Oncology
Endometrial Cancer
Endometrial Cancer and Obesity
The rising tide of overweight and obesity is contributing to the increased incidence of endometrial cancer worldwide. Presentations earlier in life (during the childbearing years) and morbid obesity–associated surgical risks are 2 related concerns.
Obesity is a very well-known—and probably the strongest—risk factor for developing endometrial cancer. In an analysis of 26 studies by the American Institute for Cancer Research, there was a 50% increased risk of developing endometrial cancer for every increase of 5 body mass index units. So, as the obesity rate increases, the incidence of endometrial cancer goes up, including among younger women.
The median age for a diagnosis of endometrial cancer is approximately 60 years, and it is less common under the age of 45 years; however, there is still a significant percentage of women who are premenopausal at diagnosis. In fact, I have even seen patients who were diagnosed before the age of 30, and it is likely that obesity is contributing to the numbers that we are seeing. Many of these younger women have treatable disease and can be cured, but this is at a point in life when there can be concerns about fertility. Thus, the net effect is also to increase the population of women who may be interested in fertility-preserving treatment.
Not only does obesity increase the risk of endometrial cancer but it can also negatively impact surgical options and can complicate postoperative recovery. Treating patients who are morbidly obese becomes more challenging. For example, they may no longer be candidates for surgery if their body mass index is too high. Most endometrial cancers are treated surgically, usually with a minimally invasive approach. For these procedures, we use the Trendelenburg position, which is not always well tolerated in the setting of morbid obesity. So, a person’s weight can adversely impact our ability to use a minimally invasive approach and is certainly something that we discuss with the patient. Finally, obesity also increases a patient’s risk of complications from surgery, including wound breakdown.
Although we cannot change a patient’s diagnosis of endometrial cancer once it occurs, we can still talk to patients about the benefits of lifestyle changes and encourage them in their attempts to maintain a healthy weight.
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