Cancer Causes & Control

, Volume 18, Issue 4, pp 399–413 | Cite as

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

  • Christine Friedenreich
  • Anne Cust
  • Petra H. Lahmann
  • Karen Steindorf
  • Marie-Christine Boutron-Ruault
  • Françoise Clavel-Chapelon
  • Sylvie Mesrine
  • Jakob Linseisen
  • Sabine Rohrmann
  • Heiner Boeing
  • Tobias Pischon
  • Anne Tjønneland
  • Jytte Halkjær
  • Kim Overvad
  • Michelle Mendez
  • M. L. Redondo
  • Carmen Martinez Garcia
  • Nerea Larrañaga
  • María-José Tormo
  • Aurelio Barricarte Gurrea
  • Sheila Bingham
  • Kay-Tee Khaw
  • Naomi Allen
  • Tim Key
  • Antonia Trichopoulou
  • Effie Vasilopoulou
  • Dimitrios Trichopoulos
  • Valeria Pala
  • Domenico Palli
  • Rosario Tumino
  • Amalia Mattiello
  • Paolo Vineis
  • H. Bas Bueno-de-Mesquita
  • Petra H. M. Peeters
  • Göran Berglund
  • Jonas Manjer
  • Eva Lundin
  • Annekatrin Lukanova
  • Nadia Slimani
  • Mazda Jenab
  • Rudolf Kaaks
  • Elio Riboli
Original Paper

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 

References

  1. 1.
    IARC Working Group (2002) IARC handbook of cancer prevention, volume 6: weight control and physical activity. IARC, Lyon, p 1Google Scholar
  2. 2.
    Kaaks R, Lukanova A, Kurzer MS (2002) Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev 11:1531–1531PubMedGoogle Scholar
  3. 3.
    Le Marchand L., Wilkens LR, Mi MP (1991) Early-age body size, adult weight gain and endometrial cancer risk. Int J Cancer 48:807–811Google Scholar
  4. 4.
    Shu XO, Brinton LA, Zheng W et al (1992) Relation of obesity and body fat distribution to endometrial cancer in Shanghai, China. Cancer Res 52:3865–3870PubMedGoogle Scholar
  5. 5.
    Swanson CA, Potischman N, Wilbanks GD et al (1993) Relation of endometrial cancer risk to past and contemporary body size and body fat distribution. Cancer Epidemiol Biomarkers Prev 2:321–327PubMedGoogle Scholar
  6. 6.
    Olson SH, Trevisan M, Marshall JR et al (1995) Body mass index, weight gain, and risk of endometrial cancer. Nutr Cancer 23:141–149PubMedCrossRefGoogle Scholar
  7. 7.
    Terry P, Baron JA, Weiderpass E, Yuen J, Lichtenstein P, Nyren O (1999) Lifestyle and endometrial cancer risk: a cohort study from the Swedish Twin Registry. Int J Cancer 82:38–42PubMedCrossRefGoogle Scholar
  8. 8.
    Trentham-Dietz A, Nichols HB, Hampton JM, Newcomb PA (2006) Weight change and risk of endometrial cancer .Int J Epidemiol 35:151–158PubMedCrossRefGoogle Scholar
  9. 9.
    Ballard-Barbash R, Swanson CA (1996) Body weight: estimation of risk for breast and endometrial cancers. Am J Clin Nutr 63:437S–41SPubMedGoogle Scholar
  10. 10.
    Schouten LJ, Goldbohm RA, van den Brandt PA (2004) Anthropometry, physical activity, and endometrial cancer risk: results from the Netherlands Cohort Study. J Natl Cancer Inst 96:1635–1638PubMedGoogle Scholar
  11. 11.
    Levi F, La Vecchia C, Negri E, Parazzini F, Franceschi S (1992) Body mass at different ages and subsequent endometrial cancer risk. Int J Cancer 50:567–571Google Scholar
  12. 12.
    Weiderpass E, Persson I, Adami HO, Magnusson C, Lindgren A, Baron JA (2000) Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 11:185–192PubMedCrossRefGoogle Scholar
  13. 13.
    French SA, Folsom AR, Jeffery RW, Zheng W, Mink PJ, Baxter JE (1997) Weight variability and incident disease in older women: the Iowa Women’s Health Study. Int J Obes Relat Metab Disord 21:217–223PubMedCrossRefGoogle Scholar
  14. 14.
    Folsom AR, Kaye SA, Potter JD, Prineas RJ (1989) Association of incident carcinoma of the endometrium with body weight and fat distribution in older women: early findings of the Iowa Women’s Health Study. Cancer Res 49:6828–6831PubMedGoogle Scholar
  15. 15.
    Lapidus L, Helgesson O, Merck C, Bjorntorp P (1988) Adipose tissue distribution and female carcinomas. A 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. Int J Obes 12:361–368PubMedGoogle Scholar
  16. 16.
    Elliott EA, Matanoski GM, Rosenshein NB, Grumbine FC, Diamond EL (1990) Body fat patterning in women with endometrial cancer. Gynecol Oncol 39:253–258PubMedCrossRefGoogle Scholar
  17. 17.
    Schapira DV, Kumar NB, Lyman GH, Cavanagh D, Roberts WS, LaPolla J (1991) Upper-body fat distribution and endometrial cancer risk. JAMA 266:1808–1811PubMedCrossRefGoogle Scholar
  18. 18.
    Austin H, Austin JM Jr, Partridge EE, Hatch KD, Shingleton HM (1991) Endometrial cancer, obesity, and body fat distribution. Cancer Res 51:568–572PubMedGoogle Scholar
  19. 19.
    Goodman MT, Hankin JH, Wilkens LR et al (1997) Diet, body size, physical activity, and the risk of endometrial cancer. Cancer Res 57:5077–5085PubMedGoogle Scholar
  20. 20.
    Beral V, Bull D, Reeves G (2005) Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 365:1543–1551PubMedCrossRefGoogle Scholar
  21. 21.
    La Vecchia C., Franceschi S, Gallus G et al (1982) Oestrogens and obesity as risk factors for endometrial cancer in Italy. Int J Epidemiol 11:120–126PubMedCrossRefGoogle Scholar
  22. 22.
    Riboli E, Kaaks R (1997) The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26 Suppl 1:S6–S14PubMedCrossRefGoogle Scholar
  23. 23.
    Riboli E, Hunt KJ, Slimani N et al (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5:1113–1124PubMedCrossRefGoogle Scholar
  24. 24.
    Bingham SA, Gill C, Welch A et al (1994) Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr 72:619–643PubMedCrossRefGoogle Scholar
  25. 25.
    Haftenberger M, Lahmann PH, Panico S et al (2002) Overweight, obesity and fat distribution in 50- to 64-year-old participants in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5:1147–1162PubMedCrossRefGoogle Scholar
  26. 26.
    Spencer EA, Roddam AW, Key TJ (2004) Accuracy of self-reported waist and hip measurements in 4492 EPIC-Oxford participants. Public Health Nutr 7:723–727PubMedCrossRefGoogle Scholar
  27. 27.
    Lahmann PH, Schulz M, Hoffmann K et al (2005) Long-term weight change and breast cancer risk: the European prospective investigation into cancer and nutrition (EPIC). Br J Cancer 93:582–589PubMedCrossRefGoogle Scholar
  28. 28.
    Haftenberger M, Schuit AJ, Tormo MJ et al (2002) Physical activity of subjects aged 50–64 years involved in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5:1163–1176PubMedCrossRefGoogle Scholar
  29. 29.
    Ainsworth BE, Haskell WL, Whitt MC et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498–S504PubMedCrossRefGoogle Scholar
  30. 30.
    Friedenreich CM, Novat T, Steindorf K et al (2006) Physical activity and risk of colon and rectal cancers: the European Prospective Investigation into Cancer and Nutrition. Cancer Epid Biomark Prev 15:2398–2407CrossRefGoogle Scholar
  31. 31.
    Margetts BM, Pietinen P (1997) European prospective investigation into cancer and nutrition: validity studies on dietary assessment methods. Int J Epidemiol 26 Suppl 1:S1–S5PubMedCrossRefGoogle Scholar
  32. 32.
    Tavassoli FA, Devilee P (Eds) 2003 Pathology and genetics—tumours of the breast and female genital organs. World Health Organization classification of tumours. IARC Press, Lyon, pp 217–258Google Scholar
  33. 33.
    Kleinbaum DG, Klein M (2002) Logistic regression: a self learning text. SpringerGoogle Scholar
  34. 34.
    Slimani N, Fahey M, Welch AA et al (2002) Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr 5:1311–1328PubMedCrossRefGoogle Scholar
  35. 35.
    Furberg AS, Thune I (2003) Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int J Cancer 104:669–676PubMedCrossRefGoogle Scholar
  36. 36.
    Jonsson F, Wolk A, Pedersen NL et al (2003) Obesity and hormone-dependent tumors: cohort and co-twin control studies based on the Swedish Twin Registry. Int J Cancer 106:594–599PubMedCrossRefGoogle Scholar
  37. 37.
    Kuriyama S, Tsubono Y, Hozawa A et al (2005) Obesity and risk of cancer in Japan. Int J Cancer 113:148–157PubMedCrossRefGoogle Scholar
  38. 38.
    Lukanova A, Bjor O, Kaaks R et al (2006) Body mass index and cancer: results from the Northern Sweden Health and Disease Cohort. Int J Cancer 118:458–466PubMedCrossRefGoogle Scholar
  39. 39.
    Petridou E, Koukoulomatis P, Dessypris N, Karalis D, Michalas S, Trichopoulos D (2002) Why is endometrial cancer less common in Greece than in other European Union countries?. Eur J Cancer Prev 11:427–432PubMedCrossRefGoogle Scholar
  40. 40.
    Xu WH, Matthews CE, Xiang YB et al (2005) Effect of adiposity and fat distribution on endometrial cancer risk in Shanghai women. Am J Epidemiol 161:939–947PubMedCrossRefGoogle Scholar
  41. 41.
    Xu WH, Xiang YB, Zheng W et al (2006) Weight history and risk of endometrial cancer among Chinese women. Int J Epidemiol 35:159–166PubMedCrossRefGoogle Scholar
  42. 42.
    Iemura A, Douchi T, Yamamoto S, Yoshimitsu N, Nagata Y (2000) Body fat distribution as a risk factor of endometrial cancer. J Obstet Gynaecol Res 26:421–425PubMedCrossRefGoogle Scholar
  43. 43.
    La Vecchia C., Parazzini F, Negri E, Fasoli M, Gentile A, Franceschi S (1991) Anthropometric indicators of endometrial cancer risk. Eur J Cancer 27:487–490PubMedGoogle Scholar
  44. 44.
    Tornberg SA, Carstensen JM (1994) Relationship between Quetelet’s index and cancer of breast and female genital tract in 47,000 women followed for 25 years. Br J Cancer 69:358–361PubMedGoogle Scholar
  45. 45.
    Akhmedkhanov A, Zeleniuch-Jacquotte A, Toniolo P (2001) Role of exogenous and endogenous hormones in endometrial cancer: review of the evidence and research perspectives. Ann N Y Acad Sci 943:296–315PubMedCrossRefGoogle Scholar
  46. 46.
    Lahmann PH, Hoffmann K, Allen N et al (2004) Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC). Int J Cancer 111:762–771PubMedCrossRefGoogle Scholar
  47. 47.
    Henderson BE, Casagrande JT, Pike MC, Mack T, Rosario I, Duke A (1983) The epidemiology of endometrial cancer in young women. Br J Cancer 47:749–756PubMedGoogle Scholar
  48. 48.
    Blitzer PH, Blitzer EC, Rimm AA (1976) Association between teen-age obesity and cancer in 56,111 women: all cancers and endometrial carcinoma. Prev Med 5:20–31PubMedCrossRefGoogle Scholar
  49. 49.
    Perry GS, Byers TE, Mokdad AH, Serdula MK, Williamson DF (1995) The validity of self-reports of past body weights by U.S. adults. Epidemiology 6:61–66PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Christine Friedenreich
    • 1
  • Anne Cust
    • 2
    • 3
    • 4
  • Petra H. Lahmann
    • 5
  • Karen Steindorf
    • 6
  • Marie-Christine Boutron-Ruault
    • 7
  • Françoise Clavel-Chapelon
    • 7
  • Sylvie Mesrine
    • 7
  • Jakob Linseisen
    • 8
  • Sabine Rohrmann
    • 8
  • Heiner Boeing
    • 5
  • Tobias Pischon
    • 5
  • Anne Tjønneland
    • 9
  • Jytte Halkjær
    • 9
  • Kim Overvad
    • 10
  • Michelle Mendez
    • 11
  • M. L. Redondo
    • 12
  • Carmen Martinez Garcia
    • 13
  • Nerea Larrañaga
    • 14
  • María-José Tormo
    • 15
  • Aurelio Barricarte Gurrea
    • 16
  • Sheila Bingham
    • 17
  • Kay-Tee Khaw
    • 18
  • Naomi Allen
    • 19
  • Tim Key
    • 19
  • Antonia Trichopoulou
    • 20
  • Effie Vasilopoulou
    • 20
  • Dimitrios Trichopoulos
    • 21
  • Valeria Pala
    • 22
  • Domenico Palli
    • 23
  • Rosario Tumino
    • 24
  • Amalia Mattiello
    • 25
  • Paolo Vineis
    • 26
    • 27
  • H. Bas Bueno-de-Mesquita
    • 28
  • Petra H. M. Peeters
    • 29
  • Göran Berglund
    • 30
  • Jonas Manjer
    • 31
  • Eva Lundin
    • 32
  • Annekatrin Lukanova
    • 33
    • 34
  • Nadia Slimani
    • 2
  • Mazda Jenab
    • 2
  • Rudolf Kaaks
    • 2
    • 8
  • Elio Riboli
    • 2
    • 27
  1. 1.Division of Population Health and InformationAlberta Cancer BoardCalgaryCanada
  2. 2.Nutrition and Hormones UnitInternational Agency for Research on CancerLyonFrance
  3. 3.School of Public HealthUniversity of SydneySydneyAustralia
  4. 4.Université Claude Bernard Lyon 1LyonFrance
  5. 5.Department of EpidemiologyGerman Institute of Human Nutrition Potsdam-RehbrueckeNuthetalGermany
  6. 6.Unit of Environmental EpidemiologyGerman Cancer Research CentreHeidelbergGermany
  7. 7.INSERM U ERI20Institut Gustave RoussyVillejuifFrance
  8. 8.Division of Clinical EpidemiologyGerman Cancer Research CentreHeidelbergGermany
  9. 9.Institute of Cancer EpidemiologyDanish Cancer SocietyCopenhagenDenmark
  10. 10.Department of Clinical EpidemiologyAalborg Hospital, Aarhus University HospitalAalborgDenmark
  11. 11.Department of EpidemiologyCatalan Institute of Oncology, IDIBELLBarcelonaSpain
  12. 12.Public Health and Health Planning DirectorateAsturiasSpain
  13. 13.Escuela Andaluza de Salud PublicaGranadaSpain
  14. 14.Department of Public Health of GuipuzkoaSan SebastianSpain
  15. 15.Department of EpidemiologyHealth Council of MurciaMurciaSpain
  16. 16.Public Health Institute of NavarraPamplonaSpain
  17. 17.MRC Centre for Nutrition and Cancer Prevention and SurvivalUniversity of CambridgeCambridgeUK
  18. 18.Department of Public Health and Primary Care, School of Clinical MedicineUniversity of CambridgeCambridgeUK
  19. 19.Cancer Research UK Epidemiology UnitUniversity of OxfordOxfordUK
  20. 20.Department of Hygiene and Epidemiology, School of MedicineUniversity of AthensAthensGreece
  21. 21.Hellenic Health FoundationAthensGreece
  22. 22.Epidemiology UnitNational Cancer InstituteMilanItaly
  23. 23.Molecular and Nutritional Epidemiology UnitCSPO–Scientific Institute of TuscanyFlorenceItaly
  24. 24.Cancer RegistryAzienda Ospedaliera “Civile M.P. Arezzo”RagusaItaly
  25. 25.Dipartimento di Medicina Clinica e SperimentaleUniversità di NapoliNaplesItaly
  26. 26.University of TorinoTurinItaly
  27. 27.Department of Epidemiology and Public HealthImperial CollegeLondonUK
  28. 28.National Institute of Public Health and the EnvironmentBilthovenThe Netherlands
  29. 29.Julius Centre for Health Sciences and Primary CareUniversity Medical CentreUtrechtThe Netherlands
  30. 30.Department of Clinical SciencesMalmö University Hospital, Lund UniversityMalmoSweden
  31. 31.Department of Surgery, Malmö University HospitalLund UniversityMalmoSweden
  32. 32.Department of Medical Biosciences, PathologyUniversity of UmeåUmeaSweden
  33. 33.Department of Obstetrics and GynecologyNYU School of MedicineNew YorkUSA
  34. 34.Department of Public Health and Clinical Medicine/Nutritional ResearchUniversity of UmeåUmeaSweden

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