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Endometrial cancer

Surgery can decrease risk of uterine cancer

Weight loss maybe key to reducing threat of most common gynaecologic cancer

Women who had bariatric surgery had a 70% lower risk of uterine cancer and an even lower risk if they maintained their weight according to findings of a study based on more than seven million hospital admissions. The study, ‘Bariatric surgery decreases the risk of uterine malignancy’, was presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer in Tampa, FL.

It has been previously reported that cancer-associated biomarkers were significantly reduced in obese women who were women who were at increased risk of endometrial cancer and who had a Roux en Y gastric bypass.

“We found that after women had bariatric surgery, their risk of uterine cancer plummeted and became the same or perhaps even a little less than in women who were not obese,” said Dr Kristy Ward, lead author and gynaecologic oncologist at UC San Diego Moores Cancer Center. “Obesity is the second leading cause of preventable death, and this research adds to the growing evidence that reducing obesity reduces cancer. We need to focus on finding ways to help women lose weight, and for appropriate patients, bariatric surgery may be an option.”

Uterine cancer is the most common cancer of the female reproductive organs, affecting about 50,000 women in 2013, according to the National Cancer Institute. Endometrial cancer (which occurs in the inner lining of the uterus) accounts for 95 percent of uterine cancers and approximately half of all cases of endometrial cancer can be traced to obesity. Obese women are two to four times more likely to develop endometrial cancer than those of normal weight.

Researchers analysed information from more than seven million admissions of women to one of more 392 US non-profit academic medical centres or affiliated hospitals between January 2009 and June 2013. Of those, 103,797 had previously had bariatric surgery and 424 (0.4%) were diagnosed with uterine cancer. Of the 832,372 who were considered obese and had not previously undergone bariatric surgery, 11,729 (1.4%) were diagnosed with uterine cancer.

In other words, obese women who had bariatric surgery were 3.5 times less likely to get uterine cancer than women who had not had the surgery. Among the nearly 6.5 million admissions of non-obese women who had not previously had bariatric surgery, 32,192 (0.5%) were diagnosed with uterine cancer.

The benefit of bariatric surgery was even more pronounced among women who were able to keep the weight off. While just having bariatric surgery reduced the risk of getting uterine cancer by 71%, the risk reduction was 81% among women who had bariatric surgery and maintained a normal weight.

"Estimating from various studies that looked at increasing BMI and endometrial cancer risk, a woman with a BMI 40 would have approximately eight times greater risk of endometrial cancer than someone with a BMI of 25," explained Ward. "This risk likely continues to go up as BMI goes up."

The study did not differentiate between types of bariatric surgery.

A number of biological mechanisms link obesity to endometrial cancer. Excessive adipose or fat tissue, for example, raises circulating levels of oestrogen, which is associated with tumour creation and metastasis. Obesity also causes chronic inflammation, boosting insulin resistance and increased oestrogen levels.

"The majority of endometrial cancers are oestrogen-driven," she said. "In a normal menstruating woman, two hormones control the endometrium (inner lining of the uterus). Oestrogen builds up the endometrium and progesterone stabilises it. A woman with excess adipose tissue has an increased level of oestrogen because the fat tissue converts steroid hormones into a form of oestrogen.

"So there is too much oestrogen, causing the endometrium to build up, but not enough progesterone to stabilise it. The endometrium continues to grow and can undergo changes into abnormal tissue, leading to cancer."

Co-authors include Angelica M Roncancio, University of Texas School of Public Health; Nina R. Shah, Mitzie-Ann Davis, Cheryl C Saenz, Michael T McHale and Steven C Plaxe, all of UC San Diego Moores Cancer Center.

The research will be published in a special issue on gynaecologic cancer prevention, treatment and survivorship in obese women in the April 2014 edition of the journal Gynecologic Oncology.

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