科研之友
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摘要
The worldwide obesity epidemic has had a major impact on the health and well-being of both men and women. Obesity is well established as a major causal factor for the development of cardiovascular disease, diabetes, a number of cancers, and several other diseases. There is a strong association between obesity and endometrial cancer among both premenopausal and postmenopausal women. This association follows a dose-response relationship: the incidence of endometrial cancer increases as body mass index increases. With the increasing rates of obesity in recent decades, the incidence of endometrial cancer is expected to rise. More than half of endometrial cancers are thought to be attributable to obesity, which is an independent risk factor for this cancer. Obesity has a negative impact on all-cause mortality. A retrospective study of women with early endometrial cancer reported that morbidly obese women had higher mortality rates compared with women with a normal body mass index; the majority of these deaths were due to noncancerous, obesity-related causes. There is limited public awareness of the link between obesity and endometrial cancer despite the clear evidence of this relationship. A survey of 1545 healthy women found that nearly 60% of the participants were unaware that obesity increased the risk of endometrial cancer. In a separate survey, only 29% of women with this cancer reported being told by their health care provider about the association between obesity and endometrial cancer. Obese women should be counseled about the obesity association with endometrial cancer. The authors discuss a number of molecular mechanisms by which obesity and adipose tissue contribute to the pathogenesis of endometrial cancer. Measures aimed at preventing endometrial cancer include behavioral lifestyle interventions, medications, and bariatric surgery. Behavioral lifestyle interventions, especially weight loss, may reduce the risk of endometrial cancer, but data to support the benefits of this intervention are lacking. Progestin-based medical therapy counteracts the proliferative effect of estrogen on the endometrium. Oral contraceptive pills containing progestins and intrauterine devices (including those without embedded progestins), are protective against endometrial cancer. Another potential chemopreventive medication, metformin, is currently under investigation. Bariatric surgery has achieved dramatic and sustainable weight loss in obese individuals. A recent meta-analysis of observational studies found a 60% reduction in risk of endometrial cancer risk among obese women who underwent bariatric surgery. Obesity in women with endometrial cancer can complicate clinical management strategies. Compared with normal-weight counterparts, obese patients are often more difficult to operate on and are also more likely to have obesity-related medical comorbidities, increasing the likelihood of perioperative complications. More young premenopausal patients are presenting with endometrial cancer. Fertility-sparing treatment for early endometrial cancer is a reasonable option for those women desiring future pregnancy; they should be properly counseled about benefits and potential risks. The key messages from this review are as follows. Greater awareness is needed among the general public and healthy obese women about the association between obesity and endometrial cancer. There is a critical need for rigorous studies to guide interventions to improve clinical outcomes for obese women with this cancer. Additional strategies should explore options for conservative, nonsurgicalmanagement of both premenopausal and postmenopausal women with endometrial cancer. With the increase in numbers of obese premenopausal women in recent decades, younger women are being diagnosed with endometrial cancer. Fertility-sparing options in this population for women who desire future pregnancy must be refined.
- 出版日期2017-3
