Peeri Noah Charles, Bertrand Kimberly A, Na Renhua, De Vivo Immaculata, Setiawan Veronica Wendy, Seshan Venkatraman E, Alemany Laia, Chen Yu, Clarke Megan A, Clendenen Tess, Cook Linda S, Costas Laura, Dal Maso Luigino, Freudenheim Jo L, Friedenreich Christine M, Gierach Gretchen L, Goodman Marc T, La Vecchia Carlo, Levi Fabio, Lopez-Querol Marta, Lu Lingeng, Moysich Kirsten B, Mutter George, Naduparambil Jeffin, Negri Eva, O'Connell Kelli, O'Mara Tracy, Palmer Julie R, Parazzini Fabio, Penney Kathryn Lee, Petruzella Stacey, Reynolds Peggy, Ricceri Fulvio, Risch Harvey, Rohan Thomas E, Sacerdote Carlotta, Sandin Sven, Shu Xiao-Ou, Stolzenberg-Solomon Rachael Z, Webb Penelope M, Wentzensen Nicolas, Wilkens Lynne R, Xu Wanghong, Yu Herbert, Zeleniuch-Jacquotte Anne, Zheng Wei, Guo Xingyi, Lipworth Loren, Du Mengmeng
Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Slone Epidemiology Center and Department of Medicine, Boston University, Boston, MA, USA.
J Natl Cancer Inst. 2025 Jan 1;117(1):76-88. doi: 10.1093/jnci/djae210.
The American Cancer Society recommends physicians inform average-risk women about endometrial cancer risk on reaching menopause, but new diagnoses are rising fastest in women aged younger than 50 years. Educating these younger women about endometrial cancer risks requires knowledge of risk factors. However, endometrial cancer in young women is rare and challenging to study in single study populations.
We included 13 846 incident endometrial cancer patients (1639 aged younger than 50 years) and 30 569 matched control individuals from the Epidemiology of Endometrial Cancer Consortium. We used generalized linear models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for 6 risk factors and endometrial cancer risk. We created a risk score to evaluate the combined associations and population attributable fractions for these factors.
In younger and older women, we observed positive associations with body mass index and diabetes and inverse associations with age at menarche, oral contraceptive use, and parity. Current smoking was associated with reduced risk only in women aged 50 years and older (Phet < .01). Body mass index was the strongest risk factor (OR≥35 vs<25 kg/m2 = 5.57, 95% CI = 4.33 to 7.16, for ages younger than 50 years; OR≥35 vs<25 kg/m2 = 4.68, 95% CI = 4.30 to 5.09, for ages 50 years and older; Phet = .14). Possessing at least 4 risk factors was associated with approximately ninefold increased risk in women aged younger than 50 years and approximately fourfold increased risk in women aged 50 years and older (Phet < .01). Together, 59.1% of endometrial cancer in women aged younger than 50 years and 55.6% in women aged 50 years and older were attributable to these factors.
Our data confirm younger and older women share common endometrial cancer risk factors. Early educational efforts centered on these factors may help mitigate the rising endometrial cancer burden in young women.
美国癌症协会建议医生在女性进入更年期时告知其子宫内膜癌风险，但新诊断病例在50岁以下女性中增长最快。向这些年轻女性宣传子宫内膜癌风险需要了解风险因素。然而，年轻女性的子宫内膜癌较为罕见，在单一研究人群中进行研究具有挑战性。
我们纳入了13846例子宫内膜癌新发病例（其中1639例年龄小于50岁）以及来自子宫内膜癌流行病学联盟的30569例匹配对照个体。我们使用广义线性模型来估计6种风险因素与子宫内膜癌风险的比值比（OR）和95%置信区间（CI）。我们创建了一个风险评分来评估这些因素的综合关联和人群归因分数。
在年轻和年长女性中，我们观察到体重指数和糖尿病与子宫内膜癌呈正相关，初潮年龄、口服避孕药使用和产次与之呈负相关。当前吸烟仅与50岁及以上女性的风险降低相关（Phet <.01）。体重指数是最强的风险因素（对于年龄小于50岁的女性，OR≥35 vs <25 kg/m2 = 5.57，95% CI = 4.33至7.16；对于年龄50岁及以上的女性，OR≥35 vs <25 kg/m2 = 4.68，95% CI = 4.30至5.09；Phet =.14）。拥有至少4种风险因素与年龄小于50岁女性的风险增加约9倍以及年龄50岁及以上女性的风险增加约4倍相关（Phet <.01）。总体而言，50岁以下女性中59.1%的子宫内膜癌以及50岁及以上女性中55.6%的子宫内膜癌可归因于这些因素。
我们的数据证实年轻和年长女性共享常见的子宫内膜癌风险因素。围绕这些因素开展早期教育工作可能有助于减轻年轻女性中不断上升的子宫内膜癌负担。
