Objective: Obesity is a risk factor for endometrial cancer (EC). Five-year survival is over 80%; however, mortality rates have increased in recent years. Post-menopausal women with EC frequently present with obesity-related comorbidities or develop comorbidities after diagnosis. Survival may vary related to this comorbidity burden. This analysis describes modifiable comorbidities (diabetes, cardiovascular disease, hypertension, and fractures) among post-menopausal EC survivors and evaluates the relationship between obesity-related comorbidities and mortality after an endometrial cancer diagnosis.
Methods: Epidemiological analysis of overall mortality in relation to incidence of obesity-related comorbidity (obesity, diabetes, cardiovascular disease, hypertension and fractures) after EC diagnosis. The participants are Post-menopausal women from 40 clinical sites across the U.S. participating in the Women's Health Initiative (WHI) observational or clinical trials and diagnosed with incident EC during follow-up. Adjusted Cox proportional hazards regression models for incident EC were used to evaluate the relationship between comorbidities and all-cause mortality.
Results: 1661 incident cases of EC were identified. Mortality rates were 55.5% for women with EC. Prevalence increased from baseline to 18 y follow-up for each comorbidity. Regression analyses for incident EC indicated that severe obesity HR (95% CI): 2.13 (1.52, 2.97), cardiovascular disease, 1.50 (1.26, 1.78), and fracture, 1.17 (1.07, 1.27) were associated with greater overall mortality.
Conclusions: Obesity-associated comorbidities are common and are associated with greater mortality in postmenopausal women diagnosed with endometrial cancer. Interventions to modify risk for comorbidity in EC survivors may improve survival and should be evaluated.
Clinical trial registration: NCT00000611.
Keywords: Endometrial Cancer; Obesity; Women’s Health Initiative.