BMI and Endometrial Cancer

I was surprised to learn recently that in contrast to decreasing incidence rates for lung and colorectal cancers, the rate of new uterine (endometrial) cancer cases has been increasing. Overall incidence rates have increased ~ 12% (0.7% per year on average) between 1999–2015 and death rates have increased 21% (1.1% per year) during a similar period.  The most recent data from 2015-2016 indicate a total of 53,911 new cases and 10,733 deaths from uterine cancer.  

In addition, closer inspection reveals significant racial and ethnic disparities.  For example, incidence among black women increased 46% (2.4% per year) and 32% (1.8% per year) among Hispanic women compared to 9% (0.5% per year) among white women.  Similarly, death rates among Hispanic (33%; 1.7%) and black (29%; 1.5%) women exceeded those among white women (18%; 1.0%).  Black women were more likely to present at a later stage and with more aggressive histologic types, which might in part account for their higher death rate.

One reason postulated for this observed increase may be elevated body mass index (BMI).  Women who are overweight (BMI = 25.0–29.9 kg/m2) or obese (BMI ≥30 kg/m2) are approximately two to four times more likely to develop endometrial cancer than those with normal weight.  According to the CDC, in recent years approximately 40% of women in the United States have been diagnosed as obese, including 56% of black women and 49% of Hispanic women.

So what can be done to reverse this trend?

• Health care providers need to promote awareness of the need for timely evaluation of abnormal vaginal bleeding.  This increases the chance for early detection and treatment. 
• Women can reduce their chances of developing uterine cancer by never taking estrogen-alone replacement therapy, maintaining a healthy weight, and being physically active.

  Judith Wolf, MD     Associate Director, WHEP

Uterine Cancer Incidence and Mortality — United States, 1999–2016                                                                                                   MMWR/ December 7, 2018 / 67(48);1333–1338