Background:
Obesity has been established as a modifiable risk factor for endometrial cancer in population-based analyses before and the link between obesity and poorer outcomes in this population has also been well established in the literature. With an observed increase in rates of endometrial cancer across Queensland (40% rise over the last 20 years) attention has turned to mitigation of such risk factors that have risen concomitantly.
Aims: This study analysis will examine overall trends in BMI among Queensland women with endometrial cancer, comparing the age specific rates of obesity at presentation.
Methods: Population data was obtained from the Queensland Oncology Repository, linked to the Queensland Cancer Registry. Treatment data was obtained from both public and private hospitals, and included FIGO staging, biomarkers, treatment data and outcomes, in association with databases from the Queensland Centre for Gynaecological Cancer. BMI data was obtained from oncology information systems and verified with values from admission for treatment. Data was compared to that from 2001 in the Queensland population.
Results: 2,925 patients were included over a 4 year period. The overall incidence of endometrial cancer rose in the interim between 2001 and 2020 by 40% (16.9 per 100,000 to 23.3 per 100,000). The rates of obesity in women aged 18+ has risen from 43% to 56%. The effect of obesity on rates of endometrial cancer is most significantly noted in the younger age group (<40yrs old) where almost 40% of new diagnoses were associated with BMI greater than 40 (in comparison to 30% of new diagnoses aged 60-69). The overall rate of women with Endometrial Cancer that were obese was 68%, which was higher than the general population (52-57%). Obesity is associated with increased medical co-morbidities (22% of class III obese patients having 2+ comorbidities in comparison to 8% of those with BMI <30) which overall impacts suitability for primary surgical treatment. Rates of surgical management in this group (class III obesity) are significantly lower than those in class II and below (73% vs >90%).
Conclusion: Increases in the rates of obesity and endometrial cancer appear potentially linked. Given the modifiable risk factor of increased BMI, more public awareness of this relationship is needed and attention needs to be directed to education and weight loss as a risk reduction tool. As the rates appear highest in the younger age groups <40yr old, attention should be directed to this age group wherein reduction of BMI may not only reduce risk of developing Endometrial Cancer but also potentially reduce the development of comorbidities that are associated with increased risks of treatment complications as well as overall morbidity and mortality.