From the Guidelines
Risk factors for endometrial cancer include obesity, genetic factors such as Lynch syndrome, and conditions that lead to prolonged exposure to estrogen without adequate progesterone, such as polycystic ovary syndrome (PCOS) and hormone therapy using estrogen alone without progesterone. According to the most recent study 1, the incidence of endometrial cancer is increasing, mainly attributed to the increasing incidence of obesity, a known risk factor for the most frequent type of endometrial cancer. The study also highlights that risk factors for endometrial cancer include body mass index (BMI), hypertension, hyperinsulinaemia, and prolonged exposure to unopposed estrogen.
Some of the key risk factors for endometrial cancer include:
- Obesity, with an increased incidence of +21% for BMI 22-27.2, +43% for BMI 27.5-29.5 and +273% for BMI >30 1
- Hypertension and hyperinsulinaemia 1
- Prolonged exposure to unopposed estrogen, often related to nulliparity and infertility associated with polycystic ovarian syndrome or tamoxifen use 1
- Genetic factors, particularly Lynch syndrome (hereditary nonpolyposis colorectal cancer), which increases the risk of developing endometrial cancer by 10-fold 1
- Family history of endometrial cancer in first-degree relatives, which doubles the risk 2
- Age, with most cases occurring in women over 50, and the average age at diagnosis being 60 3
- Diabetes and high blood pressure, which are associated with higher risk 2, 3
It is essential to note that these factors contribute to endometrial cancer development primarily through hormonal imbalance, particularly excess estrogen exposure, which stimulates endometrial cell growth and potentially leads to malignant transformation. The most recent study 1 provides the strongest evidence for these risk factors, and it is crucial to consider these factors when assessing the risk of endometrial cancer in patients.
From the Research
Risk Factors for Endometrial Cancer
The following are some of the risk factors associated with endometrial cancer:
- Older age 4, 5
- Early menarche and late menopause 4, 6
- Obesity 4, 7, 5, 6
- Family history of endometrial cancer, especially among close relatives 4
- Radiation exposure 4
- Infertility, particularly in the presence of Polycystic Ovarian Syndrome (PCOS) 4, 8
- Long-term use of unopposed oestrogens for hormone replacement therapy 4
- Caucasians have a higher incidence of endometrial cancer than African or Asian women 4
- Diabetes and hypertension may be associated with an increased risk, although the evidence is still inconclusive 4, 5
- Geographical and socioeconomic factors may also play a role, although the evidence is still limited 4
- Smoking is considered a protective factor against endometrial cancer due to its anti-estrogenic effect 4, 5
- Body mass index (BMI) and waist-to-hip ratio are associated with an increased risk of endometrial cancer in premenopausal women 7
- Parity reduces the risk of disease 7
- PCOS is associated with an increased risk of endometrial cancer, particularly due to prolonged exposure to unopposed estrogen 8
- Oral contraceptive use may be protective against endometrial cancer, particularly in women with PCOS 8, 6
- Lifestyle modification, such as caloric restriction and exercise, may help reduce the risk of endometrial cancer, particularly in obese women 8
Risk Factors by Age Group
The risk factors for endometrial cancer may vary by age group:
- In premenopausal women, early menarche, nulliparity, and obesity are associated with an increased risk 6
- In postmenopausal women, late menopause, obesity, and the use of noncontraceptive estrogens are associated with an increased risk 6
- In women under 50, BMI, diabetes, and nulliparity are associated with an increased risk, while oral contraceptive use and parity are associated with a reduced risk 5