Abnormal vaginal bleeding is the most common symptom, but a woman may also experience discharge, weight loss, abdominal or pelvic pain, dysuria, … Thus, the observed increased risk of endometrial cancer associated with diabetes may in part reflect confounding by these factors. The main risk for developing endometrial cancer comes from prolonged exposure to excess endogenous or exogenous estrogen in the absence of opposition by progestin. Epub 2006 May 4. Taking hormones after menopause that contain estrogen but not progesterone increases the risk of endometrial cancer. Endometrial cancer survivors of other races (mostly American Indian [37%] and Pacific Islander [40%]) were more likely to be diagnosed with diabetes than white endometrial cancer survivors overall (HR = 1.55, 95%CI = 1.23, 1.94) and in the first year since cancer diagnosis (HR = 2.16, 95%CI = 1.45, 3.21). It is … Please enable it to take advantage of the complete set of features! endometrial cancer that may be related to concurrent obe-sity (19, 20), although an independent association between diabetes and endometrial cancer has been reported (21). Cases (n = 723) were identified from a statewide tumor registry; controls (n = 2,291) were selected randomly from population lists. Careers. Beining RM, Dennis LK, Smith EM, Dokras A. Ann Epidemiol. Diabetes could therefore be an intermediate factor … The multivariable models simultaneously included such variables as BMI and total physical activity, which changed risk estimates of diabetes by ≥5%. The relative risk (RR) of endometrial cancer [with 95% confidence interval (95% CI)] was calculated by dividing the incidence rate among diabetic women with that among nondiabetic women. 2020 Jan;156(1):185-193. doi: 10.1016/j.ygyno.2019.10.015. Endometrial cancers can be divided into two subtypes: type 1, which are estrogen dependent and comprise about 80% of all endometrial cancers, and type 2, which are non-estrogen dependent. 23), but results did not achieve statistical significance. 8600 Rockville Pike Among 777 endometrial cancer cases and 1550 controls from Italy and Switzerland, odds ratio was 1.7 (95% confidence interval: 1.2-2.5) for diabetes, and 5.1 for obese diabetic women as compared with non-obese non-diabetic ones. Int J Epidemiol. Some of these families also have a higher risk for colon cancer5. Given the pandemic of obesity and the increasing prevalence of diabetes and physical inactivity in Western societies, these findings have also important public health implications, suggesting that a great and continuously growing percentage of the female population is at increased risk for endometrial cancer. Diabetes could therefore be an intermediate factor in the etiology of endometrial cancer. K05 CA 92002/CA/NCI NIH HHS/United States, N01 HD 2 3166/HD/NICHD NIH HHS/United States, R01 CA 47749/CA/NCI NIH HHS/United States, R01 CA 75977/CA/NCI NIH HHS/United States, R35 CA 39779/CA/NCI NIH HHS/United States. Thank you for sharing this Cancer Epidemiology, Biomarkers & Prevention article. The multivariate ORs of endometrial cancer were 2.18 for type 2 diabetes, 1.77 for hypertension, 1.20 for hyperlipidemia, between 1.62 and 2.23 for … Major strengths of our study include its population-based design and the completeness of identification of endometrial cancer cases through the Swedish cancer registries. The physical activity questions were validated by comparing with two 1-week records; Spearman correlation coefficient was 0.7 (29). Epub 2008 Feb 8. Long-term diabetes risk among endometrial cancer survivors in a population-based cohort study. Endometrial cancer is the fourth most common cancer in women, accounting for approximately 6,000 deaths per year in the United States. Education was assessed with six questions ranging from 6 years of basic education to university studies. Compared with persons without diabetes, those with diabetes had an adjusted odds ratio of 1.86 (95% confidence interval (CI) 1.37-2.52) for endometrial cancer. 2009 Jul;114(1):121-7. doi: 10.1016/j.ygyno.2009.03.039. Individuals diagnosed with diabetes were older and heavier than nondiabetics, had a little lower total physical activity and less education, and tended to have used less postmenopausal hormone treatment and oral contraceptives. We were also unable to distinguish between type 1 and type 2 diabetes, but subjects with type 1 diabetes are a distinct minority among adult diabetics in Sweden. The typical age-incidence curve for endometrial cancer shows that most cases are diagnosed after the menopause, with the highest incidence around the seventh decade of life. We also did multivariable analysis further adjusted for known risk factors, such as use of postmenopausal hormones, oral contraceptive use, parity, age at menopause, education, smoking, and total energy intake. As indicated above, impaired glucose tolerance and diabetes are risk factors for the development of endometrial cancer. Dates of death or migration from the study area were ascertained through the Swedish Death Register and the National Swedish Population Register, respectively. The lack of increased risk observed among physically active diabetics observed in our study may reflect the increased insulin sensitivity found in physically active women (53) and/or a shift in body composition containing less body fat and visceral adipose tissue (6, 7). Controlling for competing causes of death in survival analyses may therefore be crucial in order to understand the complex relationship between obesity, diabetes and endometrial cancer survival. Cases were 752 women with inci-dent, histologically confirmed endometrial cancer F75 years of age (median age 60 years, range 28–74) admitted to a network of hospitals in Milan. Decreased circulating IGF-binding protein-3 levels may also have a direct regulatory role in cell growth control and cancer (43, 44). Grant support: World Cancer Research Fund International, Swedish Cancer Foundation, Swedish Research Council/Longitudinal Studies grant DK58785, Swedish Foundation for International Cooperation in Research and Higher Education, and American Diabetes Association Award. Physically active diabetics were not at increased risk for endometrial cancer. Stage 1: Cancer is limited to the uterus. We used age-specific (<53, 53-65, and >65 years) portion sizes that were based on mean values obtained from 213 randomly chosen women from the study area who weighed and recorded their foods during four 1-week periods 3 to 4 months apart.3. Adjusting for BMI as a categorical (quartiles) variable compared with as a continuous did not change the risk estimate (RR, 1.93; 95% CI, 1.22-3.06). Section 1734 solely to indicate this fact. Diabetes has been associated with increased risk of endometrial cancer in some epidemiological studies. Int J Environ Res Public Health. 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. Overall diabetes was positively associated with endometrial cancer risk in both age-adjusted and multivariate analyses adjusting for confounders, such as BMI and total physical activity. Family history Endometrial cancer tends to run in some families. 2019 May 31;19(1):527. doi: 10.1186/s12885-019-5748-4. Friberg E, Mantzoros CS, Wolk A. Diabetes and risk of endometrial cancer: a population-based prospective cohort study. In stratified analysis, using as reference group nondiabetic women with low BMI, women with diabetes and high BMI had a >6-fold increased risk. Endometrial cancer is the most common gynaecological tumour in developed countries, and its incidence is increasing. The Swedish Cancer Registry and the Regional Cancer Registry have been estimated to be ∼100% complete (30). For endometrial cancer, obesity has been shown to be an effect modifier of the association between diabetes and cancer with a higher risk among women with both obesity and diabetes compared to those with diabetes alone . 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. All analyses were done using Statistical Analysis System software version 9.1 (SAS Institute, Cary, NC). History of type 2 diabetes was associated with endometrial cancer (odds ratio (OR) … Kim S, Park J, Chen Y, Rowe K, Snyder J, Fraser A, Smith K, Deshmukh VG, Newman M, Herget K, Porucznik CA, Ose D, Playdon M, Gaffney D, Hashibe M. Gynecol Oncol. Additional adjustment for potential confounders, such as use of postmenopausal hormones, oral contraceptive use, parity, age at menopause, education, smoking, and total energy intake, did not change the results substantially (RR, 1.96; 95% CI, 1.23-3.12). During a mean follow-up of 36,773 women in the cohort for 7 years (265,648 person-years), 225 endometrial cancer cases were diagnosed. It increases the risk of colorectal, breast , and bladder cancer by 20% to 50%. Diabetes doubles the risk of liver, pancreas, and endometrial cancer. Interventions to reduce body weight and increase physical activity may have important implications in terms of prevention of endometrial cancer and future management of diabetic subjects. Endometrial Cancer and Diabetes symptoms vary depending on how much your blood sugar is elevated. Interventions to reduce body weight and increase physical activity may have important implications in terms of prevention of endometrial cancer and future management of diabetic subjects. A Review of the Current Literature. We do not retain these email addresses. Diabetes was associated with a 2-fold increased risk, and combination of diabetes with obesity and low physical activity was associated with a further increased risk for endometrial cancer. The effect of diabetes on the risk of endometrial Cancer: an updated a systematic review and meta-analysis. The risk was increased >6-fold among obese diabetic women compared with normal weight women without diabetes, whereas diabetics with low level of physical activity had ∼3-fold increased risk compared with women without diabetes and a high level of total physical activity. Diabetes Endometrial cancer may be about twice as common in women with type 2 diabetes. Results from this analysis did not differ substantially from those for the whole cohort (multivariable RR, 1.77; 95% CI, 1.06-2.97, including 193 cases). In type 1 diabetes and Endometrial Cancer, symptoms tend to come on quickly and be more severe. Further, we examined the joint effect of diabetes combined with high BMI and physical inactivity in relation to endometrial cancer risk, dividing the subjects according to the same cutoff points as in the above analyses in Table 4. Also referred to as endometrial cancer, uterine cancer is more common in older women over the age of 50, and like other forms of cancer, can be a complication of long-term diabetes. Examples include irregular ovulation patterns, which might happen in polycystic ovary syndrome, obesity and diabetes. Diabetes and risk of endometrial cancer: a population-based prospective cohort study Cancer Epidemiol Biomarkers Prev, 16 (2007), pp. The statistical significance of interactions was tested by adding an interaction term to the Cox model, simultaneously containing the main variables and age in months. Epub 2019 Dec 12. We considered the association between diabetes and risk of endometrial cancer using data from a large case-control study conducted in Italy. FOIA Clinical Risk and Overall Survival in Patients with Diabetes Mellitus, Hyperglycemia and Glioblastoma Multiforme. Table 1 Cancer and type 1 diabetes . It is not clear whether or not the association of diabetes with endometrial cancer is explained entirely by obesity. Diabetes shows a supramultiplicative effect with body mass index, but not with physical activity or hypertension. Subjects with the most unfavorable combination of diabetes with both high BMI and low physical activity had ∼10-fold higher risk in comparison with nondiabetic women with normal weight who were highly physically active. Wang M, Tan Y, Shi Y, Wang X, Liao Z, Wei P. Front Endocrinol (Lausanne). ). The multivariate RR of endometrial cancer was 1.94 (95% CI, 1.23-3.08) for women diagnosed with diabetes compared with women without diabetes (Table 2 One limitation of our study is that identification of diabetic women in the cohort was partly based on self-reports, which might lead to underestimation of the true prevalence of diabetes. Other characteristics did not differ substantially between diabetics and nondiabetics. Type 2 diabetes and cancer share many risk factors, but potential biologic links between the two diseases are incompletely understood. Would you like email updates of new search results? Each year, endometrial cancer develops in about 142 000 women worldwide, and an estimated 42 000 women die from this cancer. We observed an ∼3-fold increased risk for obese women with diabetes comparing with obese women without diabetes. There are several mechanisms that could be potentially involved in the development of endometrial cancer in diabetic women. Physical inactivity, obesity, and diabetes are associated with different degrees of hyperinsulinemia. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Diabetes has been associated with increased risk of endometrial cancer in some epidemiological studies. Body mass index (BMI) and other measures of obesity have been associated positively with both diabetes and endometrial cancer. The cancers with the highest increase in risk tended to be different to those noted in type 2 diabetes. Accessibility shows the distribution of known and potential risk factors for endometrial cancer in diabetic and nondiabetic subjects of the cohort. Bethesda, MD 20894, Copyright The summary of RR for all 9 cohort studies was 1.56 (95% CI 1.21–2.01), and it was 1.85 (95% CI 1.53–2.23) for 13 case control studies. eISSN: 1538-7755 Sign In to Email Alerts with your Email Address. More years of menstruation. While the link between obesity, type 2 diabetes and endo-metrial cancer … Cancer Epidemiology, Biomarkers & Prevention Parazzini F, La Vecchia C, Negri E, et al. The observed associations persisted after finer adjustment for BMI to control for residual confounding. In contrast, physically active diabetic women did not have significantly increased risk for endometrial cancer compared with women without diabetes; however, this observation was based on a very few cases. Lyon: IARC Press; 2002. Physical inactivity, obesity, and diabetes are associated with different degrees of hyperinsulinemia. 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. Previous studies conducted on the association between diabetes and the risk of endometrial cancer have reported controversial results that have raised a variety of questions about the association between diabetes and the incidence of this cancer. Furthermore, we evaluated the joint effect of diabetes combined with obesity and low physical activity. The OR of endometrial cancer in women with history of diabetes was 3.0 for women with a body mass index (BMI) (QI) kg/m 2 <25, 3.6 for those with a BMI of 25–29, and 3.3 for those with a BMI ≥30. Diabetes treatment may also provide protection against endometrial cancer Date: April 6, 2011 Source: University of Warwick Summary: New research … Int J Cancer 1999; 81:539. However, this association has not always been clear as one study reported that a body mass index (BMI) of greater than 35 was not associated with endometrial cancer, while a lower BMI was associated [6]. A rare type of ovarian tumor that secretes estrogen also can increase the risk of endometrial cancer. Clipboard, Search History, and several other advanced features are temporarily unavailable. Our observation that the risk is higher among obese diabetic women than among obese nondiabetic women is in accordance with the results from the previous case-control studies (14, 25, 26) and one cohort study (22). h−1). In this population-based prospective cohort study, women with diabetes had a statistically significant ∼2-fold higher risk for developing endometrial cancer. But it cuts men's risk of prostate cancer. We considered the association between diabetes and risk of endometrial cancer using data from a large case-control study conducted in Italy. IARC. Diabetes was associated with increased risk of endometrial cancer (RR = 1.72, 95% CI 1.48–2.01). 2006 Feb;35(1):159-66. doi: 10.1093/ije/dyi223. We calculated person-years of follow-up for each woman from the date of return of the questionnaire in 1997 to the date of an endometrial cancer diagnosis, the date of a hysterectomy, the date of death from any cause, the date of migration out of the study area during June 30, 2003 to June 30, 2005 (because for this time, we only have regional information), or the end of follow-up (June 30, 2005), whichever came first. Endometrial cancer is the fourth most common cancer in women, accounting for approximately 6,000 deaths per year in the United States. 2005 May 15;161(10):939-47. doi: 10.1093/aje/kwi127. The even higher risk observed in obese diabetic women is compatible with the fact that obesity induces both a state of significant hypoadiponectinemia and hyperinsulinemia as well as an excess of circulating bioactive endogenous estrogens due to an increased estrogen production from aromatization of androgens in peripheral fat tissue (48-50) and/or through a decreased production of sex hormone–binding globulin (51). Incomplete identification of diabetic women in the cohort could lead to attenuation of our results. 2020 Jun 15;11(6):227-238. doi: 10.4239/wjd.v11.i6.227. Endometrial cancer may be about twice as common in women with type 2 diabetes. Also, diabetes is closely related to increased cancer-specific mortality (HR 2.09, 95% CI 1.31–3.35) and mortality from non-canc… the risk of endometrial cancer [8]. ). By linkage of the cohort with the Swedish Cancer Registry through July 1, 2003 and with the Regional Cancer Registry in the study area through June 30, 2005, we identified 225 adenocarcinoma endometrial cancer cases. World J Diabetes. Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments. However, most of these studies used case-control study designs and did … 52). Most epidemiological studies suggested that diabetes is a risk factor for endometrial cancer incidence; for example, a meta-analysis of 16 studies showed that diabetes was statistically significantly associated with an increased risk of endometrial cancer (summary RR 2.10, 95% CI 1.75–2.53), and there was a stronger association with a adjusting for age (RR 2.74, 95% CI 1.87–4.00) (89). Body mass index (BMI) and other measures of obesity have been associated positively with both diabetes and endometrial cancer. diabetes and endometrial cancer incidence or mortality [9– 41]. Endometrial cancer is one of the most common cancers of the female reproductive system. 2006 Jul 1;164(1):56-62. doi: 10.1093/aje/kwj152. Furthermore, we have shown that the association between diabetes and endometrial cancer may be significantly modified by physical activity. A total of 22 cohort and case-control studies were included in this meta-analysis, of which 14 showed statistically significant associations between diabetes and risk of endometrial cancer. But it cuts men's risk of prostate cancer. The prospective nature of the study fulfills the time sequence criterion for causality and makes it highly unlikely that the associations we observed were due to recall or selection biases, which can lead to spurious associations in case-control studies. Future detailed studies of the mechanisms underlying these epidemiologic observations can elucidate further the mechanisms leading to endometrial cancer and could also provide novel therapeutic opportunities. However, a formal test did not show a statistically significant interaction between diabetes and BMI (Pinteraction = 0.25). If confirmed by other studies and in other populations, these data may prove of major public health significance given the increasing prevalence of obesity, physical inactivity, and diabetes in Western societies. We have recently reported that obesity is closely associated with lower circulating levels of an endogenous insulin sensitizer, adiponectin (45), which in turn leads to type 2 diabetes and hyperinsulinemia. Weiss JM, Saltzman BS, Doherty JA, Voigt LF, Chen C, Beresford SA, Hill DA, Weiss NS. Weight control and physical activity. 22) as well as mortality (multivariate RR, 1.33; 95% CI, 0.92-1.90; ref. This site needs JavaScript to work properly. Diabetes and endometrial cancer: an Italian case-control study. The relative risks imparted by diabetes are greatest (about twofold or higher) for cancers of the liver, pancreas, and endometrium, and lesser (about 1.2–1.5 fold) for cancers of the colon and rectum, breast, and bladder. Endometrial cancer is the most common gynecologic malignancy. Type 2 diabetes mellitus (T2DM), a chronic disease increasing rapidly worldwide, is well established as an important risk factor for various types of cancer. Each year, endometrial cancer develops in about 142 000 women worldwide, and an estimated 42 000 women die from this cancer. Diabetes and cancer are common diseases with tremendous impact on health worldwide. the relationship between diabetes and endometrial cancer risk into three general types according to design: cohort studies (incidence and/or mortality rate ratio), case-control The summary of RR in hospital-based studies was higher than other studies. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. Links between type 1 diabetes and cancer are not so well recorded but it appears there is also an increase in risk of cancers for people with type 1 diabetes . Am J Epidemiol. Privacy, Help Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. We conducted analyses of diabetes stratifying by BMI and physical activity. Xu WH, Xiang YB, Zheng W, Zhang X, Ruan ZX, Cheng JR, Gao YT, Shu XO. When stratifying on total physical activity, the excess risk for endometrial cancer associated with diabetes and low physical activity was statistically significantly 3-fold higher compared with nondiabetic women with high physical activity. Uterine cancer (cancer of the uterus or womb) is a common form of cancer in women and one of many that affects the female reproductive system. Body mass index (BMI) and other measures of obesity have been associated positively with both diabetes and endometrial cancer. It is not clear whether or not the association of diabetes with endometrial cancer is explained entirely by obesity. Completion of the self-administered questionnaire indicated informed consent to participate in this study. Friberg E, Mantzoros CS, Wolk A. Diabetes and risk of endometrial cancer: a population-based It is not clear whether or not the association of diabetes with endometrial cancer is explained entirely by obesity. Unable to load your collection due to an error, Unable to load your delegates due to an error. This association was modified by … In an attempt to better disentangle the association of diabetes from the association of obesity and physical inactivity with the increased risk of endometrial cancer, we did analyses stratified by BMI and physical activity (Table 3 Prevention and treatment information (HHS). However, most of these studies used case-control study designs and did … The cancers with increased risk in type 1 diabetes include: Hyperinsulinemia is a hallmark of diabetes, obesity, and physical inactivity, and insulin has been shown to stimulate the growth of endometrial stromal cells by binding to insulin receptors on endometrial cells (31). Diabetes has been associated with a statistically significantly increased risk of endometrial cancer in most, but not all studies. Although surgery, radiotherapy, chemotherapy, and hormone therapy can significantly improve the survival of patients, the treatment of patients with very early lesions and a strong desire to retain reproductive function or late recurrence is still in the early stages. Treatment of Endometrial Cancer in Patient With Diabetes There have been some small, limited studies as well as anecdotal reports that certain alternative or “natural” treatments can help control blood glucose levels in people with Endometrial Cancer and diabetes or … The observed associations persisted after finer adjustment for BMI to control for residual confounding. It is the fourth most common cancer in women in the United States after breast, lung, and colorectal cancers. 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. Zhi-Hua Zhang, Pu-Yu Su, Jia-Hu Hao, Ye-Huan Sun, The Role of Preexisting Diabetes Mellitus on Incidence and Mortality of Endometrial Cancer, International Journal of Gynecological Cancer, 10.1097/IGC.0b013e31827b8430, 23 The risk associated with type 2 diabetes appeared not to vary greatly with respect to other endometrial cancer risk factors. Hyperinsulinemia may also increase levels of free estrogens through decreasing concentrations of circulating sex hormone–binding globulin (32, 33). Endometrial cancer is at the same time a malignancy with good prognosis. 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. Diabetes doubles the risk of liver, pancreas, and endometrial cancer. Diabetes was associated with increased risk of endometrial cancer (RR = 1.72, 95% CI 1.48-2.01). We examined the relationship of body mass index (BMI), diabetes and smoking to endometrial cancer risk in a cohort of 36 761 Norwegian women during … Meta-analysis of intrauterine device use and risk of endometrial cancer. Diabetes Endometrial cancer may be about twice as common in women with type 2 diabetes. Energy intake was assessed with the use of a self-administered food-frequency questionnaire that included food items (including alcoholic beverages) commonly consumed in Sweden. Estrogens have in turn been shown to increase endometrial cancer risk by stimulating proliferation of endometrial cells (34) when unopposed by progesterone (especially in postmenopausal women; refs. Endometrial cancer: A review and current management strategies: Part I ... sociation between diabetes and endometrial cancer has been reported [8]. Diabetes could therefore be an intermediate factor in the etiology of endometrial cancer.In conclusion, our results suggest that diabetes may increase risk for endometrial cancer especially when combined with obesity and/or physical inactivity. The costs of publication of this article were defrayed in part by the payment of page charges. To estimate the risk of endometrial cancer, we used Cox proportional hazards regression models. The mean age at diagnosis of endometrial cancer was 68.6 (±9.5) years. This study was approved by the Ethics Committees at the Uppsala University Hospital (Uppsala, Sweden) and the Karolinska Institutet (Stockholm, Sweden). Systemic unopposed estrogen therapy increases Association of diabetes combined with obesity and of diabetes combined with low physical activity (inactivity) with risk of endometrial cancer. The typical age-incidence curve for endometrial cancer shows that most cases are diagnosed after the menopause, with the highest incidence around the seventh decade of life. In sensitivity analysis, after exclusion of women with missing values of any single covariable included in the additionally adjusted multivariable model, the result did not differ substantially from the original analyses (RR, 1.98; 95% CI, 1.11-3.53). To provide a quantitative assessment of the association between diabetes and risk of endometrial cancer, we conducted a meta-analysis of case-control studies and cohort studies. The different stages of the endometrial cancer are determined by how far the disease, also called uterine cancer or womb cancer, has spread. Furthermore, by linkage with the nationwide Swedish In-patient Registry, we identified women who had a hysterectomy for reasons other than endometrial cancer. Xu WH, Matthews CE, Xiang YB, Zheng W, Ruan ZX, Cheng JR, Gao YT, Shu XO. Furthermore, we had information on all major potential confounders. Cancer and type 1 diabetes Links between type 1 diabetes and cancer are not so well recorded but it appears there is also an increase in risk of cancers for people with type 1 diabetes. We excluded two studies [28, 30] with unavailable effect estimates and three studies [29, 32, 33] that reported only crude data not adjusted for age. Similarly, women classified as having low physical activity had an ∼3-fold increased risk if they had diabetes. 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. Epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer.