Review
The epidemiology of endometrial cancer

https://doi.org/10.1016/0090-8258(91)90246-2Get rights and content

Abstract

The descriptive and analytical epidemiology of endometrial cancer is reviewed. Over the last few decades, age-standardized incidence rates have been rising in several countries. The rise has been even greater in terms of absolute numbers of cases, and hence public health implications, due to the aging of the population. Although endometrial cancer rates were found to be higher in richer countries and urban populations, there is now evidence of some changes in the socioeconomic determinants of the disease in developed countries. In etiological terms, any factor that increases exposure to unopposed estrogens (such as menopausal replacement treatment, obesity, and irregular menstrual cycles) tends to increase the risk of the disease, while factors that decrease exposure to estrogens or increase progesterone levels (such as oral contraceptives or smoking) tend to be protective. Less well defined, or more difficult to explain in biological terms, is the role of other factors, such as births, miscarriages, or diabetes and hypertension, and only suggestive evidence is available on diet from analytical epidemiology. The data reviewed herein are discussed in terms of models of carcinogenesis, as well as attributable risks and public health implications.

References (118)

  • T. Fornander et al.

    Adjuvant tamoxifen in early breast cancer: Occurrence of new primary cancers

    Lancet

    (1989)
  • L. Hardell

    Tamoxifen as risk factor for carcinoma of corpus uteri

    Lancet

    (1988)
  • R.L. Prentice et al.

    On the epidemiology of oral contraceptives and disease

    Adv. Cancer Res.

    (1987)
  • G.L. Rubin et al.

    Estrogen replacement therapy and the risk of endometrial cancer: Remaining controversies

    Am. J. Obstet. Gynecol.

    (1990)
  • S. Deutsch et al.

    Effect of diabetic status on fractionated estrogen levels in postmenopausal women

    Am. J. Obstet. Gynecol.

    (1978)
  • H.G. Stockwell et al.

    Cigarette smoking and the risk of female reproductive cancer

    Am. J. Obstet. Gynecol.

    (1987)
  • J.A. Baron et al.

    The antiestrogenic effect of cigarette smoking in women

    Am. J. Obstet. Gynecol.

    (1990)
  • T.W. McDonald et al.

    Exogenous estrogen and endometrial carcinoma: Case-control and incidence study

    Am. J. Obstet. Gynecol.

    (1977)
  • D.L. Hoogerland et al.

    Estrogen use: Risk of endometrial carcinoma

    Gynecol. Oncol.

    (1978)
  • F.R. Jelovsek et al.

    Risk of exogenous estrogen therapy and endometrial cancer

    Am. J. Obstet. Gynecol.

    (1980)
  • Z. Schwartz et al.

    A novel approach to the analysis of risk factors in endometrial carcinoma

    Gynecol. Oncol.

    (1985)
  • C.W. Tyler et al.

    Endometrial cancer: How does cigarette smoking influence the risk of women under age 55 years having this tumor?

    Am. J. Obstet. Gynecol.

    (1985)
  • R. Doll et al.

    The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today

    J. Natl. Cancer Inst.

    (1981)
  • B.K. Armstrong et al.

    Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices

    Int. J. Cancer

    (1975)
  • S.B. Gusberg

    Precursors of corpus. I. Estrogens and adenomatous hyperplasia

    Am. J. Obstet. Gynecol.

    (1947)
  • R.E. Fechner et al.

    Endometrial adenocarcinoma in Stein-Leventhal syndrome

    Cancer

    (1974)
  • K. Jafari et al.

    Endometrial adenocarcinoma and the Stein-Leventhal syndrome

    Obstet. Gynecol.

    (1978)
  • H. Mansell et al.

    Granulosa-theca cell tumors and endometrial carcinoma: A study of their relationship and a survey of 80 cases

    Obstet. Gynecol.

    (1955)
  • P.K. Siiteri

    Steroid hormones and endometrial cancer

    Cancer Res.

    (1978)
  • T.J.A. Key et al.

    The dose-effect relationship between “unopposed” oestrogens and endometrial mitotic rate: Its central role in explaining and predicting endometrial cancer risk

    Br. J. Cancer

    (1988)
  • D.M. Parkin et al.

    Estimates of the world-wide frequency of sixteen major cancers in 1980

    Int. J. Cancer

    (1989)
  • C.S. Muir et al.

    Cancer incidence in five continents V

    IARC Sci. Publ.

    (1987)
  • International Union Against Cancer
  • International Union Against Cancer
  • J.L. Lyon et al.

    The rising frequency of hysterectomy: Its effect on uterine cancer rates

    Am. J. Epidemiol.

    (1977)
  • E. Hemminki et al.

    Prescribing of noncontraceptive estrogens and progestins in the United States, 1974–1986

    Am. J. Public Health

    (1988)
  • H. Jick et al.

    Replacement estrogens and endometrial cancer

    N. Engl. J. Med.

    (1979)
  • J.L. Kelsey et al.

    A case-control study of cancer of the endometrium

    Am. J. Epidemiol.

    (1982)
  • J.M. Elwood et al.

    Epidemiology of endometrial cancer

    J. Natl. Cancer Inst.

    (1977)
  • C. La Vecchia et al.

    Risk factors for endometrial cancer at different age

    J. Natl. Cancer Inst.

    (1984)
  • E.L. Wynder et al.

    An epidemiological investigation of cancer of the endometrium

    Cancer

    (1966)
  • L. Rosenberg et al.

    Patterns and determinants of conjugated estrogen use

    Am. J. Epidemiol.

    (1979)
  • C. La Vecchia et al.

    Oestrogens and obesity as risk factors for endometrial cancer in Italy

    Int. J. Epidemiol.

    (1982)
  • N.E. Day et al.

    Multistage models and primary prevention of cancer

    J. Natl. Cancer Inst.

    (1980)
  • B.E. Henderson et al.

    Re-evaluating the role of progestogen therapy after the menopause

    Fertil. Steril.

    (1988)
  • Y. Koumantaki et al.

    A case-control study of cancer of endometrium in Athens

    Int. J. Cancer

    (1989)
  • C.A. Swanson et al.

    Breast cancer risk assessed by anthropometry in the NHANES I epidemiological follow-up study

    Cancer Res.

    (1988)
  • R.K. Severson et al.

    Body mass and prostatic cancer: A prospective study

  • C. La Vecchia et al.

    Anthropometric indicators of endometrial cancer risk

    Eur. J. Cancer

    (1991)
  • Cited by (384)

    • γ-Glutamyl cyclotransferase contributes to endometrial carcinoma malignant progression and upregulation of PD-L1 expression during activation of epithelial-mesenchymal transition

      2020, International Immunopharmacology
      Citation Excerpt :

      Endometrial carcinoma is one of the three major malignant female reproductive system tumors, accounting for 7% of the total number of female malignant tumors [1]. The global incidence of endometrial carcinoma has risen in the last 30 years, particularly in developing countries [2,3]. γ-glutamyl cyclotransferase (GGCT) is a major enzyme in the γ-glutamyl cycle, which mediates synthesis and degradation of glutathione, and may be associated with the transport of amino acids across cellular membranes [4,5].

    • Induction of uterine hyperplasia after cafeteria diet exposure

      2018, Molecular and Cellular Endocrinology
      Citation Excerpt :

      Many risk factors of endometrial cancer have been described such as, early age at menarche, nulliparity, late-onset menopause, exposure to exogenous oestrogens (without a progesterone component), diabetes and obesity (Parazzini et al., 1991; Amant et al., 2005).

    View all citing articles on Scopus
    View full text