To prevent endometrial cancer (cancer of the lining of the uterus), attention must be paid to reducing individual risk factors. Behavioral risk factors
- Diet
- Foods containing acrylamide (Group 2A carcinogen) – this is metabolically activated to glycidamide, a genotoxic metabolite; an association between exposure to acrylamide and risk of endometrial carcinoma (Type I carcinoma) has been demonstrated for patients who are neither smokers nor have taken oral contraceptives
- Micronutrient deficiency (vital substances) – see prevention with micronutrients.
- Physical activity
- “Frequent sitters” (66% higher risk from sitting while watching TV; 32% increase in risk for total sitting time)
- Psycho-social situation
- Night work
- Overweight (BMI ≥ 25; obesity), obesity – increase in BMI (body mass index) by five kg/m2 increases risk by relatively 59%; obesity is associated with earlier age at diagnosis of endometrioid endometrial cancer
Medications
- Hormone replacement therapy (HRT).
- Hormone therapy with estrogens alone without progestin protection in nonhysterectomized women.
- Long-term use of estrogens (estrogen monotherapy) (during and after menopause): 2.7-fold risk (95% CI 2.2-3.4); ≥ 10 years: 9.5-fold risk
- The use of progesterone or dydrogesterone as part of continuous combined hormone therapy may increase the risk of developing endometrial cancer.
- Tamoxifen therapy for breast cancer (mammary carcinoma) – slightly increased risk if duration of use > 5 years.
- Long-term use of tibolone (estrogenic agent used to treat symptoms of estrogen deficiency due to menopause).
Prevention factors (protective factors)
- Genetic factors:
- Genetic risk reduction depending on gene polymorphisms:
- Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
- Gene: ESR1
- SNP: rs9340799 in gene ESR1
- Allele constellation: AG (0.75-fold).
- Allele constellation: GG (0.53-fold)
- Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
- Genetic risk reduction depending on gene polymorphisms:
- Multiparity (occurrence of multiple births in the life of a woman).
- Diet: nut consumption – reduction of the risk of colorectal cancer by 24%.
- Coffee: women who drank from one cup of coffee daily had a lower risk of developing endometrial cancer (1-1.9 cups/day: RR 0.66; ≥ 2 cups/day: RR 0.69)
- Smoking
- Physical activity: high versus low leisure-time physical activity is associated with a lower risk of endometrial cancer (-21%; HR 0.79, 95% CI 0.68-0.92).
- Weight loss: obese women aged 50 to 79 years who had lost at least 5% weight after 3 years were 56% less likely to develop endometrial cancer.
- Intrauterine device (IUD) (esp. levonorgestrel-containing intrauterine devices (LNG-IUD).
- Combined hormonal contraceptives (CHD; English : combined oral contraceptives, COC; birth control pills); the protective effect is greater the longer they were taken: per 5 years, the relative risk decreases by 24% (RR 0.76; 95% confidence interval 0.73-0.78)S-3 guideline:
- “A reduction in endometrial cancer risk was observed with continuous combined hormone therapy with conjugated equine estrogens and medroxyprogesterone acetate as a progestin with an average duration of use of 5.6 years.”
- “Continuous-combination hormone therapy with <5 years of use can be considered safe with respect to endometrial cancer risk.”
- Acetylsalicylic acid (ASA): 22% risk reduction/RR = 0.78 [95% CI 0.6-0.9]; meta-analysis of 9 case-control and cohort studies identified.