Anthropometric factors and risk of endometrial cancer: the European prospective investigation into cancer and nutrition.
Friedenreich C., Cust A., Lahmann PH., Steindorf K., Boutron-Ruault M-C., Clavel-Chapelon F., Mesrine S., Linseisen J., Rohrmann S., Boeing H., Pischon T., Tjønneland A., Halkjaer J., Overvad K., Mendez M., Redondo ML., Garcia CM., Larrañaga N., Tormo M-J., Gurrea AB., Bingham S., Khaw K-T., Allen N., Key T., Trichopoulou A., Vasilopoulou E., Trichopoulos D., Pala V., Palli D., Tumino R., Mattiello A., Vineis P., Bueno-de-Mesquita HB., Peeters PHM., Berglund G., Manjer J., Lundin E., Lukanova A., Slimani N., Jenab M., Kaaks R., Riboli E.
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/m(2)) compared to normal weight (BMI < 25) women was 1.78, 95% CI = 1.41-2.26, and for morbidly obese women (BMI > or = 40) was 3.02, 95% CI = 1.66-5.52. The RR for women with a waist circumference of > or =88 cm vs. <80 cm was 1.76, 95% CI = 1.42-2.19. Adult weight gain of > or =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.