Reducing Endometrial Cancer Risk: Targeting Modifiable Risk Factors

Announcer:
You’re listening to Project Oncology on ReachMD. On this episode, Dr. Brian Slomovitz will discuss endometrial cancer prevention strategies. He’s the Director of Gynecologic Oncology and Co-Chair of the Cancer Research Committee at Mount Sinai Medical Center as well as a Professor of Obstetrics and Gynecology at Florida International University in Miami. He’ll be discussing endometrial cancer prevention. Here’s Dr. Slomovitz now.

Dr. Slomovitz:
Endometrial cancer, the way I see it, is a presenting type of cancer for multiple medical comorbidities. It's an obesity-related disease in many women. These patients have diabetes, hypertension, insulin resistance, or heart disease—a lot of comorbidities. So when we're thinking about ways to help mitigate or reduce the risk of developing endometrial cancer, I think we need to go after some of those modifiable risk factors. What do I mean by that? Diet and obesity—we see that obesity is a major risk factor for developing endometrial cancer. Obesity is related to diabetes, it's related to hypertension, and it's related to insulin resistance. In summary, it's related to this overall inflammatory state, which increases the body's susceptibility to developing cancers.

We know there was a paper out several years ago when we looked at obesity and its associated cancers. Obese patients are at the highest risk of developing cancer. The highest risk is in endometrial cancer. There's an interesting paper that was published in August showing that in those patients taking weight loss injections actually had a decreased risk of most cancers, including endometrial and ovarian cancer. There's some preliminary work that we're doing to see if initiating these therapies could help with cancer recurrence, cancer prevention, and maybe even as treatment options.

When we think about hormonal therapies, the interest in it comes and goes. For a while, we really weren't encouraging hormonal therapies. Now, we're getting back to recommending hormonal therapies for women, which I think is fine. It's important when we're talking about hormone replacement in those women who still have a uterus that they get progestin therapy as well, not just estrogen therapy. The reason is unopposed estrogen can increase the risk of endometrial abnormalities, including pre-cancerous and cancerous. So when we're giving hormone replacement to our patients, it is important to make sure we balance it out so there is no risk for endometrial overgrowth leading to endometrial cancer.

Some other risk factors—polycystic ovarian disease—we should follow patients a little bit more closely to make sure there's not a risk. We understand that there's a hereditary syndrome that includes endometrial cancer—something called Lynch syndrome. So when we're seeing these patients, and for patients in general, they should know their family history. If there's a high incidence or a high rate of colon cancers, endometrial cancers, or ovarian cancers in their family, they should be evaluated for what we call Lynch syndrome, which can increase the risk of endometrial cancer.

We can't forget also that there's a premenopausal population of patients that get endometrial cancer. So those patients should be worked up appropriately if, in fact, they have risk factors for developing endometrial cancer in order to implement mitigation strategies. So there's a lot to learn, but we do know a lot of what's going on with it, and we just need to keep pushing to come up with better prevention strategies, early treatment strategies, and clinical trials for those women who suffer from the disease to give them better treatment options.

Announcer:
That was Dr. Brian Slomovitz sharing insights about endometrial cancer prevention. To access this and other episodes in our series, visit Project Oncology on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!