ASPO Abstracts
Examining the risk factor profile of early-onset endometrial cancer
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose Endometrial cancer (EC) incidence is rising the fastest in women <50 years old, mirroring trends in younger individuals for other obesity-related cancers. Understanding the risk factor profile of early-onset EC (EOEC) is crucial to inform public health strategies to combat the rising burden of this disease. Methods We pooled data for 25 studies in the Epidemiology of Endometrial Cancer Consortium (8 cohort, 17 case-control). The analytic cohort included 13,846 EC cases and 30,610 controls matched on age, race, and study-appropriate factors. 1,639 cases and 4,087 controls were <50 years old at index date. We used generalized linear mixed model regression to estimate unconditional odds ratios (OR) and 95% confidence intervals (CI) of the association between select risk factors and EC with random effects terms for study site. Analyses were stratified by age (EOEC:<50, late-onset EC [LOEC]:≥50 years) and race, and adjusted for matched factors and covariates. Results Associations between most risk factors and EOEC were stronger than those observed with LOEC. Compared with body mass index (BMI; kg/m2) <25, women with BMI ≥35 had a 5.6-fold increased risk of EOEC (OR=5.57;95% CI:4.33,7.16) vs. a 4.7-fold increased risk of LOEC (OR=4.68;95% CI:4.30,5.09,PHet<0.05). Higher BMI was associated with increased EOEC risk across all racial groups. Participants with ≥4 livebirths were at a 69% reduced EOEC risk (OR=0.31;95% CI:0.23,0.42) and a 43% reduced LOEC risk (OR=0.57;95% CI:0.53,0.62,PHet<0.05) compared with nulliparous women. In exploratory race-stratified analyses, White and Asian women with ≥4 live births had a reduced risk of developing EOEC (OR=0.25; 95% CI:0.17,0.36 and OR=0.11;95% CI: 0.02,0.54, respectively, vs nulliparous). While associations between smoking and EOEC were inverse in White women (current vs never OR=0.80;95% CI:0.64,0.99), we observed an unexpected positive association in Black women (OR=2.52;95% CI:1.33,4.78). Discussion Modifiable factors may play an especially pronounced role in EOEC; increasing incidence may be driven by changes in modifiable factors such as obesity. As routine EC screening is not recommended in the general population, clinical vigilance and education may be warranted in women of reproductive age with high-risk pro
Keywords: Early-onset endometrial cancer, disparities