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American Journal of Epidemiology Advance Access originally published online on December 10, 2007
American Journal of Epidemiology 2008 167(5):607-614; doi:10.1093/aje/kwm333
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Diabetes and Endometrial Cancer: An Evaluation of the Modifying Effects of Other Known Risk Factors

Babette S. Saltzman1,2, Jennifer A. Doherty2, Deirdre A. Hill3, Shirley A. Beresford1,2, Lynda F. Voigt1,2, Chu Chen1,2,4 and Noel S. Weiss1,2

1 Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
2 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
3 Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM
4 Department of Otolaryngology: Head and Neck Surgery, School of Medicine, University of Washington, Seattle, WA

Correspondence to Babette S. Saltzman, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, P.O. Box 19024 (M4-C308), Seattle, WA 98109-1024 (e-mail: bsiebold{at}fhcrc.org).

Received for publication December 4, 2006. Accepted for publication October 17, 2007.

To determine whether risk of endometrial cancer among women with type 2 diabetes differs with respect to other endometrial cancer risk factors, the authors used data from a population-based case-control study (1,303 cases and 1,779 controls) conducted in western Washington State during 1985–1999. History of type 2 diabetes was associated with endometrial cancer (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.2, 2.3), more strongly among women with a recent diabetes diagnosis (<5 years) (OR = 2.6, CI: 1.5, 4.7) than among those with a more distant diagnosis (≥5 years) (OR = 1.3, CI: 0.8, 1.9). Type 2 diabetes was associated with endometrial cancer among women with a body mass index (BMI) (weight (kg)/height (m)2) less than 35 but not among women with a BMI of 35 or more. The observed associations persisted after finer adjustment for BMI to control for residual confounding. History of diabetes was associated with a twofold increased risk of endometrial cancer among hypertensive women, but no association was observed among nonhypertensive women. The risk associated with type 2 diabetes appeared not to vary greatly with respect to other endometrial cancer risk factors. These results support the hypothesis that type 2 diabetes is associated with endometrial cancer irrespective of the presence of other risk factors for this disease, except possibly hypertension and extreme obesity.

diabetes mellitus; diabetes mellitus, Type 2; endometrial neoplasms; risk factors

Abbreviations: BMI, body mass index; CARE, Contraceptive and Reproductive Experiences; CI, confidence interval; OR, odds ratio


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