Obesity is a significant risk factor for many chronic diseases, including certain gynaecological cancers. Numerous studies indicate that increased body weight correlates with higher risk, particularly for endometrial cancer, and to a lesser extent, ovarian cancer.
Endometrial Cancer
In highly developed countries, endometrial cancer is the fourth most common cancer among women and the leading gynaecological malignancy. Countries with the highest incidence rates also have the highest obesity prevalence1. In Poland, approximately 6,000 new cases are diagnosed annually2,3.
Overweight and obesity may account for around 40% of endometrial cancer cases4. Each 5 kg/m2 increase in BMI is associated with a 60% increased risk5,6. One study showed women with a BMI of 32 kg/m2 had more than double, and those with a BMI of 42 kg/m2 had ohahahver nine times the risk compared to women with normal weight (BMI <25 kg/m2)7.
Mechanisms linking excess adiposity to increased endometrial cancer risk include:
- elevated blood insulin levels (hyperinsulinaemia)
- tissue insulin resistance
- increased circulating oestrogens (hyperestrogenism)
- chronic inflammation
These factors create favourable conditions for DNA damage in endometrial cells and initiation of carcinogenesis8,9.
Ovarian Cancer
Ovarian cancer is the sixth most common cancer in women and the second most common gynaecological malignancy. In Poland, around 3,600 new cases are diagnosed annually10. Obesity is also a risk factor for ovarian cancer, though its impact is less pronounced than for endometrial cancer11. Each 5 kg/m2 increase in BMI is associated with increased risk for certain histological subtypes, such as high-grade serous, mucinous, and endometrioid ovarian cancer, with respective increases of 13%, 19%, and 17%12. No convincing evidence links overweight or obesity to the most common histological type, low-grade serous ovarian cancer13. Interestingly, for non-serous types and premenopausal cases, higher risk is associated with childhood obesity rather than adult obesity14.
References
1 Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clin 2021;71(3):209e49.
2 https://onkologia.pacjent.gov.pl/pl/kompendium-chorob-nowotworowych/endometrium/epidemiologia
3 Narodowy Instytut Onkologii im. Marii Skłodowskiej-Curie — Państwowy Instytut Badawczy. Raport otwarcia Narodowej Strategii Onkologicznej [Internet]. Warszawa: Narodowy Instytut Onkologii im. Marii Skłodowskiej-Curie — Państwowy Instytut Badawczy. 2021 [06.12.2024]. https://nio.gov.pl/wp-content/uploads/2024/01/Raport-otwarcia-Narodowej-Strategii-Onkologicznej-22.02.2022r.pdf
4 Bhaskaran K, Douglas I, Forbes H, Dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5$24 million UK adults. Lancet 2014;384(9945):755e65.
5 Crosbie EJ, Zwahlen M, Kitchener HC, Egger M, Renehan AG. Body mass index, hormone replacement therapy, and endometrial cancer risk: a meta-analysis. Cancer Epidemiol Biomark Prev 2010;19(12):3119e30.
6 Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008;371(9612):569e78.
7 Crosbie EJ, Zwahlen M, Kitchener HC, Egger M, Renehan AG. Body mass index, hormone replacement therapy, and endometrial cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2010 Dec;19(12):3119-30. doi: 10.1158/1055-9965.EPI-10-0832. Epub 2010 Oct 28. PMID: 21030602.
8 Mackintosh ML, Crosbie EJ. Obesity-driven endometrial cancer: is weight loss the answer? BJOG. 2013 Jun;120(7):791-4. doi: 10.1111/1471-0528.12106. PMID: 23659328.
9 Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 2022 Apr 9;399(10333):1412-1428. doi: 10.1016/S0140-6736(22)00323-3. PMID: 35397864.
10 https://onkologia.pacjent.gov.pl/pl/kompendium-chorob-nowotworowych/jajnik/epidemiologia
11 Foong KW, Bolton H. Obesity and ovarian cancer risk: A systematic review. Post Reprod Health. 2017 Dec;23(4):183-198. doi: 10.1177/2053369117709225. Epub 2017 Jul 18. PMID: 28720017.
12 Olsen CM, Nagle CM, Whiteman DC, Ness R, Pearce CL, Pike MC, Rossing MA, Terry KL, Wu AH; Australian Cancer Study (Ovarian Cancer); Australian Ovarian Cancer Study Group; Risch HA, Yu H, Doherty JA, Chang-Claude J, Hein R, Nickels S, Wang-Gohrke S, Goodman MT, Carney ME, Matsuno RK, Lurie G, Moysich K, Kjaer SK, Jensen A, Hogdall E, Goode EL, Fridley BL, Vierkant RA, Larson MC, Schildkraut J, Hoyo C, Moorman P, Weber RP, Cramer DW, Vitonis AF, Bandera EV, Olson SH, Rodriguez-Rodriguez L, King M, Brinton LA, Yang H, Garcia-Closas M, Lissowska J, Anton-Culver H, Ziogas A, Gayther SA, Ramus SJ, Menon U, Gentry-Maharaj A, Webb PM; Ovarian Cancer Association Consortium. Obesity and risk of ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consortium. Endocr Relat Cancer. 2013 Mar 22;20(2):251-62. doi: 10.1530/ERC-12-0395. PMID: 23404857; PMCID: PMC3857135.
13 Agnew HJ, Kitson SJ, Crosbie EJ. Gynecological malignancies and obesity. Best Pract Res Clin Obstet Gynaecol. 2023 Jun;88:102337. doi: 10.1016/j.bpobgyn.2023.102337. Epub 2023 Apr 8. PMID: 37117071.
14 Huang T, Tworoger SS, Willett WC, Stampfer MJ, Rosner BA. Associations of early life and adulthood adiposity with risk of epithelial ovarian cancer. Ann Oncol. 2019 Feb 1;30(2):303-309. doi: 10.1093/annonc/mdy546. PMID: 30576422; PMCID: PMC6821311.
