Cancer Causes & Control

, 20:1117 | Cite as

Phytoestrogen consumption and endometrial cancer risk: a population-based case–control study in New Jersey

  • Elisa V. Bandera
  • Melony G. Williams
  • Camelia Sima
  • Sharon Bayuga
  • Katherine Pulick
  • Homer Wilcox
  • Robert Soslow
  • Ann G. Zauber
  • Sara H. Olson
Original Paper


Phytoestrogens have been shown to exert anti-estrogenic and estrogenic effects in some tissues, including the breast. However, only a few studies have evaluated their role in endometrial cancer risk. We evaluated this association in a population-based case–control study in New Jersey. A total of 424 cases and 398 controls completed an interview, including a food frequency questionnaire with supplemental questions for phytoestrogen foods. Risk estimates were derived using an unconditional logistic regression, adjusting for major risk factors for endometrial cancer. There was some suggestion of a decreased risk with quercetin intake (OR: 0.65; 95% CI: 0.41–1.01 for the highest compared to the lowest quartile; p for trend: 0.02). We found a limited evidence of an association with any of the lignans evaluated, total lignans, coumestrol, individual isoflavones, total isoflavones, or total phytoestrogens. However, there was some suggestion of an inverse association with total isoflavone intake limited to lean women (BMI <25; OR for the highest tertile: 0.50; 95% CI: 0.25–0.98) and those with a waist-to-hip ratio ≤0.85 (OR: 0.59; 95% CI: 0.33–1.05). There was no evidence of effect modification by HRT use. This study suggests a reduction in endometrial cancer risk with quercetin intake and with isoflavone intake in lean women.


Endometrial neoplasms Phytoestrogens Isoflavones Lignans Quercetin Diet 



Odds ratio


Confidence interval


Food frequency questionnaire


Body mass index


Waist-to-hip ratio


Hormone replacement therapy


Estrogen replacement therapy


Oral contraceptives



We thank the interviewers and students who were involved in this study (Silvia Brendel, Dina Gifkins, Nora Geraghty, June Kittredge, Elinor Miller, Louise Salant, Mathilde Saxon, Elizabeth Ward, Doreen Wass, Kay Yoon), the New Jersey Department of Health and Senior Services personnel (Tara Blando, Joan Kay, Betsy Kohler, Kevin Masterson, and Helen Weiss), as well as all the participants who generously donated their time to the study. This work was funded by NIH-K07 CA095666 and R01CA83918.


  1. 1.
    American Cancer Society (2008) Cancer facts and figures 2008. American Cancer Society, Atlanta, GA.
  2. 2.
    Bandera EV, Kushi LH (2004) Phytoestrogens in the prevention and prognosis of female hormonal cancers. Annu Rev Food Nutr Toxic 1:63–87Google Scholar
  3. 3.
    Duffy C, Perez K, Partridge A (2007) Implications of phytoestrogen intake for breast cancer. CA Cancer J Clin 57:260–277. doi: 10.3322/CA.57.5.260 PubMedCrossRefGoogle Scholar
  4. 4.
    Kaaks R, Lukanova A, Kurzer MS (2002) Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev 11:1531–1543PubMedGoogle Scholar
  5. 5.
    Setchell KD (1998) Phytoestrogens: the biochemistry, physiology, and implications for human health of soy isoflavones. Am J Clin Nutr 68:1333S–1346SPubMedGoogle Scholar
  6. 6.
    Strauss L, Santti R, Saarinen N, Streng T, Joshi S, Makela S (1998) Dietary phytoestrogens and their role in hormonally dependent disease. Toxicol Lett 102–103:349–354. doi: 10.1016/S0378-4274(98)00332-4 PubMedCrossRefGoogle Scholar
  7. 7.
    Moutsatsou P (2007) The spectrum of phytoestrogens in nature: our knowledge is expanding. Hormones (Athens) 6:173–193Google Scholar
  8. 8.
    Messina MJ, Persky V, Setchell KD, Barnes S (1994) Soy intake and cancer risk: a review of the in vitro and in vivo data. Nutr Cancer 21:113–131PubMedCrossRefGoogle Scholar
  9. 9.
    Horn-Ross PL, John EM, Canchola AJ, Stewart SL, Lee MM (2003) Phytoestrogen intake and endometrial cancer risk. J Natl Cancer Inst 95:1158–1164 -Erratum in: J Natl Cancer Inst. 2006 Oct 18;98(20):1501Google Scholar
  10. 10.
    Xu WH, Zheng W, Xiang YB et al (2004) Soya food intake and risk of endometrial cancer among Chinese women in Shanghai: population based case–control study. BMJ 328:1285. doi: 10.1136/bmj.38093.646215.AE PubMedCrossRefGoogle Scholar
  11. 11.
    Zeleniuch-Jacquotte A, Lundin E, Micheli A et al (2006) Circulating enterolactone and risk of endometrial cancer. Int J Cancer 119:2376–2381. doi: 10.1002/ijc.22140 PubMedCrossRefGoogle Scholar
  12. 12.
    Goodman MT, Wilkens LR, Hankin JH, Lyu LC, Wu AH, Kolonel LN (1997) Association of soy and fiber consumption with the risk of endometrial cancer. Am J Epidemiol 146:294–306PubMedGoogle Scholar
  13. 13.
    Olson SH, Orlow I, Bayuga S et al (2008) Variants in hormone biosynthesis genes and risk of endometrial cancer. Cancer Causes Control 19:955–963PubMedGoogle Scholar
  14. 14.
    Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML (2005) Life after cancer epidemiology (LACE) study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 16:545–556. doi: 10.1007/s10552-004-8340-3 PubMedCrossRefGoogle Scholar
  15. 15.
    Horn-Ross PL, Barnes S, Lee M et al (2000) Assessing phytoestrogen exposure in epidemiologic studies: development of a database (United States). Cancer Causes Control 11:289–298. doi: 10.1023/A:1008995606699 PubMedCrossRefGoogle Scholar
  16. 16.
    Thompson LU, Boucher BA, Liu Z, Cotterchio M, Kreiger N (2006) Phytoestrogen content of foods consumed in Canada, including isoflavones, lignans, and coumestan. Nutr Cancer 54:184–201. doi: 10.1207/s15327914nc5402_5 PubMedCrossRefGoogle Scholar
  17. 17.
    Willett W, Stampfer M (1998) Implications of total energy intake for epidemiologic analyses. In: Willett W (ed) Nutritional epidemiology, 2nd edn. Oxford University Press, New York, pp 273–301Google Scholar
  18. 18.
    Bandera EV, Kushi LH, Moore DF, Gifkins DM, McCullough ML. The association between food, nutrition, and physical activity and the risk of endometrial cancer and underlying mechanisms. In: Second Report on Food, Nutrition, Physical Activity and the Prevention of Cancer: World Cancer Research Fund International/American Institute for Cancer Research; 2007Google Scholar
  19. 19.
    Hirose K, Tajima K, Hamajima N et al (1996) Subsite (cervix/endometrium)-specific risk and protective factors in uterus cancer. Jpn J Cancer Res 87:1001–1009PubMedGoogle Scholar
  20. 20.
    Littman AJ, Beresford SA, White E (2001) The association of dietary fat and plant foods with endometrial cancer (United States). Cancer Causes Control 12:691–702. doi: 10.1023/A:1011292003586 PubMedCrossRefGoogle Scholar
  21. 21.
    Zhou B, Yang L, Sun Q et al (2008) Cigarette smoking and the risk of endometrial cancer: a meta-analysis. Am J Med 121:501–508. doi: 10.1016/j.amjmed.2008.01.044 PubMedCrossRefGoogle Scholar
  22. 22.
    Cust AE, Armstrong BK, Friedenreich CM, Slimani N, Bauman A (2007) Physical activity and endometrial cancer risk: a review of the current evidence, biologic mechanisms and the quality of physical activity assessment methods. Cancer Causes Control 18:243–258. doi: 10.1007/s10552-006-0094-7 PubMedCrossRefGoogle Scholar
  23. 23.
    Voskuil DW, Monninkhof EM, Elias SG, Vlems FA, van Leeuwen FE (2007) Physical activity and endometrial cancer risk, a systematic review of current evidence. Cancer Epidemiol Biomarkers Prev 16:639–648. doi: 10.1158/1055-9965.EPI-06-0742 PubMedCrossRefGoogle Scholar
  24. 24.
    Bandera EV, Kushi LH, Moore DF, Gifkins DM, McCullough ML (2007) Dietary lipids and endometrial cancer: the current epidemiologic evidence. Cancer Causes Control 18:687–703. doi: 10.1007/s10552-007-9021-9 PubMedCrossRefGoogle Scholar
  25. 25.
    Bandera EV, Kushi LH, Olson SH, Chen WY, Muti P (2003) Alcohol consumption and endometrial cancer: some unresolved issues. Nutr Cancer 45:24–29. doi: 10.1207/S15327914NC4501_3 PubMedCrossRefGoogle Scholar
  26. 26.
    Galea S, Tracy M (2007) Participation rates in epidemiologic studies. Ann Epidemiol 17:643–653. doi: 10.1016/j.annepidem.2007.03.013 PubMedCrossRefGoogle Scholar
  27. 27.
    Hartge P (2006) Participation in population studies. Epidemiology 17:252–254. doi: 10.1097/01.ede.0000209441.24307.92 PubMedCrossRefGoogle Scholar
  28. 28.
    Murray MJ, Meyer WR, Lessey BA, Oi RH, DeWire RE, Fritz MA (2003) Soy protein isolate with isoflavones does not prevent estradiol-induced endometrial hyperplasia in postmenopausal women: a pilot trial. Menopause 10:456–464. doi: 10.1097/01.GME.0000063567.84134.D1 PubMedCrossRefGoogle Scholar
  29. 29.
    Kutuk O, Basaga H (2006) Phytoestrogens in cell signaling. In: Yildiz F (ed) Phytoestrogens in functional foods. CRC Press. Taylor and Francis Group, Florida, pp 123–151Google Scholar
  30. 30.
    Unfer V, Casini ML, Costabile L, Mignosa M, Gerli S, Di Renzo GC (2004) Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study. Fertil Steril 82:145–148. doi: 10.1016/j.fertnstert.2003.11.041 quiz 265PubMedCrossRefGoogle Scholar
  31. 31.
    Boots AW, Haenen GR, Bast A (2008) Health effects of quercetin: from antioxidant to nutraceutical. Eur J Pharmacol 585:325–337. doi: 10.1016/j.ejphar.2008.03.008 PubMedCrossRefGoogle Scholar
  32. 32.
    Neuhouser ML (2004) Dietary flavonoids and cancer risk: evidence from human population studies. Nutr Cancer 50:1–7. doi: 10.1207/s15327914nc5001_1 PubMedCrossRefGoogle Scholar
  33. 33.
    Cui Y, Morgenstern H, Greenland S et al (2008) Dietary flavonoid intake and lung cancer–a population-based case–control study. Cancer 112:2241–2248. doi: 10.1002/cncr.23398 PubMedCrossRefGoogle Scholar
  34. 34.
    Theodoratou E, Kyle J, Cetnarskyj R et al (2007) Dietary flavonoids and the risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 16:684–693. doi: 10.1158/1055-9965.EPI-06-0785 PubMedCrossRefGoogle Scholar
  35. 35.
    Garcia-Closas R, Gonzalez CA, Agudo A, Riboli E (1999) Intake of specific carotenoids and flavonoids and the risk of gastric cancer in Spain. Cancer Causes Control 10:71–75. doi: 10.1023/A:1008867108960 PubMedCrossRefGoogle Scholar
  36. 36.
    McCann SE, Ambrosone CB, Moysich KB et al (2005) Intakes of selected nutrients, foods, and phytochemicals and prostate cancer risk in western New York. Nutr Cancer 53:33–41. doi: 10.1207/s15327914nc5301_4 PubMedCrossRefGoogle Scholar
  37. 37.
    Adebamowo CA, Cho E, Sampson L et al (2005) Dietary flavonols and flavonol-rich foods intake and the risk of breast cancer. Int J Cancer 114:628–633. doi: 10.1002/ijc.20741 PubMedCrossRefGoogle Scholar
  38. 38.
    Gates MA, Tworoger SS, Hecht JL, De Vivo I, Rosner B, Hankinson SE (2007) A prospective study of dietary flavonoid intake and incidence of epithelial ovarian cancer. Int J Cancer 121:2225–2232. doi: 10.1002/ijc.22790 PubMedCrossRefGoogle Scholar
  39. 39.
    Lin J, Zhang SM, Wu K, Willett WC, Fuchs CS, Giovannucci E (2006) Flavonoid intake and colorectal cancer risk in men and women. Am J Epidemiol 164:644–651. doi: 10.1093/aje/kwj296 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Elisa V. Bandera
    • 1
    • 2
  • Melony G. Williams
    • 1
    • 2
  • Camelia Sima
    • 3
  • Sharon Bayuga
    • 3
  • Katherine Pulick
    • 3
  • Homer Wilcox
    • 5
  • Robert Soslow
    • 4
  • Ann G. Zauber
    • 3
  • Sara H. Olson
    • 3
  1. 1.The Cancer Institute of New JerseyRobert Wood Johnson Medical SchoolNew BrunswickUSA
  2. 2.School of Public HealthUniversity of Medicine and Dentistry of New JerseyPiscatawayUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  5. 5.New Jersey Department of Health and Senior ServicesTrentonUSA

Personalised recommendations