Understanding Endometrial Cancer Risk
- There are certain risk factors associated with endometrial cancer, like family history and genetic abnormalities, that you can’t change.
- However, you have control over many other risk factors such as maintaining a healthy healthy weight, exercise, and diet.
- Many of the health factors that increase the risk of endometrial cancer lead to an excess of the female hormone estrogen that stimulate cell growth in the uterus.
- If you are considered high-risk, regular monitoring and paying attention to symptoms such as abnormal bleeding can help you stay healthy and catch problems early.
Endometrial cancer risk factors can be divided up into two categories — inherent and modifiable.
- Inherent risks are aspects of your health that you can’t change because they are part of your health history like genetics, family history, or another medical diagnosis. You can’t erase these factors entirely, but you can still take steps to minimize their impact on your endometrial cancer risk.
- Modifiable risks are aspects of your health that you can proactively change, often through small adjustments in lifestyle habits. Keeping an eye on these factors ensures you catch any problems as early as possible.
What Are My Inherent Risks?
Genetics and Family History
Inherited genetic mutations, particularly Lynch syndrome, can increase the risk of endometrial cancer. So can having a close family member like a mother, sister, cousin or aunt who has had endometrial or colorectal cancer.
- Lynch Syndrome: Sometimes referred to as Hereditary Nonpolyposis Colorectal Cancer (HNPCC), is caused by inherited mutations in genes responsible for repairing DNA, leading to a higher chance of cells growing uncontrollably and becoming cancerous. Women with Lynch syndrome, determined by special genetic testing, may be at higher risk for getting endometrial cancer at a younger age.
- Family History: A family history of endometrial cancer increases your risk because it may indicate an inherited genetic predisposition to the disease, especially if your close relative was diagnosed at a young age. This shared genetic background is why doctors often ask about your family’s health history.
“The one patient that you might be able to screen for endometrial cancer with endometrial biopsies is a patient that has known Lynch syndrome,” Dr. Chase tells SurvivorNet. “So if you are known to have Lynch syndrome … you’ve been tested for it and you have Lynch syndrome … you could be eligible for this screening protocol, which I would discuss with your doctor.”
She adds that, while you can’t change your DNA, if you have genetic risks in your background, there are steps you can take to make sure you stay on top of your health, including:
- Scheduling regular checkins with your doctor
- Starting regular screenings at age 35 in the form of endometrial biopsies
- Seeking genetic counseling and testing to assess your risk and come up with a personal plan to manage it
Related: The Crucial Role of Genetic & Molecular Sequencing
Age
Your chance of being diagnosed with endometrial cancer increases with each birthday.
“Now we are seeing a rise potentially in premenopausal cases, but age is one of the biggest risk factors for endometrial cancer,” Dr. Chase says.
The likelihood of genetic changes in the cells of the uterus lining grows over time. With more years, there’s a greater chance for DNA damage in these cells, which can lead to cancer. Additionally, hormonal changes associated with menopause can also contribute to the risk.
Here again, regular health screenings and discussions with your doctor can help you carefully monitor for any signs and symptoms to help catch the disease early.
Staying as healthy as possible for as long as possible by eating right, exercising, and practicing other smart health habits can also help.
Race and Ethnicity
Endometrial cancer is more common in white women compared to women of other racial and ethnic groups. Although experts still aren’t sure why white woman have higher rates of endometrial cancer, it could be due to a combination of genetic, environmental, and lifestyle factors.
Reproductive Factors
Your period, any other unusual vaginal bleeding, and your fertility contribute to your endometrial cancer risk.
Women who have an increased risk of endometrial cancer include those who:
- Started menstruation before age 12
- Went through menopause after the age of 55
- Have never given birth
- Experienced problems with fertility
- Have any unusual vaginal bleeding either before or after menopause
These sort of “reproductive factors” may not be modifiable for all individuals, but they are something you should pay attention to and discus with your doctor.
Dr. Chase stresses that any irregular bleeding, even if you think it’s not serious, could indicate something is off.
“So it’s very, very important to spread the word that if you have irregular bleeding, even a pink discharge, it doesn’t have to be bright red blood, even a pink discharge, don’t hesitate or don’t be afraid to get that checked out,” Dr. Chase advises.
PCOS
PCOS is a condition with symptoms such as:
- Irregular menstrual periods
- Excess androgens (acne, excess facial hair, and scalp hair loss),
- Ovaries that appear on an ultrasound to be “polycystic” meaning they have many cysts
Women with PCOS face a higher risk of endometrial cancer because of female hormone imbalances. Because PCOS results in too much estrogen and not enough progesterone, it stimulates excess growth of cells in the uterus that can become cancerous.
“PCOS is a condition that involves irregular menses, meaning women with PCOS have anovulatory bleeding. They don’t ovulate every month,” Dr. Chase explains. “So anovulatory bleeding is a risk factor for endometrial cancer, and it’s one of the characteristics of a patient that has PCOS. ”
Additionally, PCOS increases insulin resistance so that the body’s cells don’t respond normally to insulin. This further overstimulates cell growth.
If you have PCOS, this does not necessarily mean you will get endometrial cancer, reassures Dr. Chase. Your doctor will recommend regular monitoring and management strategies, to both treat the disease and watch for endometrial cancer. Recommendations usually include lifestyle changes to maintain a healthy weight and medications to regulate the menstrual cycle and reduce insulin resistance.
Related: Fitness Guru Jillian Michaels & Millions Dealing with PCOS
Breast Cancer Tamoxifen
Tamoxifen is a medication used to treat and prevent breast cancer by blocking estrogen in the breast tissue. While beneficial in breast cancers that are estrogen receptor-positive, it can act like estrogen in other parts of the body, such as the uterus, increasing the risk of endometrial cancer.
Doctors prescribe tamoxifen because its benefits in preventing and treating breast cancer can outweigh the risks of side effects, including the increased chances of endometrial cancer for many patients.
Risk varies among individuals, but studies suggest that tamoxifen may roughly double the chances of developing endometrial cancer, although the absolute risk remains relatively low.
To manage the risk of endometrial cancer when taking tamoxifen:
- Discuss the risks and benefits of taking the drug with your doctor
- Get regular gynecological exams to monitor for early signs of uterine changes
- Report any unusual symptoms, like vaginal bleeding, to your doctor immediately
“While it helps to prevent the breast cancer from coming back, believe it or not, it can stimulate the endometrial cells to proliferate and if they proliferate uncontrollably, they can turn into endometrial cancer. So if you are on Tamoxifen or have been on Tamoxifen and you have irregular bleeding, you should get evaluated for sure,” Dr. Chase says.
“Being on Tamoxifen doesn’t mean you should go in for more frequent exams or biopsies, but definitely if you have irregular bleeding on Tamoxifen, it should be worked up right away,” she adds.
What Risk Factors Can I Control?
There are several endometrial cancer risk factors that are more in your control. Making meaningful changes to them can lower your chances of getting endometrial cancer.
Obesity
“If your BMI is in the obese range, you could be at increased risk for endometrial cancer,” warns Dr. Chase.
Excess body fat can lead to increased estrogen production, which in turn may promote the growth of endometrial cells. Achieving and maintaining a healthy weight through a balanced diet and regular exercise and movement can help reduce endometrial cancer risk.
Compared to women at a healthy weight, women who are overweight have double the risk of endometrial cancer, and women who have obesity have three times the risk.
Even modest weight loss can have a beneficial effect on lowering risk.
Hormone Therapy
Estrogen-only hormone replacement therapy (HRT) without progesterone is commonly used to manage menopausal symptoms but it has been associated with an increased risk of endometrial cancer. Here again, it comes down to too much estrogen causing excess cell growth.
If your doctor tells you that hormone therapy is necessary, you should discuss a combined estrogen and progesterone therapy or other alternative treatments that can lower endometrial cancer risk. If you and your doctor determine that estrogen-only therapy is right for you, you and your doctor will put a plan in place to monitor for endometrial cancer.
Alcohol Consumption
Heavy alcohol consumption has been associated with a higher risk of endometrial cancer, potentially because it stimulates estrogen production.
Limiting alcohol intake to moderate levels (defined as up to one drink per day for women) or refraining from drinking alcohol altogether can help reduce endometrial cancer risk.
Dietary Factors
Diets high in red meat, processed meats, saturated fats, and refined carbohydrates have been linked to an increased risk of endometrial cancer, while diets rich in fruits, vegetables, whole grains, and lean proteins may be protective.
Adopting a healthy eating pattern that emphasizes plant-based foods, whole grains, lean proteins, and healthy fats can help lower endometrial cancer risk. Additionally, reducing intake of processed and sugary foods may further mitigate risk.
By addressing these modifiable risk factors through lifestyle changes and proactive health management, individuals can significantly reduce their risk of developing endometrial cancer and improve their overall health and well-being.
Related: Understanding the Risks and Symptoms of Uterine Cancer
Prevention Strategies
Lifestyle and medical strategies do make a difference. To lower your chances of developing endometrial cancer, consider the following:
- Discuss hormone therapy with your healthcare team
If you’re contemplating hormone replacement therapy for menopause symptoms, discuss the pros and cons. Combining estrogen with progestin in hormone therapy can lessen the risk associated with estrogen-only therapy. However, hormone therapy has other risks, so it’s important that you and your doctor evaluate the benefits and risks carefully.
- Consider using birth control pills
Taking oral contraceptives for at least a year can decrease your risk of endometrial cancer. Birth control pills help keep female hormones balanced and they decrease the chance of uncontrolled cell growth in the uterus.
The protective effect of birth control pills can persist for several years after you stop taking the pills. However, birth control pills have side effects, so you need to weigh the pros and cons of taking them carefully.
- Aim for a healthy weight
Strive to reach and maintain a healthy weight by increasing physical activity and reducing calorie intake. Even a modest weight loss can have a positive impact on health.
- Stay physically active
Exercise helps regulate hormones, including insulin and estrogen, and can help maintain a healthy weight. Your goal should beat least 150 minutes of moderate cardiovascular activity, like walking, swimming or cycling, or 75 minutes of vigorous activity each week such as running, along with strength training at least twice a week.
- Eat a healthy diet
While there’s no specific diet to prevent endometrial cancer, a diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health and help maintain a healthy weight. Limiting intake of red and processed meats, sugary beverages, and highly processed foods may also contribute to a lower risk of endometrial cancer.
- Manage other health conditions
Conditions such as diabetes and PCOS can increase the risk of endometrial cancer. Managing these conditions through medication, lifestyle changes, and regular check-ups can help reduce the risk.
- Regular screening and monitoring
National Comprehensive Cancer Network, a coalition of more than 30 top cancer centers, recommends regular screening for women at high risk of endometrial cancer, such as those with a family history of the disease or certain genetic conditions. While they don’t recommend regular screening for most women who have no symptoms, high risk women should begin regular check ups in their twenties.
Discussing individual risk factors with a healthcare provider can help determine the best screening strategy.
Dr. Chase underscores the importance of getting regular checkups and paying attention to any unusual symptoms.
“It’s really important if you have irregular bleeding to have a pelvic exam, because remember, this is the most common gynecologic cancer,” Dr. Chase says. “We’ve made a lot of progress but for many reasons, endometriaI cancer is on the rise.”
Questions to Ask Your Doctor
If you are concerned about your risk of endometrial cancer, discuss it with your health care provider team. You can consider asking them the following questions:
- What steps should I take to lower my chance of developing endometrial cancer?
- Am I considered high-risk?
- What are my options for cancer screening?
- Should I meet with a genetic counselor?
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