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

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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.

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Acknowledgments

The work described in this article was carried out with financial support of the “Europe Against Cancer Program” of the European Commission (SANCO); Danish Cancer Society; German Cancer Aid; Ligue Nationale contre le Cancer, 3M Company, INSERM Institut Gustave Roussy; German Cancer Research Center; German Federal Ministry of Education and Research; Dutch Ministry of Public Health, Welfare and Sports; National Cancer Registry and the Regional Cancer Registries Amsterdam, East and Maastricht of The Netherlands; Norwegian Cancer Society; Norwegian Research Council; Health Research Fund (FIS) of the Spanish Ministry of Health; Greek Ministry of Health; Greek Ministry of Education; Italian Association for Research on Cancer; the ISCIII Network RCESP (C03/09) and RETICC C03/10, Spanish Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra and the Catalan Institute of Oncology; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skane, Sweden; Cancer Research UK; Medical Research Council, UK; Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; Wellcome Trust, UK. This work was initiated while Christine Friedenreich was a Visiting Scientist at the International Agency for Research on Cancer. Christine Friedenreich is also supported by a Canadian Institute of Health Research New Investigator Award and an Alberta Heritage Foundation for Medical Research Health Scholar Award. Anne Cust is supported by a doctoral scholarship from the University of Sydney and a Research Scholar Award from the Cancer Institute NSW, Australia.

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Authors and Affiliations

  1. Division of Population Health and Information, Alberta Cancer Board, T2N 4N2, Calgary, Alberta, Canada

    Christine Friedenreich

  2. Nutrition and Hormones Unit, International Agency for Research on Cancer, Lyon, France

    Anne Cust, Nadia Slimani, Mazda Jenab, Rudolf Kaaks & Elio Riboli

  3. School of Public Health, University of Sydney, Sydney, Australia

    Anne Cust

  4. Université Claude Bernard Lyon 1, Lyon, France

    Anne Cust

  5. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

    Petra H. Lahmann, Heiner Boeing & Tobias Pischon

  6. Unit of Environmental Epidemiology, German Cancer Research Centre, Heidelberg, Germany

    Karen Steindorf

  7. INSERM U ERI20, Institut Gustave Roussy, Villejuif, France

    Marie-Christine Boutron-Ruault, Françoise Clavel-Chapelon & Sylvie Mesrine

  8. Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany

    Jakob Linseisen, Sabine Rohrmann & Rudolf Kaaks

  9. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    Anne Tjønneland & Jytte Halkjær

  10. Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

    Kim Overvad

  11. Department of Epidemiology, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain

    Michelle Mendez

  12. Public Health and Health Planning Directorate, Asturias, Spain

    M. L. Redondo

  13. Escuela Andaluza de Salud Publica, Granada, Spain

    Carmen Martinez Garcia

  14. Department of Public Health of Guipuzkoa, San Sebastian, Spain

    Nerea Larrañaga

  15. Department of Epidemiology, Health Council of Murcia, Murcia, Spain

    María-José Tormo

  16. Public Health Institute of Navarra, Pamplona, Spain

    Aurelio Barricarte Gurrea

  17. MRC Centre for Nutrition and Cancer Prevention and Survival, University of Cambridge, Cambridge, UK

    Sheila Bingham

  18. Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK

    Kay-Tee Khaw

  19. Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK

    Naomi Allen & Tim Key

  20. Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Athens, Greece

    Antonia Trichopoulou & Effie Vasilopoulou

  21. Hellenic Health Foundation, Athens, Greece

    Dimitrios Trichopoulos

  22. Epidemiology Unit, National Cancer Institute, Milan, Italy

    Valeria Pala

  23. Molecular and Nutritional Epidemiology Unit, CSPO–Scientific Institute of Tuscany, Florence, Italy

    Domenico Palli

  24. Cancer Registry, Azienda Ospedaliera “Civile M.P. Arezzo”, Ragusa, Italy

    Rosario Tumino

  25. Dipartimento di Medicina Clinica e Sperimentale, Università di Napoli, Naples, Italy

    Amalia Mattiello

  26. University of Torino, Turin, Italy

    Paolo Vineis

  27. Department of Epidemiology and Public Health, Imperial College, London, UK

    Paolo Vineis & Elio Riboli

  28. National Institute of Public Health and the Environment, Bilthoven, The Netherlands

    H. Bas Bueno-de-Mesquita

  29. Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands

    Petra H. M. Peeters

  30. Department of Clinical Sciences, Malmö University Hospital, Lund University, Malmo, Sweden

    Göran Berglund

  31. Department of Surgery, Malmö University Hospital, Lund University, Malmo, Sweden

    Jonas Manjer

  32. Department of Medical Biosciences, Pathology, University of Umeå, Umea, Sweden

    Eva Lundin

  33. Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, USA

    Annekatrin Lukanova

  34. Department of Public Health and Clinical Medicine/Nutritional Research, University of Umeå, Umea, Sweden

    Annekatrin Lukanova

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  1. Christine Friedenreich
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  2. Anne Cust
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  3. Petra H. Lahmann
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  4. Karen Steindorf
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  5. Marie-Christine Boutron-Ruault
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  6. Françoise Clavel-Chapelon
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  7. Sylvie Mesrine
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  8. Jakob Linseisen
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  9. Sabine Rohrmann
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  10. Heiner Boeing
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  14. Kim Overvad
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  15. Michelle Mendez
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  16. M. L. Redondo
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  17. Carmen Martinez Garcia
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  18. Nerea Larrañaga
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  19. María-José Tormo
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  20. Aurelio Barricarte Gurrea
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  21. Sheila Bingham
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  22. Kay-Tee Khaw
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  23. Naomi Allen
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  27. Dimitrios Trichopoulos
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  28. Valeria Pala
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  29. Domenico Palli
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  30. Rosario Tumino
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  31. Amalia Mattiello
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  32. Paolo Vineis
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  33. H. Bas Bueno-de-Mesquita
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  34. Petra H. M. Peeters
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  35. Göran Berglund
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  36. Jonas Manjer
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  37. Eva Lundin
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  38. Annekatrin Lukanova
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  39. Nadia Slimani
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  40. Mazda Jenab
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  41. Rudolf Kaaks
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  42. Elio Riboli
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Corresponding author

Correspondence to Christine Friedenreich.

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Friedenreich, C., Cust, A., Lahmann, P.H. et al. Anthropometric factors and risk of endometrial cancer: the European prospective investigation into cancer and nutrition. Cancer Causes Control 18, 399–413 (2007). https://doi.org/10.1007/s10552-006-0113-8

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  • DOI: https://doi.org/10.1007/s10552-006-0113-8

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