Type I and II Endometrial Cancers: Have They Different Risk Factors?

Veronica Wendy Setiawan(Cancer Prevention Institute of California), Hannah Yang(Cancer Prevention Institute of California), Malcolm C. Pike(Cancer Prevention Institute of California), Susan E. McCann(Cancer Prevention Institute of California), Herbert Yu(Cancer Prevention Institute of California), Yong‐Bing Xiang(Cancer Prevention Institute of California), Alicja Wolk(Cancer Prevention Institute of California), Nicolas Wentzensen(Cancer Prevention Institute of California), Noel S. Weiss(Cancer Prevention Institute of California), Penelope M. Webb(Cancer Prevention Institute of California), Piet A. van den Brandt(Cancer Prevention Institute of California), Koen Van de Vijver(Cancer Prevention Institute of California), Pamela J. Thompson(Cancer Prevention Institute of California), The Australian National Endometrial Cancer Study Group(Cancer Prevention Institute of California), Brian L. Strom(Cancer Prevention Institute of California), Amanda B. Spurdle(Cancer Prevention Institute of California), Robert A. Soslow(Cancer Prevention Institute of California), Xiao‐Ou Shu(Cancer Prevention Institute of California), Catherine Schairer(Cancer Prevention Institute of California), Carlotta Sacerdote(Cancer Prevention Institute of California), Thomas E. Rohan(Cancer Prevention Institute of California), Kim Robien(Cancer Prevention Institute of California), Harvey A. Risch(Cancer Prevention Institute of California), Fulvio Ricceri(Cancer Prevention Institute of California), Timothy R. Rebbeck(Cancer Prevention Institute of California), Radhai Rastogi(Cancer Prevention Institute of California), Jennifer Prescott(Cancer Prevention Institute of California), Silvia Polidoro(Cancer Prevention Institute of California), Yikyung Park(Cancer Prevention Institute of California), Sara H. Olson(Cancer Prevention Institute of California), Kirsten B. Moysich(American Cancer Society), Anthony B. Miller(Cancer Prevention Institute of California), Marjorie L. McCullough(Cancer Prevention Institute of California), Rayna K. Matsuno(Cancer Prevention Institute of California), Anthony M. Magliocco(Cancer Prevention Institute of California), Galina Lurie(Cancer Prevention Institute of California), Lingeng Lu(Cancer Prevention Institute of California), Jolanta Lissowska(Cancer Prevention Institute of California), Xiaolin Liang(Cancer Prevention Institute of California), James V. Lacey(Cancer Prevention Institute of California), Laurence N. Kolonel(Cancer Prevention Institute of California), Brian E. Henderson(Cancer Prevention Institute of California), Susan E. Hankinson(Cancer Prevention Institute of California), Niclas Håkansson(Cancer Prevention Institute of California), Marc T. Goodman(Cancer Prevention Institute of California), Mia M. Gaudet(Cancer Prevention Institute of California), Montserrat García‐Closas(Alberta Health Services), Christine M. Friedenreich(Cancer Prevention Institute of California), Jo L. Freudenheim(Dartmouth College), Jennifer A. Doherty(Cancer Prevention Institute of California), Immaculata De Vivo(Cancer Prevention Institute of California), Kerry S. Courneya(Cancer Prevention Institute of California), Linda S. Cook(Cancer Prevention Institute of California), Chu Chen(Cancer Prevention Institute of California), James R. Cerhan(Cancer Prevention Institute of California), Hui Cai(Cancer Prevention Institute of California), Louise A. Brinton(Cancer Prevention Institute of California), Leslie Bernstein(Cancer Prevention Institute of California), Kristin E. Anderson(Cancer Prevention Institute of California), Hoda Anton‐Culver(Cancer Prevention Institute of California), Leo J. Schouten(Cancer Prevention Institute of California), Pamela L. Horn‐Ross(Cancer Prevention Institute of California)
Journal of Clinical Oncology
June 4, 2013
10.1200/jco.2012.48.2596
Cited by 830Open Access
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Abstract

PURPOSE: Endometrial cancers have long been divided into estrogen-dependent type I and the less common clinically aggressive estrogen-independent type II. Little is known about risk factors for type II tumors because most studies lack sufficient cases to study these much less common tumors separately. We examined whether so-called classical endometrial cancer risk factors also influence the risk of type II tumors. PATIENTS AND METHODS: Individual-level data from 10 cohort and 14 case-control studies from the Epidemiology of Endometrial Cancer Consortium were pooled. A total of 14,069 endometrial cancer cases and 35,312 controls were included. We classified endometrioid (n = 7,246), adenocarcinoma not otherwise specified (n = 4,830), and adenocarcinoma with squamous differentiation (n = 777) as type I tumors and serous (n = 508) and mixed cell (n = 346) as type II tumors. RESULTS: Parity, oral contraceptive use, cigarette smoking, age at menarche, and diabetes were associated with type I and type II tumors to similar extents. Body mass index, however, had a greater effect on type I tumors than on type II tumors: odds ratio (OR) per 2 kg/m(2) increase was 1.20 (95% CI, 1.19 to 1.21) for type I and 1.12 (95% CI, 1.09 to 1.14) for type II tumors (P heterogeneity < .0001). Risk factor patterns for high-grade endometrioid tumors and type II tumors were similar. CONCLUSION: The results of this pooled analysis suggest that the two endometrial cancer types share many common etiologic factors. The etiology of type II tumors may, therefore, not be completely estrogen independent, as previously believed.

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