Investigator
University Of Southern California
Inflammatory and insulinemic dietary and lifestyle patterns and incidence of endometrial cancer: the multiethnic cohort
The incidence of endometrial cancer (EC) is increasing, particularly among racial and ethnic minority groups. Obesity is an established EC risk factor, and obesity-related inflammation and hyperinsulinemia may play an important role in EC etiology. We examined the association of 5 empirical hypothesis-oriented dietary and lifestyle indices, which assess the inflammatory and insulinemic potentials of diet and lifestyle, with risk of EC in ethnically diverse females. We included 60,441 female participants from the multiethnic cohort study, a cohort-based in the United States, who were African American, Japanese American, Latino, Native Hawaiian, or White, aged 45-75 y at baseline in 1993-1996. Using a quantitative food frequency questionnaire at baseline, we computed the empirical dietary inflammatory pattern (EDIP), empirical dietary index for hyperinsulinemia (EDIH), empirical lifestyle index for hyperinsulinemia (ELIH), empirical dietary index for insulin resistance (EDIR), and empirical lifestyle index for insulin resistance (ELIR). Multivariable Cox models adjusting for known risk factors for EC were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between each index (using quintiles) and EC risk. We identified 1328 incident EC cases with a median follow-up of 25.2 y (IQR = 7.4 y). Females with higher ELIH had an increased risk of EC (HR In this ethnically diverse cohort, lifestyle patterns with higher insulinemic potential were associated with an increased risk of EC. Lifestyle changes that include more physical activity and achieving a healthy body weight, in addition to reducing insulinemic and diets, may lower EC risk.
Differential trends in rising endometrial cancer incidence by age, race, and ethnicity
Abstract Endometrial cancer (EC) incidence is on the rise. Although early-onset endometrial cancer (EOEC; age at diagnosis <50 years) is relatively uncommon, the incidence of EOEC has been reportedly increasing in recent decades. However, the rising EOEC has not been thoroughly described with regard to the racial and ethnic disparities and compared with late-onset EC (age at diagnosis ≥50 years). We used the Cancer in North America (CiNA) Analytic File, 1995-2018, from the North American Association of Central Cancer Registries, which allowed us to examine trends in invasive EC incidence by racial and ethnic groups and by age at diagnosis. We found striking differences for demographic and tumor characteristics as well as racial and ethnic patterns and time trends in EC incidence between EOEC and late-onset EC. The faster increases in EOEC incidence rates, especially among non-White women, mirror similar observations in other cancers, pointing to a possible link with rising obesity epidemic in younger generations.
Hypertension and Risk of Endometrial Cancer: A Pooled Analysis in the Epidemiology of Endometrial Cancer Consortium (E2C2)
Abstract Background: The incidence rates of endometrial cancer are increasing, which may partly be explained by the rising prevalence of obesity, an established risk factor for endometrial cancer. Hypertension, another component of metabolic syndrome, is also increasing in prevalence, and emerging evidence suggests that it may be associated with the development of certain cancers. The role of hypertension independent of other components of metabolic syndrome in the etiology of endometrial cancer remains unclear. In this study, we evaluated hypertension as an independent risk factor for endometrial cancer and whether this association is modified by other established risk factors. Methods: We included 15,631 endometrial cancer cases and 42,239 controls matched on age, race, and study-specific factors from 29 studies in the Epidemiology of Endometrial Cancer Consortium. We used multivariable unconditional logistic regression models to estimate ORs and 95% confidence intervals (CI) to evaluate the association between hypertension and endometrial cancer and whether this association differed by study design, race/ethnicity, body mass index, diabetes status, smoking status, or reproductive factors. Results: Hypertension was associated with an increased risk of endometrial cancer (OR, 1.14; 95% CI, 1.09–1.19). There was significant heterogeneity by study design (Phet < 0.01), with a stronger magnitude of association observed among case–control versus cohort studies. Stronger associations were also noted for pre-/perimenopausal women and never users of postmenopausal hormone therapy. Conclusions: Hypertension is associated with endometrial cancer risk independently from known risk factors. Future research should focus on biologic mechanisms underlying this association. Impact: This study provides evidence that hypertension may be an independent risk factor for endometrial cancer.
