Risk Factors for Endometrial Cancer: Results from a Hospital-Based Case-Control Study

  • Andarieh, Maryam Ghanbari (Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science) ;
  • Delavar, Mouloud Agajani (Department of Midwifery, Babol University of Medical Science) ;
  • Moslemi, Dariush (Department of Radiation Oncology, Babol University of Medical Science) ;
  • Esmaeilzadeh, Sedighe (Department of Obstetrics and Gynecology, Babol University of Medical Science)
  • Published : 2016.10.01


Objectives: The purpose of this investigation was to examine the association between endometrial cancer and possible etiological agents. Methods: A case-control study was conducted in Iran between March 2012 and May 2016. The demographic and reproductive factors of 205 women with endometrial cancer were compared, and 590 healthy cases were participated in the control group. For each endometrial cancer case, there were three controls, who were matched in terms of age and residence. The data were considered significant at $p{\leq}0.05$. Results: After adjusting the variables, the nulliparity (OR 6.23, 95% CI 2.86-13.59), the nulligravidity (OR 5.94, 95% CI 2.51-14.06), the positive family history of reproductive cancer (OR 4.97, 95% CI 2.33-10.59), the infertility history (OR 2.38, 95%CI 1.32-4.31), the obesity ($BMI{\geq}25$) (OR 1.71, 95% CI 1.16-2.52), the early menarche age (<12 years) (OR 2.10, 95% CI 1.17-3.75), and the hormonal contraception use (OR 1.69, 95% CI 1.15-2.49) were found to be associated with an increased risk of endometrial cancer. Nevertheless, the education level, the job of women, the marital age, the leisure activities, and the breast feeding were not found to be associated with the endometrial cancer after adjusting the variables. Conclusion: Scheduling of the screening program is vitally indispensable to identify endometrial cancer in women with nulliparity, nulligravidity and the positive family history of cancer. In addition, women with early menarche, those with the history of infertility, the obese ones, and those who use contraception pills need to be particularly aware of the potential risks.


Endometrial cancer;risk factors;case-control;parity;gravidity;positive family history


  1. Al-Zoughool M, Dossus L, Kaaks R, et al (2007). Risk of endometrial cancer in relationship to cigarette smoking: results from the EPIC study. Int J Cancer, 121, 2741-7.
  2. Arbyn M, Anttila A, Jordan J, et al (2010). European guidelines for quality assurance in cervical cancer screening. -summary document. Ann Oncol, 21, 448-58.
  3. Beral V, Bull D, Green J, et al (2007). Ovarian cancer and hormone replacement therapy in the million women study. Lancet, 369, 1703.
  4. Bokhman JV (1983). Two pathogenetic types of endometrial carcinoma. Gynecol Oncol, 15, 7-10.
  5. Brinton LA, Berman ML, Mortel R, et al (1992). Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study. Am J Obstet Gynecol, 167, 1317-25.
  6. Brinton LA, Westhoff CL, Scoccia B, et al (2005). Causes of infertility as predictors of subsequent cancer risk. Epidemiology, 16, 500-7.
  7. Brons N, Baandrup L, Dehlendorff C, et al (2015). Use of nonsteroidal anti-inflammatory drugs and risk of endometrial cancer: a nationwide case-control study. Cancer Causes Control, 26, 973-81.
  8. Dossus L, Allen N, Kaaks R, et al (2010). Reproductive risk factors and endometrial cancer: the european prospective investigation into cancer and nutrition. Int J Cancer, 127, 442-51.
  9. Felix AS, Weissfeld JL, Stone RA, et al (2010). Factors associated with Type I and Type II endometrial cancer. Cancer Causes Control, 21, 1851-6.
  10. Filomeno M, Bosetti C, Bidoli E, et al (2015). Mediterranean diet and risk of endometrial cancer: a pooled analysis of three Italian case-control studies. Br J Cancer, 112, 1816-21.
  11. Foley K, Lee RB (1990). Surgical complications of obese patients with endometrial carcinoma. Gynecol Oncol, 39, 171-4.
  12. Frumovitz M, Jhingran A, Soliman PT, et al (2014). Morbid obesity as an independent risk factor for disease-specific mortality in women with cervical cancer. Obstet Gynecol, 124, 1098-104.
  13. Fujita M, Tase T, Kakugawa Y, et al (2008). Smoking, earlier menarche and low parity as independent risk factors for gynecologic cancers in Japanese: a case-control study. Tohoku J exp Med, 216, 297-307.
  14. Furness S, Roberts H, Marjoribanks J, et al (2009). Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev, 15, CD000402.
  15. Gong TT, Wang YL, Ma XX (2015). Age at menarche and endometrial cancer risk: a dose-response meta-analysis of prospective studies. Sci Rep, 5, 14051.
  16. Hirth JM, Laz TH, Rahman M, et al (2016). Racial/ethnic differences affecting adherence to cancer screening guidelines among women. J Women’s Health, 25, 371-80.
  17. Ichinose M, Fujimoto A, Osuga Y, et al (2013). The influence of infertility treatment on the prognosis of endometrial cancer and atypical complex endometrial hyperplasia. Int J Gynecol Cancer, 23, 288-93.
  18. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  19. Koumantaki Y, Tzonou A, Koumantakis E, et al (1989). A case-control study of cancer of endometrium in athens. Int J Cancer, 43, 795-9.
  20. Kvale G, Heuch I, Ursin G (1988). Reproductive factors and risk of cancer of the uterine corpus: a prospective study. Cancer Res, 48, 6217-21.
  21. La Vecchia C, Franceschi S, Decarli A, et al (1984). Risk factors for endometrial cancer at different ages. J Natl Cancer Inst, 73, 667-71.
  22. Lee JY, Kim EY, Jung KW, et al (2014). Trends in gynecologic cancer mortality in East Asian regions. J Gynecol Oncol, 25, 174-82.
  23. Liao C, Zhang D, Mungo C, et al (2014). Is diabetes mellitus associated with increased incidence and disease-specific mortality in endometrial cancer? A systematic review and meta-analysis of cohort studies. Gynecol Oncol, 135, 163-71.
  24. Liat LG, Jaron R, Liraz O, et al (2012). Are infertility treatments a potential risk factor for cancer development? Perspective of 30 years of follow-up. Gynecol Endocrinol, 28, 809-14.
  25. Lindemann K, Vatten L, Ellstrom-Engh M, et al (2008). Body mass, diabetes and smoking, and endometrial cancer risk: a follow-up study. Br J Cancer, 98, 1582-5.
  26. Matikainen T, Perez GI, Jurisicova A, et al (2001). Aromatic hydrocarbon receptor-driven Bax gene expression is required for premature ovarian failure caused by biohazardous environmental chemicals. Nat Genet, 28, 355-60.
  27. Niyazi M, Husaiyin S, Han L, et al (2016). Prevalence of and risk factors for high-risk human papillomavirus infection: A population-based study from Hetian, Xinjiang, China. Bosn J Basic Med Sci, 16, 46.
  28. Parazzini F, Negri E, La Vecchia C, et al (1998). Role of reproductive factors on the risk of endometrial cancer. Int J Cancer, 76, 784-6.<784::AID-IJC2>3.0.CO;2-U
  29. Parslov M, Lidegaard O, Klintorp S, et al (2000). Risk factors among young women with endometrial cancer: a Danish case-control study. Am J Obstet Gynecol, 182, 23-9.
  30. Rapp K, Schroeder J, Klenk J, et al (2005). Obesity and incidence of cancer: a large cohort study of over 145000 adults in Austria. Br J Cancer, 93, 1062-7.
  31. Renehan AG, Tyson M, Egger M, et al (2008). Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet, 371, 569-78.
  32. Salazar-Martinez E, Lazcano-Ponce EC, Lira-Lira GG, et al (2000). Case-control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women. Cancer Causes Control, 11, 707-11.
  33. Siegel R, Naishadham D, Jemal A (2012). Cancer statistics, 2012. CA Cancer J Clin, 62, 10-29.
  34. Soliman PT, Bassett-Jr RL, Wilson EB, et al (2008). Limited public knowledge of obesity and endometrial cancer risk: what women know. Obstet Gynecol, 112, 835-42.
  35. Soliman PT, Oh JC, Schmeler KM, et al (2005). Risk factors for young premenopausal women with endometrial cancer. Obstet Gynecol, 105, 575-80.
  36. Terry P, Baron JA, Weiderpass E, et al (1999). Lifestyle and endometrial cancer risk: a cohort study from the Swedish Twin Registry. Int J Cancer, 82, 38-42.<38::AID-IJC8>3.0.CO;2-Q
  37. Torre LA, Bray F, Siegel RL, et al (2015). Global cancer statistics, 2012. CA Cancer J Clin, 65, 87-108.
  38. Urban M, Banks E, Egger S, et al (2012). Injectable and oral contraceptive use and cancers of the breast, cervix, ovary, and endometrium in black South African women: case-control study. PLoS Med, 9, e1001182.
  39. Viswanathan AN, Feskanich D, De Vivo I, et al (2005). Smoking and the risk of endometrial cancer: results from the Nurses’ Health Study. Int J Cancer, 114, 996-1001.
  40. Weiderpass E, Adami HO, Baron JA, et al (1999). Use of oral contraceptives and endometrial cancer risk (Sweden). Cancer Causes Control, 10, 277-84.
  41. Win AK, Reece JC, Ryan S (2015). Family history and risk of endometrial cancer: a systematic review and meta-analysis. Obstet Gynecol, 125, 89-98.
  42. Yang H, Cook L, Weiderpass E, et al (2015). Infertility and incident endometrial cancer risk: a pooled analysis from the epidemiology of endometrial cancer consortium (E2C2). Br J Cancer, 112, 925-33.
  43. Zhou B, Yang L, Sun Q, et al (2008). Cigarette smoking and the risk of endometrial cancer: a meta-analysis. Am J Med, 121, 501-8.