June 3, 2024
By Catlin Nalley
New findings revealed a temporal association between the increasing incidence of endometrial cancer and obesity, with a disproportionate impact on younger women and minority populations. This data was recently presented during the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, held May 31-June 4 in Chicago (Abstract 5507).
While additional research is needed to confirm a causal relationship, targeted health services and public health interventions are warranted to “stabilize and ultimately reverse the concomitantly rising rates of obesity and endometrial cancer,” according to the researchers.
“Uterine cancer has been on the rise in incidence and mortality in the U.S.,” noted study author Alex A. Francoeur, MD, Gynecologic Oncology Fellow, UC Irvine Health. “There have been studies demonstrating that obesity increases the risk of uterine cancer, but there are no studies strongly linking these trends temporally. We aimed to use large, population-based, longitudinal data to comment on these trends.”
Comprehensive national databases were used to explore trends in obesity and endometrial cancer rates. Francoeur and colleagues chose to only focus on endometrial adenocarcinoma as a histologic subtype because it has the strongest association with obesity compared to other subtypes of uterine cancer.
To obtain endometrial adenocarcinoma data, the researchers obtained data from the United States Cancer Statistics (USCS) database, a comprehensive database representing over 99 percent of new cancer cases in the United States from 2001 to 2018, according to Francoeur. Two additional databases were used—the Behavioral Risk Factor Surveillance System and the National Cancer Database—to correct for hysterectomy, pregnancy, and previous cancer diagnosis.
“To look at obesity, we collected data from the National Health and Nutrition Examination Survey (NHANES) database, which uses dummy coding and population sampling to represent accurate data of the entire U.S. population. We pulled obesity data from 1988 to 2018,” Francoeur said. “We then used Joinpoint to analyze trends in the data reported out as average annual percent change (AAPC). We also calculated Pearson correlation coefficients between the databases.”
Through USCS data, the investigators identified 615,656 cases of endometrial adenocarcinoma from 2001 to 2018.
“We found that endometrial adenocarcinoma is increasing most in minority and young reproductive age populations,” Francoeur reported. The annual increase in endometrial cancer is as follows: Hispanic 1.37 percent (p<0.0001), Black 1.30 percent (p<0.0001), and White -0.17 (p=0.656). Women aged 20-29 have a 4.48 percent annual increase (p<0.0001) and women aged 30-39 have a 3 percent annual increase (p<0.0001).
Intersection analysis showed that Hispanic women have the largest rate of increase in the 30-39 age group at 4.67 percent, followed by Black women (3.85%) and White women (2.12%). When examining the 20-29 age group, study authors observed that rates of endometrial adenocarcinoma are increasing in White and Hispanic women at 4.79 percent and 4.29 percent, respectively.
“Obesity rates in the U.S. have also been increasing. Hispanic and Black women have the highest incidence of obesity compared to White women,” Francoeur said. “Women aged 20-29 are seeing the highest increase in obesity, as well with an AAPC of 7.48 percent.
“We then performed a correlation analysis on endometrial adenocarcinoma and obesity data. Endometrial adenocarcinoma and obesity were strongly correlated with 20-29-year-old women and 30-39-year-old women (r=0.72, p=0.03 and r=0.88, p=0.001, respectively),” she outlined while discussing her team’s findings with Oncology Times. “There was also a strong correlation between obesity and endometrial adenocarcinoma in Black and Hispanic women (r=0.78, p=0.01 and r=0.91, p=0.0007, respectively).”
Since the United States does not have a linked national health care database, this project is limited in its ability to speak on causation, according to Francoeur. However, she noted there appears to be a compelling relationship between endometrial adenocarcinoma and obesity.
Additionally, the study showed that rates of this cancer are on the rise, especially among minority populations and young women. “This represents a major public health issue and actions need to be taken to reverse this concerning trend,” Francoeur told Oncology Times.
When discussing the next steps, she noted that, while prospective linked cohort data would be valuable, the trends highlighted in this research are compelling enough to warrant intervention.
“More awareness needs to be brought into the public eye regarding the risk of endometrial cancer and obesity,” Francoeur recommended. “We need a multidisciplinary approach to address these trends including specialists from public health, bariatric medicine and surgery, primary care, and gynecological oncology.
“Patients who are obese with a new diagnosis of complex atypical hyperplasia or endometrial cancer should be educated regarding the association of their disease with obesity and referred to weight management,” she concluded.
There are a number of studies of interest currently underway, according to Francoeur, such as concurrent bariatric surgery at the time of endometrial cancer surgery and increasing medical management of obesity.
Catlin Nalley is a contributing writer.