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Body size over the life-course and the risk of endometrial cancer: the California Teachers Study

Abstract

Purpose

Obesity is a public health epidemic and a major risk factor for endometrial cancer. Here, we identify key aspects of body size which jointly, over the life-course (since adolescence), are associated with endometrial cancer risk.

Methods

Among 88,142 participants in the California Teachers Study, 887 were diagnosed with invasive type 1 endometrial cancer between 1997–1998 and 2012. Multivariable Cox proportional hazards models provided estimates of hazard rate ratios (HR) and 95% confidence intervals (CI) for endometrial cancer associated with life-course body size phenotypes, which incorporated validated measures.

Results

Among women currently using hormone therapy, endometrial cancer risk was only associated with height (HR 1.78, 95% CI 1.32–2.40 for ≥67 vs. <67 inches). Among women not using hormone therapy, tall women who were overweight/obese in adolescence (HR 4.33, 95% CI 2.51–7.46) or who became overweight/obese as adults (HR 4.74, 95% CI 2.70–8.32) were at greatest risk.

Conclusions

Considering absolute body mass, changes in adiposity over time, and body fat distribution together, instead of each measure alone, we identified lifetime obesity phenotypes associated with endometrial cancer risk. These results more clearly define specific risk groups, and may explain inconsistent findings across studies, improve risk prediction models, and aid in developing targeted interventions for endometrial cancer.

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Acknowledgments

This work was supported by the National Cancer Institute at the National Institutes of Health (Grant R01 CA77398). The collection of cancer incidence data used in this study was supported by the California Department of Public Health (CDPH) as a part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103,885; by the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results Program under contracts N01-PC-35136 and HHSN261201000140C awarded to the Cancer Prevention Institute of California, N02-PC-15105 and HHSN261201000034C awarded to the Public Health Institute (PHI), HHSN261201000035C University of Southern California; and the Centers for Disease Control and Prevention’s (CDCP) National Program of Cancer Registries, under agreements U55/CCR921930-02 awarded to PHI and U58DP003862-01 awarded to the CDPH. The ideas and opinions expressed herein are those of the author(s) and endorsement by the CDPH, NCI, and CDCP or their contractors and subcontractors are not intended nor should be inferred. The authors would like to thank the Steering Committee who are responsible for the formation and maintenance of the cohort within which this study was conducted.

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Correspondence to Pamela L. Horn-Ross.

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The authors declare they have no conflict of interest.

Ethical standards

All procedures performed in the California Teachers Study involving human participants were in accordance with the ethnical standards of the Institutional Review Boards of the Cancer Prevention Institute of California, City of Hope National Medical Center, the University of Southern California, the University of California at Irvine, and the California Health and Human Services Agency and were in compliance with the 1964 Helsinki Declaration and its later amendments or comparable ethnical standards.

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Informed consent was obtained from all individual participants included in the study.

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Horn-Ross, P.L., Canchola, A.J., Bernstein, L. et al. Body size over the life-course and the risk of endometrial cancer: the California Teachers Study. Cancer Causes Control 27, 1419–1428 (2016). https://doi.org/10.1007/s10552-016-0820-8

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Keywords

  • Body size
  • Endometrial cancer
  • Height
  • Life-course
  • Obesity