More risk of endometrial cancer after menopause


April 27, 1993|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

Most women know about cervical cancer because the media and doctors have emphasized the need for regular screening for that disease. However, they know much less about the other common cancer of the uterus, endometrial cancer. This cancer is very different from cervical cancer, as has been pointed out by Dr. Elizabeth Elliott and others at Johns Hopkins who have studied women with endometrial cancer.

Who is at risk for endometrial cancer?

Endometrial cancer usually occurs in middle- or upper-class women in their post-menopausal years. In fact, the frequency of the cancer rises rapidly around the time of menopause and falls again in later years. It occurs more frequently in women who have had no children and who are obese. Fortunately, the rate of survival from this cancer is very good. About 70 percent of patients survive five years or more.

What are warning signs of endometrial cancer?

The main symptom is vaginal bleeding after menopause, which usually brings the woman to the doctor because most women know that abnormal bleeding needs a doctor's attention. There is no routine, simple screening test for this cancer.

The chance of getting endometrial cancer is greater if a woman has an increase in estrogen either because she takes post-menopausal estrogen without progesterone or because her body makes estrogen by metabolizing stored body fat.

What is the relationship between obesity and estrogen?

Before menopause, estrogen levels are high due to ovarian function, but after menopause small amounts of estrogen can be made from other hormones. This occurs more commonly in obese women because the body makes estrogen by metabolizing stored body fat. It appears that women who are shaped more like apples than pears may be better able to make estrogen. "Apple-shaped" women are those who have a higher ratio of upper to lower body fat. The relationship between estrogen levels and body shape isn't yet proven, but it is under study.

Are there any other diseases related to body shape?

Diabetes and high blood pressure have been associated with the "apple" and "pear" differences in body shape. These are also diseases that occur with increased frequency in women with endometrial cancer. We don't know yet how these pieces fit together, but the message seems to be that all fat is not the same.

Does cigarette smoking play a role in endometrial cancer?

Cigarette smoking reduces the risk of endometrial cancer. This certainly is a different message than we usually get about cigarettes, but it has been shown in several studies. The protection seems to occur only in women who are current smokers and is most protective in those who are obese. This correlation has led investigators to speculate that the protective effect of smoking somehow relates to reducing the excess estrogen that is thought to be made from body fat.

There is some evidence that smoking may cause estrogen to be metabolized through a different metabolic pathway. We just don't know enough about how estrogen is metabolized in post-menopausal women to have the answers. Lose weight if you want to prevent this cancer, but don't start smoking.

Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.

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