Review PaperThe effect of body mass index on endometrial cancer: a meta-analysis
Introduction
Endometrial cancer is the seventh most common cancer in women worldwide and the most common gynecological malignancy in developed countries.1, 2 Its incidence has been increasing over the last decades.3 The main etiology of uterine cancer is not well known. Some risk factors reported for uterine cancer are age, reproductive history, diabetes, early menarche, late menopause, and the use of estrogen hormone without progesterone.2, 4, 5
The prevalence of overweight and obesity is dramatically increasing in most parts of the world and is generally higher in women than in men.6 The association between body mass index (BMI) and breast, ovarian, and cervical cancers has already been addressed.7, 8, 9 Some studies reported a significant association between BMI and endometrial cancer10, 11, 12, 13 while others have not confirmed the association.14, 15, 16, 17, 18 The findings from a current meta-analysis which included the published papers by 2011 confirmed the association between BMI and endometrial cancer.19 The present up-to-date meta-analysis was conducted to assess the results of both cohort and case-control studies addressing the correlation between BMI and endometrial cancer separately based on the current evidence.
Section snippets
Definitions
Endometrial cancer is the cancer of the uterine corpus. Two major types of endometrial cancer have been described. Type I tumors are mostly endometrioid adenocarcinomas (about 80% of endometrial cancers) and Type II tumors are mainly serous and clear cell adenocarcinomas.20, 21
BMI is weight in kilograms divided by the square of the height in meters. Based on the World Health Organization classification, BMI is divided into underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight
Description of studies
As shown in Fig. 1, we retrieved 6241 references up to March 2015, including 5952 references through searching electronic databases, 289 references through checking other sources such as reference lists, related conference databases, or through personal contact with authors of the included studies. Of 158 references considered potentially eligible after screening, 118 studies were excluded and 40 studies were eventually included for meta-analysis including 20 prospective cohort studies1, 2, 10,
Discussion
The results of this meta-analysis revealed that increase in BMI is significantly associated with an increased risk of endometrial cancer, so that, compared to normal weight individuals, the risk of endometrial cancer increase about 1.5 fold in overweight people and more than 2.5 fold in obese people. In other words, as BMI increases, the risk of endometrial cancer also increases. This evidence shows a dose-response relationship for BMI and endometrial cancer. When a dose-response relationship
Acknowledgments
We would like to thank the Vice-chancellor of Research and Technology of Islamic Azad University, Branch Toyserkan for approval of this study.
Ethical approval
Ethical approval was not sought, as it was not required for conducting a meta-analysis.
Funding
This study was supported by the Vice-chancellor of Research and Technology of Islamic Azad University, Branch Toyserkan.
Conflict of interest statement
The authors have declared that no competing interests exist.
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