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American Journal of Epidemiology Advance Access published online on August 5, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn168
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Risk of Complex and Atypical Endometrial Hyperplasia in Relation to Anthropometric Measures and Reproductive History

Meira Epplein1,2,5, Susan D. Reed1,3,4, Lynda F. Voigt1,2, Katherine M. Newton2,4, Victoria L. Holt1,2 and Noel S. Weiss1,2

1 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 Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, WA
4 Group Health Center for Health Studies, Seattle, WA
5 Current affiliation: Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI

Correspondence to Dr. Meira Epplein, Epidemiology Program, Cancer Research Center of Hawaii, 1236 Lauhala Street, Suite 407, Honolulu, HI 96822 (e-mail: mepplein{at}crch.hawaii.edu).

Received for publication July 9, 2007. Accepted for publication February 15, 2008.

The authors sought to test the hypothesis that characteristics and exposures which influence the balance of estrogen and progesterone bear on the incidence of endometrial hyperplasia (EH), a noninvasive proliferation of the lining of the uterus. Cases included all female members of Group Health (Washington State) who were diagnosed with complex EH or EH with atypia during the period 1985–2003 and whose diagnoses were confirmed in a pathology review (n = 446). Controls were selected randomly from Group Health membership files and were matched to the cases by age and enrollment status at the reference date. An increased risk of EH was associated with increasing body mass index and nulliparity. There was a suggestion of a decreased risk of EH with atypia among current smokers. No association with diabetes or hypertension was found. The risk factors observed to be associated with EH in this study are similar to those associated with endometrial cancer. Whether these risk factors predispose women to cancer simply by increasing EH incidence or continue to augment cancer risk even after EH is present is currently unknown.

endometrial hyperplasia; endometrial neoplasms; endometrium; obesity; parity; smoking

Abbreviations: BMI, body mass index; CI, confidence interval

Editor's note: An invited commentary on this article appears on page 000, and the authors' response appears on page 000.


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