Elsevier

Gynecologic Oncology

Volume 128, Issue 2, February 2013, Pages 181-186
Gynecologic Oncology

Body mass index, physical activity, and survival after endometrial cancer diagnosis: Results from the Women's Health Initiative

https://doi.org/10.1016/j.ygyno.2012.10.029Get rights and content

Abstract

Objective

While low physical activity and high body mass index (BMI) have been associated with higher endometrial cancer incidence, no previous studies have evaluated the association between physical activity and survival after endometrial cancer diagnosis, and studies on BMI and survival have not been performed in a prospective cohort.

Methods

We examined pre-diagnosis BMI and moderate- to vigorous-intensity physical activity in relation to overall and disease-specific survival among 983 postmenopausal women who were diagnosed with endometrial cancer in the Women's Health Initiative Observational Study and Clinical Trials.

Results

Over a median 5.2 (max 14.1) years from diagnosis to death or end of follow-up, 163 total deaths were observed, 66 of which were due to endometrial cancer. We observed a higher all-cause mortality hazard ratio (HR) = 1.85 (95% CI 1.19–2.88) comparing women with a BMI  35 kg/m2 to women with BMI < 25 kg/m2. For endometrial cancer-specific mortality the HR = 2.23 (95% CI 1.09–4.54) comparing extreme BMI categories. To examine histologic subtypes we analyzed type I endometrial tumors separately and found an HR = 1.20 (95% CI 1.07–1.35) associated with all-cause mortality for each 5-unit change in BMI. Moderate- to vigorous-intensity physical activity was not associated with all-cause or endometrial cancer-specific mortality.

Conclusions

Pre-diagnosis BMI, but not physical activity, was associated with survival among women with endometrial cancer. Future studies should investigate mechanisms and timing of BMI onset to better understand the burden of disease attributable to BMI.

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,

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    This work has not been submitted in part or whole for consideration elsewhere and no authors have conflict of interest to report.

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