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Letters
Open Access

Highlighting obesity as a risk factor for endometrial cancer

Andrea N. Simpson and Genevieve Lennox
CMAJ January 11, 2021 193 (2) E58; DOI: https://doi.org/10.1503/cmaj.77367
Andrea N. Simpson
Obstetrician and gynecologist, co-chair, Community of Practice in Obesity of the Society of Gynecologic Oncology of Canada, Ottawa, Ont.; St. Michael’s Hospital/Unity Health Toronto, University of Toronto, Toronto, Ont.
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Genevieve Lennox
Gynecologic oncologist, co-chair, Community of Practice in Obesity of the Society of Gynecologic Oncology of Canada, Ottawa, Ont.; Trillium Health Partners, University of Toronto, Toronto, Ont.
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On behalf of the Community of Practice in Obesity of the Society of Gynecologic Oncology of Canada (www.g-o-c.org), we thank the authors of the recent guideline on the management of obesity in adults1 for highlighting the elevated risk of endometrial cancer among women with obesity. Endometrial cancer is the fourth most common gynecologic malignancy in women, with 7400 new diagnoses annually in Canada.2 Obesity is one of the most significant risk factors for endometrial cancer: the risk is tripled in women with a body mass index above 30 kg/m2.3

We advocate for increasing provider and public awareness of the association between obesity and endometrial cancer. In addition, we want to highlight that abnormal uterine bleeding or postmenopausal bleeding are red flags that require urgent assessment with an office endometrial biopsy. Endometrial biopsy is essential for diagnosis and cannot be replaced by imaging. Furthermore, young women with obesity and irregular menstrual cycles are at an increased risk for the development of endometrial hyperplasia and cancer. Management strategies for endometrial protection include progestin-containing intrauterine devices4 and the oral contraceptive pill.5

Aligning with the authors’ recommendation to focus on patient-centred health outcomes rather than weight loss alone,1 such risk-reducing interventions should routinely be offered to women with obesity, particularly in the setting of infrequent (anovulatory) menstrual cycles.

Footnotes

  • Competing interests: None declared.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    1. Wharton S,
    2. Lau DCW,
    3. Vallis M,
    4. et al
    . Obesity in adults: a clinical practice guideline. CMAJ 2020;192:E875–91.
    OpenUrlFREE Full Text
  2. ↵
    Canadian Cancer Statistics Advisory Committee. Canadian cancer statistics 2019. Toronto: Canadian Cancer Society; 2019. Available: cancer.ca/Canadian-Cancer-Statistics-2019-EN (accessed 2020 Sept. 30).
  3. ↵
    1. Amant F,
    2. Moerman P,
    3. Neven P,
    4. et al
    . Endometrial cancer. Lancet 2005;366:491–505.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Jareid M,
    2. Thalabard J-C,
    3. Aarflot M,
    4. et al
    . Levonorgestrel-releasing intrauterine system use is associated with a decreased risk of ovarian and endometrial cancer, without increased risk of breast cancer. Results from the NOWAC Study. Gynecol Oncol 2018;149:127–32.
    OpenUrlCrossRefPubMed
  5. ↵
    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 2015;16:1061–70.
    OpenUrlCrossRefPubMed
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Canadian Medical Association Journal: 193 (2)
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Vol. 193, Issue 2
11 Jan 2021
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Highlighting obesity as a risk factor for endometrial cancer
Andrea N. Simpson, Genevieve Lennox
CMAJ Jan 2021, 193 (2) E58; DOI: 10.1503/cmaj.77367

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Andrea N. Simpson, Genevieve Lennox
CMAJ Jan 2021, 193 (2) E58; DOI: 10.1503/cmaj.77367
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