Association between diabetes, diabetes treatment and risk of developing endometrial cancer.

J. Luo, S. Beresford, C. Chen, R. Chlebowski, Lorena Garcia, L. Kuller, M. Regier, J. Wactawski-Wende, K. L. Margolis

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

A growing body of evidence suggests that diabetes is a risk factor for endometrial cancer incidence. However, most of these studies used case-control study designs and did not adjust for obesity, an established risk factor for endometrial cancer. In addition, few epidemiological studies have examined the association between diabetes treatment and endometrial cancer risk. The objective of this study was to assess the relationships among diabetes, diabetes treatment and endometrial cancer risk in postmenopausal women participating in the Women's Health Initiative (WHI). A total of 88 107 postmenopausal women aged 50-79 years who were free of cancer and had no hysterectomy at baseline were followed until date of endometrial cancer diagnosis, death, hysterectomy or loss to follow-up, whichever came first. Endometrial cancers were confirmed by central medical record and pathology report review. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% confidence interval (CI)) for diagnosis of diabetes and metformin treatment as risk factors for endometrial cancer. Over a mean of 11 years of follow-up, 1241 endometrial cancers developed. In the primary analysis that focused on prevalent diabetes at enrolment, compared with women without diabetes, women with self-reported diabetes, and the subset of women with treated diabetes, had significantly higher risk of endometrial cancer without adjusting for BMI (HR=1.44, 95% CI: 1.13-1.85 for diabetes, HR=1.57, 95% CI: 1.19-2.07 for treated diabetes). However after adjusting for BMI, the associations between diabetes, diabetes treatment, diabetes duration and the risk of endometrial cancer became non-significant. Elevated risk was noted when considering combining diabetes diagnosed at baseline and during follow-up as time-dependent exposure (HR=1.31, 95% CI: 1.08-1.59) even after adjusting for BMI. No significant association was observed between metformin use and endometrial cancer risk. Our results suggest that the relationship observed in previous research between diabetes and endometrial cancer incidence may be largely confounded by body weight, although some modest independent elevated risk remains.

Original languageEnglish (US)
Pages (from-to)1432-1439
Number of pages8
JournalBritish Journal of Cancer
Volume111
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Endometrial Neoplasms
Therapeutics
Confidence Intervals
Metformin
Hysterectomy
Incidence
Women's Health
Proportional Hazards Models
Medical Records
Case-Control Studies
Epidemiologic Studies
Obesity
Body Weight
Pathology

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Luo, J., Beresford, S., Chen, C., Chlebowski, R., Garcia, L., Kuller, L., ... Margolis, K. L. (2014). Association between diabetes, diabetes treatment and risk of developing endometrial cancer. British Journal of Cancer, 111(7), 1432-1439. https://doi.org/10.1038/bjc.2014.407

Association between diabetes, diabetes treatment and risk of developing endometrial cancer. / Luo, J.; Beresford, S.; Chen, C.; Chlebowski, R.; Garcia, Lorena; Kuller, L.; Regier, M.; Wactawski-Wende, J.; Margolis, K. L.

In: British Journal of Cancer, Vol. 111, No. 7, 2014, p. 1432-1439.

Research output: Contribution to journalArticle

Luo, J, Beresford, S, Chen, C, Chlebowski, R, Garcia, L, Kuller, L, Regier, M, Wactawski-Wende, J & Margolis, KL 2014, 'Association between diabetes, diabetes treatment and risk of developing endometrial cancer.', British Journal of Cancer, vol. 111, no. 7, pp. 1432-1439. https://doi.org/10.1038/bjc.2014.407
Luo, J. ; Beresford, S. ; Chen, C. ; Chlebowski, R. ; Garcia, Lorena ; Kuller, L. ; Regier, M. ; Wactawski-Wende, J. ; Margolis, K. L. / Association between diabetes, diabetes treatment and risk of developing endometrial cancer. In: British Journal of Cancer. 2014 ; Vol. 111, No. 7. pp. 1432-1439.
@article{2e74aece49f84f549eb9a7ea4af65919,
title = "Association between diabetes, diabetes treatment and risk of developing endometrial cancer.",
abstract = "A growing body of evidence suggests that diabetes is a risk factor for endometrial cancer incidence. However, most of these studies used case-control study designs and did not adjust for obesity, an established risk factor for endometrial cancer. In addition, few epidemiological studies have examined the association between diabetes treatment and endometrial cancer risk. The objective of this study was to assess the relationships among diabetes, diabetes treatment and endometrial cancer risk in postmenopausal women participating in the Women's Health Initiative (WHI). A total of 88 107 postmenopausal women aged 50-79 years who were free of cancer and had no hysterectomy at baseline were followed until date of endometrial cancer diagnosis, death, hysterectomy or loss to follow-up, whichever came first. Endometrial cancers were confirmed by central medical record and pathology report review. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95{\%} confidence interval (CI)) for diagnosis of diabetes and metformin treatment as risk factors for endometrial cancer. Over a mean of 11 years of follow-up, 1241 endometrial cancers developed. In the primary analysis that focused on prevalent diabetes at enrolment, compared with women without diabetes, women with self-reported diabetes, and the subset of women with treated diabetes, had significantly higher risk of endometrial cancer without adjusting for BMI (HR=1.44, 95{\%} CI: 1.13-1.85 for diabetes, HR=1.57, 95{\%} CI: 1.19-2.07 for treated diabetes). However after adjusting for BMI, the associations between diabetes, diabetes treatment, diabetes duration and the risk of endometrial cancer became non-significant. Elevated risk was noted when considering combining diabetes diagnosed at baseline and during follow-up as time-dependent exposure (HR=1.31, 95{\%} CI: 1.08-1.59) even after adjusting for BMI. No significant association was observed between metformin use and endometrial cancer risk. Our results suggest that the relationship observed in previous research between diabetes and endometrial cancer incidence may be largely confounded by body weight, although some modest independent elevated risk remains.",
author = "J. Luo and S. Beresford and C. Chen and R. Chlebowski and Lorena Garcia and L. Kuller and M. Regier and J. Wactawski-Wende and Margolis, {K. L.}",
year = "2014",
doi = "10.1038/bjc.2014.407",
language = "English (US)",
volume = "111",
pages = "1432--1439",
journal = "British Journal of Cancer",
issn = "0007-0920",
publisher = "Nature Publishing Group",
number = "7",

}

TY - JOUR

T1 - Association between diabetes, diabetes treatment and risk of developing endometrial cancer.

AU - Luo, J.

AU - Beresford, S.

AU - Chen, C.

AU - Chlebowski, R.

AU - Garcia, Lorena

AU - Kuller, L.

AU - Regier, M.

AU - Wactawski-Wende, J.

AU - Margolis, K. L.

PY - 2014

Y1 - 2014

N2 - A growing body of evidence suggests that diabetes is a risk factor for endometrial cancer incidence. However, most of these studies used case-control study designs and did not adjust for obesity, an established risk factor for endometrial cancer. In addition, few epidemiological studies have examined the association between diabetes treatment and endometrial cancer risk. The objective of this study was to assess the relationships among diabetes, diabetes treatment and endometrial cancer risk in postmenopausal women participating in the Women's Health Initiative (WHI). A total of 88 107 postmenopausal women aged 50-79 years who were free of cancer and had no hysterectomy at baseline were followed until date of endometrial cancer diagnosis, death, hysterectomy or loss to follow-up, whichever came first. Endometrial cancers were confirmed by central medical record and pathology report review. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% confidence interval (CI)) for diagnosis of diabetes and metformin treatment as risk factors for endometrial cancer. Over a mean of 11 years of follow-up, 1241 endometrial cancers developed. In the primary analysis that focused on prevalent diabetes at enrolment, compared with women without diabetes, women with self-reported diabetes, and the subset of women with treated diabetes, had significantly higher risk of endometrial cancer without adjusting for BMI (HR=1.44, 95% CI: 1.13-1.85 for diabetes, HR=1.57, 95% CI: 1.19-2.07 for treated diabetes). However after adjusting for BMI, the associations between diabetes, diabetes treatment, diabetes duration and the risk of endometrial cancer became non-significant. Elevated risk was noted when considering combining diabetes diagnosed at baseline and during follow-up as time-dependent exposure (HR=1.31, 95% CI: 1.08-1.59) even after adjusting for BMI. No significant association was observed between metformin use and endometrial cancer risk. Our results suggest that the relationship observed in previous research between diabetes and endometrial cancer incidence may be largely confounded by body weight, although some modest independent elevated risk remains.

AB - A growing body of evidence suggests that diabetes is a risk factor for endometrial cancer incidence. However, most of these studies used case-control study designs and did not adjust for obesity, an established risk factor for endometrial cancer. In addition, few epidemiological studies have examined the association between diabetes treatment and endometrial cancer risk. The objective of this study was to assess the relationships among diabetes, diabetes treatment and endometrial cancer risk in postmenopausal women participating in the Women's Health Initiative (WHI). A total of 88 107 postmenopausal women aged 50-79 years who were free of cancer and had no hysterectomy at baseline were followed until date of endometrial cancer diagnosis, death, hysterectomy or loss to follow-up, whichever came first. Endometrial cancers were confirmed by central medical record and pathology report review. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% confidence interval (CI)) for diagnosis of diabetes and metformin treatment as risk factors for endometrial cancer. Over a mean of 11 years of follow-up, 1241 endometrial cancers developed. In the primary analysis that focused on prevalent diabetes at enrolment, compared with women without diabetes, women with self-reported diabetes, and the subset of women with treated diabetes, had significantly higher risk of endometrial cancer without adjusting for BMI (HR=1.44, 95% CI: 1.13-1.85 for diabetes, HR=1.57, 95% CI: 1.19-2.07 for treated diabetes). However after adjusting for BMI, the associations between diabetes, diabetes treatment, diabetes duration and the risk of endometrial cancer became non-significant. Elevated risk was noted when considering combining diabetes diagnosed at baseline and during follow-up as time-dependent exposure (HR=1.31, 95% CI: 1.08-1.59) even after adjusting for BMI. No significant association was observed between metformin use and endometrial cancer risk. Our results suggest that the relationship observed in previous research between diabetes and endometrial cancer incidence may be largely confounded by body weight, although some modest independent elevated risk remains.

UR - http://www.scopus.com/inward/record.url?scp=84909997906&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84909997906&partnerID=8YFLogxK

U2 - 10.1038/bjc.2014.407

DO - 10.1038/bjc.2014.407

M3 - Article

C2 - 25051408

AN - SCOPUS:84909997906

VL - 111

SP - 1432

EP - 1439

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 7

ER -