American Journal of Epidemiology Vol. 146, No. 6: 476-482
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Insulin and Endometrial Cancer
Environmental Epidemiology Branch, National Cancer Institute Bethesda, MD
Reprint requests to Dr. Rebecca Troisi, Environmental Epidemiology Branch, National Cancer Institute, EPN Room 443, 6130 Executive Blvd., Bethesda, MD 20892-7374
Elevated insulin levels may explain part of the increased risk of endometrial cancer observed in obese postmenopausal women. Circulating sex hormones and fasting C-peptide levels were measured in sera obtained from 165 postmenopausal endometrial cancer cases accrued between June 1, 1987, and May 15, 1990, from hospitals in Chicago, Illinois; Hershey, Pennsylvania; Irvine and Long Beach, California; Minneapolis, Minnesota; and Winston-Salem, North Carolina, and 180 community and hysterectomy controls. Women with a personal history of diabetes were excluded. Among controls, C-peptide was positively correlated with body mass index (BMI) ((r = 0.44), waist-to-thigh circumference ratio ((r = 0.24), estrone ((r = 0.18), and estradiol ((r = 0.28) (albumin-bound (r = 0.45), and free (r = 0.37)) and negatively correlated with sex hormone-binding globulin (r = –0.48). In age-adjusted analyses, the odds ratios and 95% confidence intervals for tertiles of C-peptide and endometrial cancer were, from lowest to highest: 1.0 (reference), 0.78 (95% confidence interval (CI) 0.43–1.4), and 2.2 (95% CI 1.3–3.7). Further adjustment for BMI substantially attenuated the odds ratios for the highest tertile of C-peptide (odds ratio = 1.2, 95% CI 0.63–2.1), and adjustment for body mass index and other risk factors for endometrial cancer eliminated the association (odds ratio = 1.0, 95% CI 0.55–2.0). In contrast, adjustment for C-peptide had little influence on the magnitude of the positive associations between body mass index (odds ratio for highest vs. lowest tertile, without and with adjustment for C-peptide = 4.1 (95% Cl 2.3–7.5) and 3.7 (95% CI 1.9–7.1), respectively) or several steroid hormones and endometrial cancer. These data are not consistent with the hypothesis that the effect of obesity on endometrial cancer risk is mediated through high insulin levels. Am J Epidemiol 1997;146:476-82.
mass index; C-peptide; endometrial neoplasms; hyperinsulinism; sex hormones
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