Alex Andrea Francoeur, MD, on Endometrial Cancer and Obesity Trends

Obesity has been identified to be a risk factor for endometrial cancer, but trends overtime have not been well studied. So the objective of our study was to study the trends of endometrial cancer and obesity from 2001 to 2018 in the United States using a large national database. Additionally, we aim to identify people most at risk based on these findings and identify disparities on a population-based level. For this study, we used the United States Cancer Statistics Database to gather data on endometrial cancer. This database represents over 99% of all cancer cases diagnosed in the United States. We then performed a correction for hysterectomy and pregnancy within this database. For data on obesity, we used the NHANES database, which provides population-based statistics on obesity for the United States. To compare the relationship in trends between endometrial adenocarcinoma and obesity, a Pearson correlation coefficient was calculated for selected groups. We identified 586,000 cases of endometrioid adenocarcinoma from 2001 to 2018. When looking at our obesity data, the majority of the US female population is either overweight or obese. And the majority of Black and Hispanic women are overweight or obese. Endometrioid adenocarcinoma rates are increasing in younger age groups. In the 20 to 29 year old age group, we found that there's been a 137% increase in the rate of endometrial adenocarcinoma since 2001. In the 30 to 39 year old age group, we found that there's been a 71% increase. When looking at trends by race and ethnicity, we found that in Black women, there's been an increase in endometrial cancers of 25% since 2001, and in Hispanic women, there's been an increase of 17%. We then performed a trend analysis of obesity and endometrial cancer in parallel. Rates of obesity are rising at 7.5% in the 20 to 29 year old age group per year. The highest rate of increase in any age group. Rates of endometrial cancer are rising in this age group at 4.5% per year, also the highest of any age group. The correlation coefficient for this age group was 0.78, demonstrating a strong correlation. We see a similar trend in women age 30 to 39 with rates of obesity rising at 4.5% annually, and rates of cancer rising at 3% per year. Again, demonstrating a strong correlation with an R of 0.88. We see similar trends when we look at race and ethnicity, where obesity and endometrioid adenocarcinoma are statistically significantly correlated. In conclusion, the current data, although retrospective, demonstrate a strong temporal association in the rising rates of obesity and endometrioid adenocarcinoma in the United States. This represents a public health emergency, and actions are needed to address the impact of obesity on endometrial cancer. These actions can include increased awareness, medications, targeting weight management, surgical management of obesity, and increased research in this area.