Uterine Cancer Prevention
Unlike breast and ovarian cancers, which can run in some families, there is little evidence that this is the case for uterine cancer. There is no known way to prevent the disease, but several known factors increase your risk of developing uterine cancer:
- Age: You are at higher risk if you are post-menopausal and are over age 50.
- Obesity: Estrogen and progesterone are stored in the fat tissues of your body. Women who are obese have higher estrogen levels. Women who are 50 pounds above ideal body weight have a 10-fold higher chance of getting uterine cancer. Women 30 pounds above ideal body weight have a three-fold increased chance. Women who weigh more than 200 pounds have a seven-fold higher chance of getting uterine cancer than women weighing less than 125 pounds.
- Irregular menstrual periods: Obese women may not ovulate regularly during the reproductive years. This can upset the delicate balance between estrogen that encourages the development of cancer and the progestogen that protects against cancer.
- Hypertension: High blood pressure has been associated with uterine cancer, but not as strongly as some of the risk factors mentioned earlier. The relationship between hypertension and uterine cancer may be due to the fact that many women with hypertension are also obese, which is a very strong risk factor for uterine cancer.
- Diabetes: Women with diabetes have twice the risk of uterine cancer as women who do not have diabetes. As is the case with hypertension, however, many women with diabetes are also obese. It is not entirely clear how much of the increased risk in women with diabetes is due to the diabetic condition as opposed to being overweight.
- Estrogen replacement therapy: Estrogen replacement therapy (ERT) has been prescribed after menopause for a variety of reasons, including prevention of hot flashes and relieving other menopausal symptoms, as well as preventing osteoporosis (a bone-thinning disease associated with estrogen depletion after menopause). However, recent major studies indicate that the health risks of using ERT, with or without progestin, clearly outweigh any health benefits, including the prevention of osteoporosis. ERT is typically prescribed only to women who no longer have a uterus because of its known risk of stimulating growth of the uterine lining — a risk factor for uterine cancer; the addition of progestin to the hormone therapy — a combination known as hormone replacement therapy, or HRT, prevents this risk for women who have not had their uterus removed.
Uterine Cancer Prevention (cont'd)
The safety of both short-term and long-term HRT use is now under intense scrutiny by the federal government — scrutiny triggered by major studies of HRT published in 2002. One of those studies, part of the Women’s Health Initiative (WHI) — one of the largest studies of women’s health ever undertaken and still under way — investigated the use of combination estrogen-progestin hormone therapy for the prevention of coronary heart disease on healthy women between the ages of 50 to 79 years.
In January 2003, the U.S. Food and Drug Administration (FDA) announced that it would require a new, highlighted “black-box” warning on all estrogen products for use by post-menopausal women. The warning suggests an increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen — risks illuminated by part of the WHI study, which was abruptly halted when the risks were identified.
Also emphasized by the "black-box" warning is that estrogen products are not approved for heart disease prevention. It advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time.
Discuss your questions about ERT and HRT use with your health care professional with your personal health needs and health history in mind.
- Late menopause: Women who have a later menopause have a slightly increased risk of developing uterine cancer.
- Nonpolyposis colorectal cancer: Women with or at risk for hereditary nonpolyposis colorectal cancer have an increased risk for developing uterine cancer and annual screenings should be offered with endometrial biopsy beginning at age 35.
Another factor to consider is race. For reasons that are not entirely clear, uterine cancer is approximately twice as common in Caucasians as it is in African Americans and other non-Caucasians. On the other hand, African Americans who get this type of cancer are more likely to die of their disease.
Also, several studies have shown that the breast cancer drug Tamoxifen significantly increases the risk of uterine cancer, but it is not associated with an increase in mortality from uterine cancer. However, it is believed that the lowered incidence of breast cancer deaths when taking this drug outweighs the risk of developing uterine cancer. If you are receiving Tamoxifen, you do not need routine x-rays or biopsies, but should be examined by your gynecologist at least once a year or right away if irregular bleeding occurs.
Although decisions regarding contraception and family planning are complex, you should be aware that bearing children decreases the risk of developing both uterine and ovarian cancer.
So, how can you take care of yourself? Women who are at risk for uterine cancer need to monitor their health closely. You should report any abnormal bleeding to your health care professional immediately and have regular check-ups. Early diagnosis and treatment are key to recovery from uterine cancer.
Uterine Cancer Prevention (cont'd)
And although there is no known way to prevent the disease, you may be able to reduce your risk by following these suggestions:
- Consider using birth control pills. Prescriptions that contain estrogens and/or progestins can have an impact on your risk of uterine or endometrial cancer. Taking birth control pills during childbearing years can markedly decrease your risk of both uterine and ovarian cancer. Although it is not widely known, several studies have demonstrated that use of the pill for five to 10 years decreases the risk of both these cancers by about 50 percent.
- Eat a diet low in animal fat. (There is some evidence that it may have more to do with overall caloric intake as well as the amount of fat per se in diet.)
- Control your weight by eating healthy foods and exercising. Exercise and diet regimens that result in significant weight loss can markedly decrease your risk of developing uterine cancer and also can decrease the risk of a number of other illnesses, including heart disease.
- Control your blood pressure by decreasing stress and eating a diet low in salt.
- Report abnormal bleeding promptly to your health care professional.
- Have an annual pelvic exam, including a Pap smear. (Bear in mind though that the Pap smear was neither designed to nor is it an accurate way of detecting uterine cancer.)
Copyright 2003
National Women's Health Resource Center Inc. (NWHRC).