Body mass index, physical activity, and survival after endometrial cancer diagnosis: Results from the Women's Health Initiative☆
Highlights
► We examined pre-diagnosis body mass index and physical activity with mortality among women diagnosed with endometrial cancer. ► Risk of all cause and endometrial cancer specific mortality was higher among heavier women. ► No association was observed for pre-diagnosis physical activity and survival.
Introduction
High body mass index (BMI) and low physical activity have consistently been associated with higher risk of developing endometrial cancer [1]. In a recent study, 93% of endometrial cancer survivors had abdominal obesity and 12% met the U.S. government physical activity recommendation of 150 minutes of moderate to vigorous physical activity per week [2]. Despite this high prevalence of overweight and inactivity, the relationship between BMI, physical activity and survival after endometrial cancer diagnosis is unclear. A recent systematic review of BMI and survival after endometrial cancer diagnosis showed mixed results [3], with some studies showing no association after multivariate adjustment [4], [5], [6], [7], [8], [9], [10], [11] and others suggesting worse survival associated with higher BMI [12], [13], [14], [15]. Of the studies summarized in the review, none stratified by tumor type, none were performed in a prospective cohort setting, and most utilized BMI data abstracted from medical charts. To our review no previous studies address the association between physical activity and morality among women with endometrial cancer. We hypothesized that BMI would be associated with a decreased risk of mortality, and that physical activity would show a protective association. With this background, we examined associations between pre-diagnosis, baseline BMI and physical activity with survival among endometrial cancer patients in the Women's Health Initiative (WHI).
Section snippets
Study population
Eligibility criteria and recruitment methods have been published [16]. In short, between October 1993 and December 1998, 161,808 women were enrolled in the WHI Observational Study (OS) (n = 93,676) or Clinical Trial (CT) (n = 68,132) from 40 U.S. clinical centers. Eligible women were between 50 and 79 years of age, postmenopausal, had an anticipated survival of > 3 years and were accessible for follow up. The institutional review boards at all institutions approved the protocol and all participants
Results
Among the 983 women included in analysis, BMI, physical activity and other characteristics were measured at baseline a median of 5.1 years (max 13.5 years) before diagnosis, and women were followed a median of 5.2 years (max 14.1 years) from diagnosis to death or end of follow up. Overweight or obese women tended to be African American (p < 0.001), had higher rates of diabetes (p < 0.001), menarche ≥ age 12 (p = 0.022) and lower moderate to vigorous intensity physical activity levels (p < 0.001) (Table 1).
Discussion
In this prospective analysis of BMI, physical activity and survival among women diagnosed with endometrial cancer, we found that higher BMI, measured a median of 5.1 years before diagnosis, was associated with higher all-cause and endometrial cancer-specific mortality. The association between BMI and overall mortality was most apparent in women with type I tumors, particularly among women with poorly differentiated tumors. Moderate to vigorous intensity physical activity was not associated with
Conflict of interest statement
No authors have conflict of interest to report.
Acknowledgments
This work was supported in part by the training grant T32 CA105666t. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services (through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C).
Short list of WHI investigators
Program Office: (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Jacques Rossouw, Shari Ludlam,
References (41)
- et al.
Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship
Gynecol Oncol
(2009) - et al.
The effect of body mass index on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer
Gynecol Oncol
(2003) - et al.
Role of body mass index as a risk and prognostic factor of endometrioid uterine cancer in Korean women
Gynecol Oncol
(2010) - et al.
Risk factors for early and late postoperative complications of patients with endometrial cancer
Eur J Obstet Gynecol Reprod Biol
(2006) - et al.
Impact of body mass index on treatment outcomes in endometrial cancer patients receiving doxorubicin and cisplatin: a Gynecologic Oncology Group study
Gynecol Oncol
(2007) - et al.
Outcomes ascertainment and adjudication methods in the Women's Health Initiative
Ann Epidemiol
(2003) - et al.
Endometrial cancer
Lancet
(2005) Prognostic parameters of endometrial carcinoma
Hum Pathol
(2004)- et al.
Correlation of presenting symptoms and patient characteristics with endometrial cancer prognosis in Japanese women
Int J Gynaecol Obstet
(2005) - et al.
The prognostic significance of surgical staging for carcinoma of the endometrium
Gynecol Oncol
(1992)
Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival
Gynecol Oncol
Cardiovascular disease is the leading cause of death among endometrial cancer patients
Gynecol Oncol
Complete surgical staging of early endometrial adenocarcinoma: optimizing patient outcomes
Semin Radiat Oncol
Morbid obesity and endometrial cancer: surgical, clinical, and pathologic outcomes in surgically managed patients
Gynecol Oncol
Lifestyle challenges in endometrial cancer survivorship
Obstet Gynecol
Obesity and prognosis in endometrial cancer
Am J Obstet Gynecol
Body mass index as a prognostic factor in endometrioid adenocarcinoma of the endometrium
J Natl Med Assoc
Influence of body mass index on prognosis in gynecological malignancies
Cancer Causes Control
Is body mass index an independent risk factor of survival among patients with endometrial cancer?
Am J Clin Oncol
Cited by (41)
Bariatric surgery in patients with breast and endometrial cancer in California: population-based prevalence and survival
2022, Surgery for Obesity and Related DiseasesProspective cohort study of metabolic syndrome and endometrial cancer survival
2020, Gynecologic OncologyCitation Excerpt :These findings add to current literature that suggests cancer survivors with greater physical activity participation experience better survival, although specific estimates among endometrial cancer survivors are limited [33,34]. Arem and colleagues previously reported an association between pre-diagnosis recreational moderate-to-vigorous-intensity physical activity and lower overall 5-year mortality, but not 10-year mortality, endometrial cancer-specific mortality or all-cause mortality in the Women's Health Initiative [35] and the National Institutes of Health- American Association of Retired Persons (NIH–AARP) Diet and Health Study [36]. This study has several key strengths, including a substantial study follow-up time of nearly 17 years.
Significance of body weight change during fertility-sparing progestin therapy in young women with early endometrial cancer
2017, Gynecologic OncologyCitation Excerpt :However, the association between obesity and prognosis in type I endometrial cancer is controversial. Some studies suggested that obesity is associated with a poor endometrial cancer prognosis [11,15–18], whereas others suggested it is associated with a good prognosis [19,20]. In contrast, other studies reported no association between obesity and prognosis in endometrial cancer [21–23].
Up-regulation of genes involved in the insulin signalling pathway (IGF1, PTEN and IGFBP1) in the endometrium may link polycystic ovarian syndrome and endometrial cancer
2016, Molecular and Cellular EndocrinologyBody mass index and mortality in endometrial cancer: A systematic review and meta-analysis
2016, Gynecologic OncologyCitation Excerpt :Others have also reported an association between obesity and increased risk of death in women with endometrial cancer [4,8,12–17]. These studies either investigated clinical outcomes from incident endometrial cancers identified in large prospective cohort studies [4,8,12,13,15] and a registry study [14], or ancillary studies from GOG therapeutic clinical trials for women with endometrial cancer [16,17]. Arem and colleagues evaluated the association between obesity and clinical outcome in incident endometrial cancer cases identified in two large prospective cohort studies conducted in the United States; the Women's Health Initiative (WHI) Observational Study and Clinical Trials, and the National Institutes of Health (NIH) — American Association of Retired Persons (AARP) Diet and Health Study [8,12].
- ☆
This work has not been submitted in part or whole for consideration elsewhere and no authors have conflict of interest to report.