Changing Trends in the Epidemiology of Endometrial Cancer

Uterine corpus cancer (UCC) is the 6th most common female malignancy worldwide and the 14th most deadly. Importantly, UCC represents a significant locus of health disparities both globally and within the United States, with notable differences seen in both its geographical incidence and in outcomes between various racial/ethnic cohorts. UCC is categorized into Type I and Type II carcinomas, each with its own idiosyncratic presentation, epidemiologic risk factors, and prognosis. Type II carcinomas are rarer, and typically arise in older patients in the setting of an atrophic endometrium. Type I carcinomas are more common and are thought to arise due to chronic exposure to estrogen unopposed by a progestogen, with various potential risk factors tied to either endogenous or exogenous estrogen exposure. This chapter presents the most recent epidemiologic data regarding UCC, briefly introduces the many avenues of investigation that have been conducted into its risk factors, and summarizes the most recent findings on each topic. Particular attention is devoted to the role that geographic and racial/ethnic differences play in UCC risk factors and outcomes, and because UCC incidence is higher in Western and more industrialized countries, this chapter examines obesity, diabetes mellitus, and various lifestyle factors that are especially relevant to these regions. Also considered is the impact of estrogen-modifying therapies (e.g., oral contraceptives, hormone replacement therapy, tamoxifen, and aromatase inhibitors) on UCC risk. Finally, the most up-to-date information on the role of parity, contraception, and sterilization is presented, with careful attention paid to genetic syndromes as well.