Original Paper

Cancer Causes & Control

, Volume 18, Issue 4, pp 399-413

Anthropometric factors and risk of endometrial cancer: the European prospective investigation into cancer and nutrition

  • Christine FriedenreichAffiliated withDivision of Population Health and Information, Alberta Cancer Board Email author 
  • , Anne CustAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerSchool of Public Health, University of SydneyUniversité Claude Bernard Lyon 1
  • , Petra H. LahmannAffiliated withDepartment of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke
  • , Karen SteindorfAffiliated withUnit of Environmental Epidemiology, German Cancer Research Centre
  • , Marie-Christine Boutron-RuaultAffiliated withINSERM U ERI20, Institut Gustave Roussy
  • , Françoise Clavel-ChapelonAffiliated withINSERM U ERI20, Institut Gustave Roussy
  • , Sylvie MesrineAffiliated withINSERM U ERI20, Institut Gustave Roussy
  • , Jakob LinseisenAffiliated withDivision of Clinical Epidemiology, German Cancer Research Centre
  • , Sabine RohrmannAffiliated withDivision of Clinical Epidemiology, German Cancer Research Centre
    • , Heiner BoeingAffiliated withDepartment of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke
    • , Tobias PischonAffiliated withDepartment of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke
    • , Anne TjønnelandAffiliated withInstitute of Cancer Epidemiology, Danish Cancer Society
    • , Jytte HalkjærAffiliated withInstitute of Cancer Epidemiology, Danish Cancer Society
    • , Kim OvervadAffiliated withDivision of Population Health and Information, Alberta Cancer BoardDepartment of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital
    • , Michelle MendezAffiliated withDivision of Population Health and Information, Alberta Cancer BoardDepartment of Epidemiology, Catalan Institute of Oncology, IDIBELL
    • , M. L. RedondoAffiliated withDivision of Population Health and Information, Alberta Cancer BoardPublic Health and Health Planning Directorate
    • , Carmen Martinez GarciaAffiliated withDivision of Population Health and Information, Alberta Cancer BoardEscuela Andaluza de Salud Publica
    • , Nerea LarrañagaAffiliated withDivision of Population Health and Information, Alberta Cancer BoardDepartment of Public Health of Guipuzkoa
    • , María-José TormoAffiliated withDivision of Population Health and Information, Alberta Cancer BoardDepartment of Epidemiology, Health Council of Murcia
    • , Aurelio Barricarte GurreaAffiliated withDivision of Population Health and Information, Alberta Cancer BoardPublic Health Institute of Navarra
    • , Sheila BinghamAffiliated withDivision of Population Health and Information, Alberta Cancer BoardMRC Centre for Nutrition and Cancer Prevention and Survival, University of Cambridge
    • , Kay-Tee KhawAffiliated withDivision of Population Health and Information, Alberta Cancer BoardDepartment of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge
    • , Naomi AllenAffiliated withDivision of Population Health and Information, Alberta Cancer BoardCancer Research UK Epidemiology Unit, University of Oxford
    • , Tim KeyAffiliated withDivision of Population Health and Information, Alberta Cancer BoardCancer Research UK Epidemiology Unit, University of Oxford
    • , Antonia TrichopoulouAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerDepartment of Hygiene and Epidemiology, School of Medicine, University of Athens
    • , Effie VasilopoulouAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerDepartment of Hygiene and Epidemiology, School of Medicine, University of Athens
    • , Dimitrios TrichopoulosAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerHellenic Health Foundation
    • , Valeria PalaAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerEpidemiology Unit, National Cancer Institute
    • , Domenico PalliAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerMolecular and Nutritional Epidemiology Unit, CSPO–Scientific Institute of Tuscany
    • , Rosario TuminoAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerCancer Registry, Azienda Ospedaliera “Civile M.P. Arezzo”
    • , Amalia MattielloAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerDipartimento di Medicina Clinica e Sperimentale, Università di Napoli
    • , Paolo VineisAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerUniversity of TorinoDepartment of Epidemiology and Public Health, Imperial College
    • , H. Bas Bueno-de-MesquitaAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerNational Institute of Public Health and the Environment
    • , Petra H. M. PeetersAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerJulius Centre for Health Sciences and Primary Care, University Medical Centre
    • , Göran BerglundAffiliated withSchool of Public Health, University of SydneyDepartment of Clinical Sciences, Malmö University Hospital, Lund University
    • , Jonas ManjerAffiliated withSchool of Public Health, University of SydneyDepartment of Surgery, Malmö University Hospital, Lund University
    • , Eva LundinAffiliated withSchool of Public Health, University of SydneyDepartment of Medical Biosciences, Pathology, University of Umeå
    • , Annekatrin LukanovaAffiliated withSchool of Public Health, University of SydneyDepartment of Obstetrics and Gynecology, NYU School of MedicineDepartment of Public Health and Clinical Medicine/Nutritional Research, University of Umeå
    • , Nadia SlimaniAffiliated withNutrition and Hormones Unit, International Agency for Research on Cancer
    • , Mazda JenabAffiliated withNutrition and Hormones Unit, International Agency for Research on Cancer
    • , Rudolf KaaksAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerDivision of Clinical Epidemiology, German Cancer Research Centre
    • , Elio RiboliAffiliated withNutrition and Hormones Unit, International Agency for Research on CancerDepartment of Epidemiology and Public Health, Imperial College

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Abstract

Objective

To examine the association between anthropometry and endometrial cancer, particularly by menopausal status and exogenous hormone use subgroups.

Methods

Among 223,008 women in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, there were 567 incident endometrial cancer cases during 6.4 years of follow-up. The analysis was performed with Cox proportional hazards modeling.

Results

Weight, body mass index (BMI), waist and hip circumferences and waist–hip ratio (WHR) were strongly associated with increased risk of endometrial cancer. The relative risk (RR) for obese (BMI 30– < 40 kg/m2) compared to normal weight (BMI < 25) women was 1.78, 95% CI = 1.41–2.26, and for morbidly obese women (BMI ≥ 40) was 3.02, 95% CI = 1.66–5.52. The RR for women with a waist circumference of ≥88 cm vs. <80 cm was 1.76, 95% CI = 1.42–2.19. Adult weight gain of ≥20 kg compared with stable weight (±3 kg) increased risk independent of body weight at age 20 (RR = 1.75, 95% CI = 1.11–2.77). These associations were generally stronger for postmenopausal than premenopausal women, and oral contraceptives never-users than ever-users, and much stronger among never-users of hormone replacement therapy compared to ever-users.

Conclusion

Obesity, abdominal adiposity, and adult weight gain were strongly associated with endometrial cancer risk. These associations were particularly evident among never-users of hormone replacement therapy.

Keywords

Anthropometry Endometrial cancer Etiology Risk factors Obesity Adiposity Mechanisms Hormone replacement therapy