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Among postmenopausal women, intentional weight loss protects against endometrial cancer, even if that loss is modest (5% or more), according to a report in the Journal of Clinical Oncology.
Endometrial cancer is the malignancy most strongly associated with obesity, but to date few studies have examined the effect of intentional weight loss on risk. Researchers analyzed data from the prospective Women’s Health Initiative to assess this relationship in a large, ethnically diverse population of postmenopausal women with detailed records on potentially confounding factors such as body mass index, smoking status, physical activity level, hormone therapy use, parity, age at menarche, age at first birth, and family history.
They focused on 36,793 women who participated in the WHI and who reported whether they had maintained a stable weight, lost 5% or more of their total weight, or gained 5% or more of their total weight during the first 3 years after enrollment. During a mean of 11.4 years of follow-up, 566 of these women developed endometrial cancer, said Juhua Luo, PhD, of the department of epidemiology and biostatistics, Indiana University School of Public Health, Bloomington, and her associates.
Women who lost weight intentionally showed a significantly lower risk of endometrial cancer than did those who had stable weight (HR, 0.71). This association was most pronounced among obese women: Those who lost at least 5% of their body weight intentionally showed a dramatic reduction in endometrial cancer risk (HR, 0.44). In contrast, unintentional weight loss was not associated with a lower risk of endometrial cancer. And women who gained 10 pounds or more during the first 3 years of the study showed a significantly higher risk of endometrial cancer, the investigators said (J Clin Oncol. 2017 Feb 6. doi: 10.1200/JCO.2016.70.5822).
In a sensitivity analysis, women who intentionally lost weight and achieved a normal BMI showed the same risk of endometrial cancer as that of those who had maintained a stable BMI throughout the study.
Luo et al. showed that women who deliberately lost 5% or more of their body weight during a 3-year period reduced their long-term risk of endometrial cancer by nearly 30%, and obese women did so by 56%. At a minimum, clinicians should inform their patients about this association, especially because the link between obesity and endometrial cancer is clearly underrecognized.
But given the difficulty of losing weight, more aggressive strategies may be beneficial. Bariatric surgery and the use of progestational agents such as levonorgestrel IUDs warrant consideration.
Screening for endometrial cancer currently is very limited, so it also should be reassessed. Endometrial sampling and transvaginal ultrasound have drawbacks, including a lack of sensitivity and specificity in asymptomatic women. If more novel strategies prove reliable and cost-effective, including uterine lavage and collection of exfoliated cells from the cervix, they can be widely adapted into clinical practice.
Jason D. Wright, MD, is in the division of gynecologic oncology at Columbia University, New York, and New York Presbyterian Hospital. He reported having no relevant financial disclosures. Dr. Wright made these remarks in an editorial accompanying Dr. Luo’s report (J Clin Oncol. 2017 Feb 6. doi: 10.1200/JCO.2016.71.7991).
Luo et al. showed that women who deliberately lost 5% or more of their body weight during a 3-year period reduced their long-term risk of endometrial cancer by nearly 30%, and obese women did so by 56%. At a minimum, clinicians should inform their patients about this association, especially because the link between obesity and endometrial cancer is clearly underrecognized.
But given the difficulty of losing weight, more aggressive strategies may be beneficial. Bariatric surgery and the use of progestational agents such as levonorgestrel IUDs warrant consideration.
Screening for endometrial cancer currently is very limited, so it also should be reassessed. Endometrial sampling and transvaginal ultrasound have drawbacks, including a lack of sensitivity and specificity in asymptomatic women. If more novel strategies prove reliable and cost-effective, including uterine lavage and collection of exfoliated cells from the cervix, they can be widely adapted into clinical practice.
Jason D. Wright, MD, is in the division of gynecologic oncology at Columbia University, New York, and New York Presbyterian Hospital. He reported having no relevant financial disclosures. Dr. Wright made these remarks in an editorial accompanying Dr. Luo’s report (J Clin Oncol. 2017 Feb 6. doi: 10.1200/JCO.2016.71.7991).
Luo et al. showed that women who deliberately lost 5% or more of their body weight during a 3-year period reduced their long-term risk of endometrial cancer by nearly 30%, and obese women did so by 56%. At a minimum, clinicians should inform their patients about this association, especially because the link between obesity and endometrial cancer is clearly underrecognized.
But given the difficulty of losing weight, more aggressive strategies may be beneficial. Bariatric surgery and the use of progestational agents such as levonorgestrel IUDs warrant consideration.
Screening for endometrial cancer currently is very limited, so it also should be reassessed. Endometrial sampling and transvaginal ultrasound have drawbacks, including a lack of sensitivity and specificity in asymptomatic women. If more novel strategies prove reliable and cost-effective, including uterine lavage and collection of exfoliated cells from the cervix, they can be widely adapted into clinical practice.
Jason D. Wright, MD, is in the division of gynecologic oncology at Columbia University, New York, and New York Presbyterian Hospital. He reported having no relevant financial disclosures. Dr. Wright made these remarks in an editorial accompanying Dr. Luo’s report (J Clin Oncol. 2017 Feb 6. doi: 10.1200/JCO.2016.71.7991).
Among postmenopausal women, intentional weight loss protects against endometrial cancer, even if that loss is modest (5% or more), according to a report in the Journal of Clinical Oncology.
Endometrial cancer is the malignancy most strongly associated with obesity, but to date few studies have examined the effect of intentional weight loss on risk. Researchers analyzed data from the prospective Women’s Health Initiative to assess this relationship in a large, ethnically diverse population of postmenopausal women with detailed records on potentially confounding factors such as body mass index, smoking status, physical activity level, hormone therapy use, parity, age at menarche, age at first birth, and family history.
They focused on 36,793 women who participated in the WHI and who reported whether they had maintained a stable weight, lost 5% or more of their total weight, or gained 5% or more of their total weight during the first 3 years after enrollment. During a mean of 11.4 years of follow-up, 566 of these women developed endometrial cancer, said Juhua Luo, PhD, of the department of epidemiology and biostatistics, Indiana University School of Public Health, Bloomington, and her associates.
Women who lost weight intentionally showed a significantly lower risk of endometrial cancer than did those who had stable weight (HR, 0.71). This association was most pronounced among obese women: Those who lost at least 5% of their body weight intentionally showed a dramatic reduction in endometrial cancer risk (HR, 0.44). In contrast, unintentional weight loss was not associated with a lower risk of endometrial cancer. And women who gained 10 pounds or more during the first 3 years of the study showed a significantly higher risk of endometrial cancer, the investigators said (J Clin Oncol. 2017 Feb 6. doi: 10.1200/JCO.2016.70.5822).
In a sensitivity analysis, women who intentionally lost weight and achieved a normal BMI showed the same risk of endometrial cancer as that of those who had maintained a stable BMI throughout the study.
Among postmenopausal women, intentional weight loss protects against endometrial cancer, even if that loss is modest (5% or more), according to a report in the Journal of Clinical Oncology.
Endometrial cancer is the malignancy most strongly associated with obesity, but to date few studies have examined the effect of intentional weight loss on risk. Researchers analyzed data from the prospective Women’s Health Initiative to assess this relationship in a large, ethnically diverse population of postmenopausal women with detailed records on potentially confounding factors such as body mass index, smoking status, physical activity level, hormone therapy use, parity, age at menarche, age at first birth, and family history.
They focused on 36,793 women who participated in the WHI and who reported whether they had maintained a stable weight, lost 5% or more of their total weight, or gained 5% or more of their total weight during the first 3 years after enrollment. During a mean of 11.4 years of follow-up, 566 of these women developed endometrial cancer, said Juhua Luo, PhD, of the department of epidemiology and biostatistics, Indiana University School of Public Health, Bloomington, and her associates.
Women who lost weight intentionally showed a significantly lower risk of endometrial cancer than did those who had stable weight (HR, 0.71). This association was most pronounced among obese women: Those who lost at least 5% of their body weight intentionally showed a dramatic reduction in endometrial cancer risk (HR, 0.44). In contrast, unintentional weight loss was not associated with a lower risk of endometrial cancer. And women who gained 10 pounds or more during the first 3 years of the study showed a significantly higher risk of endometrial cancer, the investigators said (J Clin Oncol. 2017 Feb 6. doi: 10.1200/JCO.2016.70.5822).
In a sensitivity analysis, women who intentionally lost weight and achieved a normal BMI showed the same risk of endometrial cancer as that of those who had maintained a stable BMI throughout the study.
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Among postmenopausal women, intentional weight loss protects against endometrial cancer, even if that loss is modest (5% or more).
Major finding: Women who intentionally lost at least 5% of their total body weight showed a significantly lower risk of endometrial cancer than did those who had stable weight (HR, 0.71), and obese women showed a dramatically reduced risk (HR, 0.44).
Data source: A secondary analysis of data from 36,793 women participating in the Women’s Health Initiative.
Disclosures: No sponsor was cited for this study. Dr. Luo reported having no relevant financial disclosures; her associates reported ties to numerous industry sources.