The epidemiology of endometrial cancer

Parazzini, Fabio; Vecchia, Carlo La; Bocciolone, Luca; Franceschi, Silvia

doi:10.1016/0090-8258(91)90246-2

Cited by 367 publications

(211 citation statements)

References 93 publications

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“…Selective antagonism of the progesterone receptor in premenopausal women who are actively elaborating estrogens is of some concern, as protracted estrogenic stimulation of the endometrium has been associated with a dose-and durationdependent 2-to 10-fold increased risk for endometrial cancer. [3][4][5] Under physiological conditions, it is the intermittent elaboration of progesterone during the luteal phase of the menstrual cycle that opposes the otherwise mitogenic effects of estrogens. The pharmacological effects of PRMs are, however, not purely antagonistic, nor is their effect restricted to the progesterone receptor itself.…”

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The spectrum of endometrial pathology induced by progesterone receptor modulators

Bergeron²,

et al. 2008

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Progesterone receptor modulators (PRM) are hormonally active drugs effective in the management of endometriosis and uterine leiomyomata. The endometrial effects of progestin blockade by PRMs in premenopausal women are currently being evaluated in several clinical trials, but few pathologists have had access to these materials and published information of the histological changes is scanty. Eighty-four endometrial specimens from women receiving one of four different PRMs were reviewed by a panel of seven experienced gynecologic pathologists to develop consensus observations and interpretive recommendations as part of an NIH-sponsored workshop. Although the pathologists were blinded to agent, dose, and exposure interval, the review was intended to provide an overview of the breadth of possible findings, and a venue to describe unique features. Endometrial histology included inactive and normal-appearing cycling endometrium. Overtly premalignant lesions (atypical hyperplasia or EIN) were not seen. In a subset of cases, asymmetry of stromal and epithelial growth resulted in prominent cystically dilated glands with admixed estrogen (mitotic) and progestin (secretory) epithelial effects of a type not encountered in contemporary clinical practice. The variety of endometrial appearances suggested that findings might differ by agent and dose over time according to relationships that must be specified for each agent. The constellation of changes seen in those endometria with cystically dilated glands is so novel that new terminology and diagnostic criteria are required for pathologists to recognize them. The panel has designated these changes as PRM-associated endometrial changes (PAEC). Additional follow-up studies will be needed to fully define their natural history and relationship to specific agents and administration regimens.

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The spectrum of endometrial pathology induced by progesterone receptor modulators

Bergeron²,

et al. 2008

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“…The first line is based on ecological contrasts, secular trends and studies in migrants (Armstrong and Doll, 1975;Tomatis, 1990), whereas the second is derived from analytical epidemiological investigations that have revealed obesity as a factor of overwhelming importance in the aetiology of the disease (Kelsey et al, 1982;Pike, 1987;Koumantaki et al, 1989). Several studies using variable research instruments and base populations have explored qualitative aspects of diet but no striking pattern has emerged (Parazzini et al, 1991). Major concerns in case-control studies include selection and information bias.…”

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confidence: 99%

Dietary factors and the risk of endometrial cancer: a case - control study in Greece

Τζώνου

Lipworth²,

Kalandidi³

et al. 1996

Br J Cancer

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Summary In a hospital-based case -control study of endometrial cancer undertaken in Athens (1992 -94), 145 women residents of Greater Athens with confirmed cancer of the endometrium were compared with 298 control patients with orthopaedic diseases. Personal interviews were conducted in the hospital setting, and diet was assessed using a validated semiquantitative food frequency questionnaire. Nutrient intakes for individuals were calculated by multiplying the nutrient intake of a typical portion size for each specified food item by the frequency at which the food was consumed per month and summing these estimates for all food items. Data were modelled through logistic regression, controlling for demographic, reproductive and somatometric risk factors for endometrial cancer as well as for total energy intake. No macronutrient was significantly associated with endometrial cancer risk, but increasing intake of monounsaturated fat, mostly olive oil, by about one standard deviation was associated with a 26% risk reduction (odds ratio=0.74; 95% confidence interval 0.54-1.03). Among micronutrients, only calcium intake was significantly inversely associated with endometrial cancer risk, whereas there was evidence against retinol and zinc imparting protection against the disease. With respect to food groups, there was weak and non-significant evidence that vegetables are protective, whereas consumption of pulses was positively associated with disease possibly because they contribute substantially in Greece to energy intake in excess of physical activity-dependent requirements.Keywords: endometrial cancer; diet; nutrition; olive oil; calcium; retinolThe high international variability of endometrial cancer incidence, the increasing incidence of this cancer in less developed countries, the changing disease incidence among migrants (Armstrong and Doll, 1979;Tomatis, 1990;Parkin et al., 1992) and the inability to explain adequately the observed patterns of variation on the basis of established risk factors for the disease have indicated that dietary variables may influence the occurrence of the disease. It has already been shown that obesity is a major risk factor for endometrial cancer (Kelsey et al., 1982;Pike, 1987;Koumantaki et al., 1989), but there is considerable uncertainty about the role of qualitative aspects of diet. It has been suggested that, in relation to endometrial cancer, a high intake of added fats and oils (La Vecchia et al., 1986), beans and peas (Levi et al., 1993), meat, fish and eggs (Levi et al., 1993;Shu et al., 1993;Zheng et al., 1995), carbohydrates (Armstrong, 1979), may increase the risk; that a high intake of vegetables and fruits (La Vecchia et al., 1986;Shu et al., 1993), cereals and whole grain foods (La Vecchia et al., 1986;Potischman et al., 1993) Overall, it appears that no particular dietary factor stands out as being of overwhelming importance, although methodological factors may also have contributed to the divergence of the empirical evidence. We have undertaken a case-control study of...

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“…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).…”

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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).…”

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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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The epidemiology of endometrial cancer

Cited by 367 publications

References 93 publications

The spectrum of endometrial pathology induced by progesterone receptor modulators

The spectrum of endometrial pathology induced by progesterone receptor modulators

Dietary factors and the risk of endometrial cancer: a case - control study in Greece

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

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