies showed a statistically significantly increased risk and four a non-significant increased risk of endometrial cancer. In our meta-analysis we found that diabetes was statistically significantly associated with an increased risk of endometrial cancer (summary RR 2.10, 95% CI 1.75-2.53). The risk estimates were somewhat stronger among case-control (RR 2.22, 95% CI 1.80-2.74) than among cohort studies (RR 1.62, 95% CI 1.21-2.16), stronger among studies adjusting only for age (RR 2.74, 95% CI 1.87-4.00) compared with multivariate adjustment (RR 1.92, 95% CI 1.58-2.33) and slightly lower in studies performed in the USA than in those performed Europe. The analysis of type 1 diabetes and endometrial cancer was based on three studies and found a statistically significant positive association (summary RR 3.15, 95%CI 1.07-9.29). Conclusions/interpretation Results from the meta-analysis support a relationship between diabetes and increased risk of endometrial cancer.

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“…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).…”

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confidence: 99%

“…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). Although the association between diabetes and endometrial cancer may be partly or largely accounted for by the higher body weight of endometrial cancer cases, it has been found to persist after adjustment for body mass index (BMI) (Brinton et al, 1992;La Vecchia et al, 1994;Parazzini et al, 1999;Salazar-Martinez et al, 2000;Friberg et al, 2007).A few of the above studies have investigated the combined role of diabetes and BMI on risk, finding a higher risk among obese diabetic women, most of these, but not all (Anderson et al, 2001), reporting some excess risk also among non-overweight diabetic women.Diabetes is associated with hypertension and physical inactivity, which in turn have been related to endometrial cancer risk (Parazzini et al, 1999; Cust et al, 2007;Voskuil et al, 2007). In a Swedish cohort study of 225 cases of endometrial cancer, the relative risk was 2.7 for diabetic women reporting low physical activity and 1.1 among those reporting high physical activity (Friberg et al, 2007).…”

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

et al. 2007

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Among 777 endometrial cancer cases and 1550 controls from Italy and Switzerland, odds ratio was 1.7 (95% confidence interval: 1.2 -2.5) for diabetes, and 5.1 for obese diabetic women as compared with non-obese non-diabetic ones. 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). Although the association between diabetes and endometrial cancer may be partly or largely accounted for by the higher body weight of endometrial cancer cases, it has been found to persist after adjustment for body mass index (BMI) (Brinton et al, 1992;La Vecchia et al, 1994;Parazzini et al, 1999;Salazar-Martinez et al, 2000;Friberg et al, 2007).A few of the above studies have investigated the combined role of diabetes and BMI on risk, finding a higher risk among obese diabetic women, most of these, but not all (Anderson et al, 2001), reporting some excess risk also among non-overweight diabetic women.Diabetes is associated with hypertension and physical inactivity, which in turn have been related to endometrial cancer risk (Parazzini et al, 1999; Cust et al, 2007;Voskuil et al, 2007). In a Swedish cohort study of 225 cases of endometrial cancer, the relative risk was 2.7 for diabetic women reporting low physical activity and 1.1 among those reporting high physical activity (Friberg et al, 2007). In an Italian case -control study, the association with diabetes was of similar magnitude in women with or without hypertension (Parazzini et al, 1999).We therefore investigated whether the association between diabetes and endometrial cancer was modified by BMI, physical activity and hypertension in two case -control studies from Italy and Switzerland. MATERIALS AND METHODSWe analysed the combined data of two case -control studies of endometrial cancer, the first conducted in the greater Milan area and the Swiss Canton of Vaud between 1988 and 1994 on 410 cases and 753 controls (Augustin et al, 2003), the second conducted in the provinces of Pordenone and Milan, in northern Italy, and Naples, in southern Italy, in 1992-2006 on 454 cases and 908 controls. A subset from the latter included in a previous study was excluded . This left a total of 777 women (aged 18-79 years, median 61 years) with histologically confirmed endometrial cancer, with no previous diagnosis of cancer, and 1550 control women (aged 18-80 years, median 61 years) admitted to the same network of hospitals as cases for acute, non-neoplastic, and non-gynaecologic, nonhormone-related, non-metabolic conditions. Wom...

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Reproductive, menstrual, and medical risk factors for endometrial cancer: Results from a case-control study

Cited by 343 publications

References 19 publications

Reproductive risk factors for endometrial cancer among Polish women

Reproductive risk factors for endometrial cancer among Polish women

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

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

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