"A concerted campaign is needed to educate women and their doctors about the risk obesity poses for developing endometrial adenocarcinoma," says Dr. Alex Francoeur.
Endometrial cancer, once found mainly in post-menopausal women, has risen dramatically in recent years among women under 40, baffling reproductive health experts.
UCI Health researchers now report that the alarming increase among younger women, is strongly correlated with soaring obesity rates, a trend they say that requires concerted action to reverse.
From 2001 to 2018, endometrial adenocarcinoma cases increased 137% among women ages 20 to 29, and 71% among women ages 30 to 39, the researchers revealed in a study presented at a recent American Society of Clinical Oncology (ASCO) conference. The rates were even greater for younger Black women and Latinas.
Over the same period, obesity rates increased 7.5% a year among women ages 20 to 29, and 4.5% annually among women ages 30 to 39, the study found.
A ‘public health emergency’
“Endometrial cancer is most common gynecological cancer encountered in the United States,” says UCI Health gynecologic oncologist Dr. Krishnansu Tewari, co-author of the study.
Now the sixth most common cancer overall in women, endometrial adenocarcinoma also is increasingly deadly. It is expected to claim more than 13,000 lives this year, up from 3,000 deaths annually in the late 1980s.
“This represents a public health emergency,” says the study’s lead author, Dr. Alex Francoeur, who calls for a concerted campaign to educate women and their doctors about the risk obesity poses for developing endometrial adenocarcinoma.
Comparing two decades of research
The retrospective study analyzed data from more than 580,000 U.S. cases of endometrial adenocarcinoma collected over the last two decades, then compared it with a parallel examination of obesity rates among women during the same period.
Researchers also found that the correlation between the rise in rates of cancer of the uterine lining and obesity disproportionately affected younger women and women of color.
“When looking at trends by race and ethnicity, we found that among Black women there has been an increase in the rate of endometrial cancer of 25% since 2001, and 17% in Hispanic women,” says Francoeur, a gynecologic oncology fellow at the UCI School of Medicine’s Department of Obstetrics & Gynecology.
While additional research is needed to confirm a causal relationship, she says the data warrants targeted health services and public health interventions to educate women and lower obesity rates.
Increasing awareness is essential
“Actions are need to address the impact of obesity on endometrial cancer,” Francoeur adds. She specifically recommends:
- Increasing awareness. “Sharing this information with gynecology patients and giving them early education about the risk factors of obesity on reproductive health is extremely important.”
- Weight management. “Discussions regarding weight should be a routine part of health maintenance, the same way that cervical cancer screenings and mammography have become standards of preventive care.”
“There are so many ways for a patient to get help, including consulting a dietitian, medications targeting weight loss and surgical management of obesity,” she adds.
Fertility-sparing treatment
Even when endometrial cancer is found in women of child-bearing age, treatment does not always mean surgery.
“With early-stage endometrial cancers, we can manage it with hormones and preserve the ability of patients to conceive,” says Tewari, a professor and chief of the Division of Gynecologic Oncology in the Department of Obstetrics & Gynecology.
Progestin therapy can be used to shrink or eliminate the cancer for some time in women who still want to have children. The most used medications are:
- Medroxyprogesterone acetate, given as an injection or pill
- Megestrol acetate, given as a pill or liquid
“This is not yet a standard treatment and may increase the risk of cancer growth and spread,” says Tewari. “It’s important to confirm the grade of the cancer with a gynecologic oncologist and a pathologist, and to consult with a fertility specialist before starting progestin therapy.”
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