Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology

Racial/ethnic differences in anthropometric and hormone-related factors and endometrial cancer risk: the Multiethnic Cohort Study

British Journal of Cancer volume 124, pages 1724–1733 (2021)Cite this article

Subjects

Abstract

Background

Anthropometric and hormone-related factors are established endometrial cancer risk factors; however, little is known about the impact of these factors on endometrial cancer risk in non-White women.

Methods

Among 110,712 women participating in the Multiethnic Cohort (MEC) Study, 1150 incident invasive endometrial cancers were diagnosed. Hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with endometrial cancer risk for race/ethnicity and for risk factors across racial/ethnic groups were calculated.

Results

Having a higher body mass index (BMI) at baseline or age 21 years was strongly associated with increased risk (pint race/ethnicity ≥ 0.36). Parity (vs nulliparity) was inversely associated with risk in all the groups except African Americans (pint 0.006). Current use of postmenopausal hormones at baseline (PMH-E; vs never use) was associated with increased risk in Whites and Japanese Americans (pint 0.002). Relative to Whites, endometrial cancer risk was lower in Japanese Americans and Latinas and non-significantly higher in Native Hawaiians. Risk in African Americans did not differ from that in Whites.

Conclusions

Racial/ethnic differences in endometrial cancer risk were not fully explained by anthropometric or hormone-related risk factors. Further studies are needed to identify reasons for the observed racial/ethnic differences in endometrial cancer risk.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Howlader, N., Noone, A. M., Krapcho, M., Miller, D., Brest, A., Yu, M. et al. SEER Cancer Statistics Review, 1975–2016 (National Cancer Institute, 2019).

  2. Hawaii Tumor Registry. Hawaii Cancer At A Glance 2012–2016 (Hawaii Tumor Registry, 2020).

  3. Arnold, M., Pandeya, N., Byrnes, G., Renehan, P. A. G., Stevens, G. A., Ezzati, P. M. et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol. 16, 36–46 (2015).

    Article  PubMed  Google Scholar 

  4. Clarke, M. A., Devesa, S. S., Harvey, S. V. & Wentzensen, N. Hysterectomy-corrected uterine corpus cancer incidence trends and differences in relative survival reveal racial disparities and rising rates of nonendometrioid cancers. J. Clin. Oncol. 37, 1895–1908 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gaber, C., Meza, R., Ruterbusch, J. J. & Cote, M. L. Endometrial cancer trends by race and histology in the USA: projecting the number of new cases from 2015 to 2040. J. Racial Ethn. Health Disparities 4, 895–903 (2017).

    Article  Google Scholar 

  6. Key, T. J. & Pike, M. C. The dose-effect relationship between ‘unopposed’ oestrogens and endometrial mitotic rate: its central role in explaining and predicting endometrial cancer risk. Br. J. Cancer 57, 205–212 (1988).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Merritt, M. A. & Cramer, D. W. Molecular pathogenesis of endometrial and ovarian cancer. Cancer Biomark. 9, 287–305 (2010).

    Article  PubMed  CAS  Google Scholar 

  8. Hopkins, B. D., Goncalves, M. D. & Cantley, L. C. Obesity and cancer mechanisms: cancer metabolism. J. Clin. Oncol. 34, 4277–4283 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Calle, E. E. & Kaaks, R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat. Rev. Cancer 4, 579–591 (2004).

    Article  CAS  PubMed  Google Scholar 

  10. Sponholtz, T. R., Palmer, J. R., Rosenberg, L., Hatch, E. E., Adams-Campbell, L. L. & Wise, L. A. Body size, metabolic factors, and risk of endometrial cancer in Black women. Am. J. Epidemiol. 183, 259–268 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cote, M. L., Alhajj, T., Ruterbusch, J. J., Bernstein, L., Brinton, L. A., Blot, W. J. et al. Risk factors for endometrial cancer in black and white women: a pooled analysis from the Epidemiology of Endometrial Cancer Consortium (E2C2). Cancer Causes Control 26, 287–296 (2015).

    Article  PubMed  Google Scholar 

  12. Park, S. L., Goodman, M. T., Zhang, Z. F., Kolonel, L. N., Henderson, B. E. & Setiawan, V. W. Body size, adult BMI gain and endometrial cancer risk: the multiethnic cohort. Int. J. Cancer 126, 490–499 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sponholtz, T. R., Palmer, J. R., Rosenberg, L., Hatch, E. E., Adams-Campbell, L. L. & Wise, L. A. Reproductive factors and incidence of endometrial cancer in U.S. black women. Cancer Causes Control 28, 579–588 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sponholtz, T. R., Palmer, J. R., Rosenberg, L. A., Hatch, E. E., Adams-Campbell, L. L. & Wise, L. A. Exogenous hormone use and endometrial cancer in U.S. Black women. Cancer Epidemiol. Biomark. Prev. 27, 558–565 (2018).

    Article  CAS  Google Scholar 

  15. Setiawan, V. W., Pike, M. C., Kolonel, L. N., Nomura, A. M., Goodman, M. T. & Henderson, B. E. Racial/ethnic differences in endometrial cancer risk: the multiethnic cohort study. Am. J. Epidemiol. 165, 262–270 (2007).

    Article  PubMed  Google Scholar 

  16. Kolonel, L. N., Altshuler, D. & Henderson, B. E. The multiethnic cohort study: exploring genes, lifestyle and cancer risk. Nat. Rev. Cancer 4, 519–527 (2004).

    Article  CAS  PubMed  Google Scholar 

  17. Kolonel, L. N., Henderson, B. E., Hankin, J. H., Nomura, A. M., Wilkens, L. R., Pike, M. C. et al. A multiethnic cohort in Hawaii and Los Angeles: baseline characteristics. Am. J. Epidemiol. 151, 346–357 (2000).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Greenland, S. Modeling and variable selection in epidemiologic analysis. Am. J. Public Health 79, 340–349 (1989).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Feskanich, D., Hankinson, S. E. & Schernhammer, E. S. Nightshift work and fracture risk: the Nurses’ Health Study. Osteoporos. Int. 20, 537–542 (2009).

    Article  CAS  PubMed  Google Scholar 

  20. Kawachi, A., Shimazu, T., Budhathoki, S., Sawada, N., Yamaji, T., Iwasaki, M. et al. Association of BMI and height with the risk of endometrial cancer, overall and by histological subtype: a population-based prospective cohort study in Japan. Eur. J. Cancer Prev. 28, 196–202 (2019).

    Article  PubMed  Google Scholar 

  21. Wakamatsu, M., Sugawara, Y., Zhang, S., Tanji, F., Tomata, Y. & Tsuji, I. Weight change since age 20 and incident risk of obesity-related cancer in Japan: a pooled analysis of the Miyagi Cohort Study and the Ohsaki Cohort Study. Int. J. Cancer 144, 967–980 (2019).

    Article  CAS  PubMed  Google Scholar 

  22. Aune, D., Navarro Rosenblatt, D. A., Chan, D. S., Vingeliene, S., Abar, L., Vieira, A. R. et al. Anthropometric factors and endometrial cancer risk: a systematic review and dose-response meta-analysis of prospective studies. Ann. Oncol. 26, 1635–1648 (2015).

    Article  CAS  PubMed  Google Scholar 

  23. Stevens, V. L., Jacobs, E. J., Patel, A. V., Sun, J., Gapstur, S. M. & McCullough, M. L. Body weight in early adulthood, adult weight gain, and risk of endometrial cancer in women not using postmenopausal hormones. Cancer Causes Control 25, 321–328 (2014).

    Article  PubMed  Google Scholar 

  24. Lim, U., Monroe, K. R., Buchthal, S., Fan, B., Cheng, I., Kristal, B. S. et al. Propensity for intra-abdominal and hepatic adiposity varies among ethnic groups. Gastroenterology 156, 966–975 e10 (2019).

    Article  PubMed  Google Scholar 

  25. Setiawan, V. W., Haiman, C. A., Stanczyk, F. Z., Le Marchand, L. & Henderson, B. E. Racial/ethnic differences in postmenopausal endogenous hormones: the multiethnic cohort study. Cancer Epidemiol. Biomark. Prev. 15, 1849–1855 (2006).

    Article  CAS  Google Scholar 

  26. Freeman, E. W., Sammel, M. D., Lin, H. & Gracia, C. R. Obesity and reproductive hormone levels in the transition to menopause. Menopause 17, 718–726 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Santoro, N., Lasley, B., McConnell, D., Allsworth, J., Crawford, S., Gold, E. B. et al. Body size and ethnicity are associated with menstrual cycle alterations in women in the early menopausal transition: The Study of Women’s Health across the Nation (SWAN) Daily Hormone Study. J. Clin. Endocrinol. Metab. 89, 2622–2631 (2004).

    Article  CAS  PubMed  Google Scholar 

  28. Randolph, J. F. Jr, Sowers, M., Gold, E. B., Mohr, B. A., Luborsky, J., Santoro, N. et al. Reproductive hormones in the early menopausal transition: relationship to ethnicity, body size, and menopausal status. J. Clin. Endocrinol. Metab. 88, 1516–1522 (2003).

    Article  CAS  PubMed  Google Scholar 

  29. Perel, E. & Killinger, D. W. The interconversion and aromatization of androgens by human adipose tissue. J. Steroid Biochem. 10, 623–627 (1979).

    Article  CAS  PubMed  Google Scholar 

  30. Meredith, I., Sarfati, D., Ikeda, T., Atkinson, J. & Blakely, T. High rates of endometrial cancer among Pacific women in New Zealand: the role of diabetes, physical inactivity, and obesity. Cancer Causes Control 23, 875–885 (2012).

    Article  PubMed  Google Scholar 

  31. Sjogren, L. L., Morch, L. S. & Lokkegaard, E. Hormone replacement therapy and the risk of endometrial cancer: a systematic review. Maturitas 91, 25–35 (2016).

    Article  CAS  PubMed  Google Scholar 

  32. Salazar-Martinez, E., Lazcano-Ponce, E. C., Gonzalez Lira-Lira, G., Escudero-De Ios Rios, P., Salmeron-Castro, J. & Hernandez-Avila, M. Reproductive factors of ovarian and endometrial cancer risk in a high fertility population in Mexico. Cancer Res. 59, 3658–3662 (1999).

    CAS  PubMed  Google Scholar 

  33. Wernli, K. J., Ray, R. M., Gao, D. L., De Roos, A. J., Checkoway, H. & Thomas, D. B. Menstrual and reproductive factors in relation to risk of endometrial cancer in Chinese women. Cancer Causes Control 17, 946–955 (2006).

    Article  Google Scholar 

  34. Gong, T. T., Wang, Y. L. & Ma, X. X. Age at menarche and endometrial cancer risk: a dose-response meta-analysis of prospective studies. Sci. Rep. 5, 14051 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  35. Dossus, L., Allen, N., Kaaks, R., Bakken, K., Lund, E., Tjonneland, A. et al. Reproductive risk factors and endometrial cancer: the European Prospective Investigation into Cancer and Nutrition. Int. J. Cancer 127, 442–451 (2010).

    CAS  PubMed  Google Scholar 

  36. Collaborative Group on Epidemiological Studies on Endometrial Cancer. Endometrial cancer and oral contraceptives: an individual participant meta-analysis of 27 276 women with endometrial cancer from 36 epidemiological studies. Lancet Oncol. 16, 1061–1070 (2015).

    Article  CAS  Google Scholar 

  37. Gavrilyuk, O., Braaten, T., Weiderpass, E., Licaj, I. & Lund, E. Lifetime number of years of menstruation as a risk index for postmenopausal endometrial cancer in the Norwegian Women and Cancer Study. Acta Obstet. Gynecol. Scand. 97, 1168–1177 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  38. Xu, W. H., Xiang, Y. B., Ruan, Z. X., Zheng, W., Cheng, J. R., Dai, Q. et al. Menstrual and reproductive factors and endometrial cancer risk: results from a population-based case-control study in urban Shanghai. Int. J. Cancer 108, 613–619 (2004).

    Article  CAS  PubMed  Google Scholar 

  39. Xu, W. H., Xiang, Y. B., Ruan, Z. X., Zheng, W., Cheng, J. R., Dai, Q. et al. Type I and II endometrial cancers: have they different risk factors?. J. Clin. Oncol. 31, 2607–2618 (2013).

    Article  Google Scholar 

  40. Viswanathan, A. N., Feskanich, D., De Vivo, I., Hunter, D. J., Barbieri, R. L., Rosner, B. et al. Smoking and the risk of endometrial cancer: results from the Nurses’ Health Study. Int. J. Cancer 114, 996–1001 (2005).

    Article  CAS  PubMed  Google Scholar 

  41. Felix, A. S., Yang, H. P., Gierach, G. L., Park, Y. & Brinton, L. A. Cigarette smoking and endometrial carcinoma risk: the role of effect modification and tumor heterogeneity. Cancer Causes Control 25, 479–489 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gunter, M. J., Hoover, D. R., Yu, H., Wassertheil-Smoller, S., Manson, J. E., Li, J. et al. A prospective evaluation of insulin and insulin-like growth factor-I as risk factors for endometrial cancer. Cancer Epidemiol. Biomark. Prev. 17, 921–929 (2008).

    Article  CAS  Google Scholar 

  43. Temkin, S. M., Minasian, L. & Noone, A. M. The end of the hysterectomy epidemic and endometrial cancer incidence: what are the unintended consequences of declining hysterectomy rates?. Front. Oncol. 6, 89 (2016).

    PubMed  PubMed Central  Google Scholar 

  44. Villanueva, E. V. The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health 1, 11 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Kyulo, N. L., Knutsen, S. F., Tonstad, S., Fraser, G. E. & Singh, P. N. Validation of recall of body weight over a 26-year period in cohort members of the Adventist Health Study 2. Ann. Epidemiol. 22, 744–746 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  46. Lim, U., Wilkens, L. R., Albright, C. L., Novotny, R., Le Marchand, L. & Kolonel, L. N. University of Hawai’i Cancer Center Connection: bias in self-reported anthropometry in relation to adiposity and adulthood weight gain among postmenopausal Caucasian and Japanese American Women. Hawaii J. Med. Public Health 72, 445–449 (2013).

    PubMed  PubMed Central  Google Scholar 

  47. Jordan, S. J., Na, R., Johnatty, S. E., Wise, L. A., Adami, H. O., Brinton, L. A. et al. Breastfeeding and endometrial cancer risk: an analysis from the Epidemiology of Endometrial Cancer Consortium. Obstet. Gynecol. 129, 1059–1067 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Setiawan, V. W., Pike, M. C., Karageorgi, S., Deming, S. L., Anderson, K., Bernstein, L. et al. Age at last birth in relation to risk of endometrial cancer: pooled analysis in the epidemiology of endometrial cancer consortium. Am. J. Epidemiol. 176, 269–278 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA

    Danja Sarink, Lynne R. Wilkens, Kami K. White, Loïc Le Marchand, S. Lani Park, Song-Yi Park & Melissa A. Merritt

  2. Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Anna H. Wu & V. Wendy Setiawan

  3. Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA

    Jeffrey L. Killeen

  4. Kapiolani Medical Center for Women and Children, Honolulu, HI, USA

    Jeffrey L. Killeen

Authors
  1. Danja Sarink
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynne R. Wilkens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kami K. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Loïc Le Marchand
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna H. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Wendy Setiawan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Lani Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Song-Yi Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jeffrey L. Killeen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Melissa A. Merritt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception of the study (D.S., L.R.W., L.L.M., M.A.M.), design of the study (all authors), data acquisition and/or analysis (D.S., L.R.W., K.K.W., L.L.M., S.-Y.P., J.L.K., M.A.M.), interpretation of data (D.S., L.R.W., M.A.M.), creation of new software used in the work (not applicable), drafting and/or substantially revising the work (all authors).

Corresponding author

Correspondence to Melissa A. Merritt.

Ethics declarations

Ethics approval and consent to participate

Our study was approved by the Institutional Review Board at the University of Hawaii. The Multiethnic Cohort Study was approved by the Institutional Review Boards at the University of Hawaii and the University of Southern California, who considered return of the completed baseline questionnaire as active consent. This study was performed in accordance with the Declaration of Helsinki.

Data availability

For information on applications to gain access to data from the Multiethnic Cohort Study, please see: https://www.uhcancercenter.org/for-researchers/mec-data-sharing.

Competing interests

The authors declare no competing interests.

Funding information

The Multiethnic Cohort Study is supported by National Cancer Institute grants R37CA54281 (L.N. Kolonel) and U01CA164973 (L.L.M., C. Haiman, L.R.W.).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sarink, D., Wilkens, L.R., White, K.K. et al. Racial/ethnic differences in anthropometric and hormone-related factors and endometrial cancer risk: the Multiethnic Cohort Study. Br J Cancer 124, 1724–1733 (2021). https://doi.org/10.1038/s41416-021-01292-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41416-021-01292-2

Search

Advanced search

Quick links