Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Endometrial carcinoma: Epidemiology and risk factors

INTRODUCTION

Worldwide in 2008, 288,000 women were diagnosed with uterine cancer [1]. The mortality rate was 1.7 to 2.4 per 100,000 women. In the United States, as with other developed countries, uterine cancer was the most common gynecologic malignancy, with over 50,000 new cases and almost 8600 deaths from the disease in each year [2]. Adenocarcinoma of the endometrium (lining of the uterus) is the most common histologic site and type of uterine cancer.

The main risk factor for endometrioid endometrial carcinoma is an excess of endogenous or exogenous estrogen without adequate opposition by a progestin (eg, postmenopausal estrogen therapy without a progestin). Other risk factors include tamoxifen therapy, obesity, and nulliparity (table 1). In addition, women with Lynch syndrome (hereditary nonpolyposis colon cancer) are at a markedly increased risk of endometrial cancer.

The epidemiology and risk factors of endometrial carcinoma are reviewed here. An overview of endometrial carcinoma can be found separately. (See "Overview of endometrial carcinoma".) Related topics are discussed in detail separately, including:

Histopathology and pathogenesis (See "Endometrial carcinoma: Histopathology and pathogenesis".)

Clinical features, diagnosis, and screening for high-risk women (See "Endometrial carcinoma: Clinical features and diagnosis".)

                                  

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Oct 2014. | This topic last updated: Oct 6, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. World cancer research fund international. Cancer facts and figures: Endometrial cancer rates. http://www.wcrf.org/cancer_statistics/cancer_facts/endometrial_cancer_rates.php (Accessed on January 30, 2013).
  2. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64:9.
  3. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011; 61:69.
  4. http://seer.cancer.gov/statfacts/html/corp.html (Accessed on August 13, 2012).
  5. Yap OW, Matthews RP. Racial and ethnic disparities in cancers of the uterine corpus. J Natl Med Assoc 2006; 98:1930.
  6. Allard JE, Maxwell GL. Race disparities between black and white women in the incidence, treatment, and prognosis of endometrial cancer. Cancer Control 2009; 16:53.
  7. Smotkin D, Nevadunsky NS, Harris K, et al. Histopathologic differences account for racial disparity in uterine cancer survival. Gynecol Oncol 2012; 127:616.
  8. Elshaikh MA, Munkarah AR, Robbins JR, et al. The impact of race on outcomes of patients with early stage uterine endometrioid carcinoma. Gynecol Oncol 2013; 128:171.
  9. Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983; 15:10.
  10. Felix AS, Weissfeld JL, Stone RA, et al. Factors associated with Type I and Type II endometrial cancer. Cancer Causes Control 2010; 21:1851.
  11. Brinton LA, Berman ML, Mortel R, et al. Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study. Am J Obstet Gynecol 1992; 167:1317.
  12. Barakat RR, Park RC, Grigsby PW, et al. Corpus: Epithelial Tumors. In: Principles and Practice of Gynecologic Oncology, 2nd, Hoskins WH, Perez CA, Young RC (Eds), Lippincott-Raven Publishers, Philadelphia 1997. p.859.
  13. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice: Tamoxifen and endometrial Cancer. Committee opinion 232. ACOG 2000; Washington, DC.
  14. Woodruff JD, Pickar JH. Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone. The Menopause Study Group. Am J Obstet Gynecol 1994; 170:1213.
  15. Schiff I, Sela HK, Cramer D, et al. Endometrial hyperplasia in women on cyclic or continuous estrogen regimens. Fertil Steril 1982; 37:79.
  16. Furness S, Roberts H, Marjoribanks J, et al. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev 2009; :CD000402.
  17. Henderson BE. The cancer question: an overview of recent epidemiologic and retrospective data. Am J Obstet Gynecol 1989; 161:1859.
  18. Persson I, Adami HO, Bergkvist L, et al. Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study. BMJ 1989; 298:147.
  19. Beral V, Bull D, Reeves G, Million Women Study Collaborators. Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 2005; 365:1543.
  20. Chu J, Schweid AI, Weiss NS. Survival among women with endometrial cancer: a comparison of estrogen users and nonusers. Am J Obstet Gynecol 1982; 143:569.
  21. Shapiro S, Kelly JP, Rosenberg L, et al. Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens. N Engl J Med 1985; 313:969.
  22. Smith DC, Prentice R, Thompson DJ, Herrmann WL. Association of exogenous estrogen and endometrial carcinoma. N Engl J Med 1975; 293:1164.
  23. Voigt LF, Weiss NS, Chu J, et al. Progestagen supplementation of exogenous oestrogens and risk of endometrial cancer. Lancet 1991; 338:274.
  24. Furness S, University of Manchester, Manchester England, personal communication regarding unpublished data from the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial, 2009.
  25. Cohen I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol Oncol 2004; 94:256.
  26. Anderson GL, Judd HL, Kaunitz AM, et al. Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial. JAMA 2003; 290:1739.
  27. Iqbal J, Ginsburg OM, Wijeratne TD, et al. Endometrial cancer and venous thromboembolism in women under age 50 who take tamoxifen for prevention of breast cancer: a systematic review. Cancer Treat Rev 2012; 38:318.
  28. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Davies C, Godwin J, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 2011; 378:771.
  29. Riggs BL, Hartmann LC. Selective estrogen-receptor modulators -- mechanisms of action and application to clinical practice. N Engl J Med 2003; 348:618.
  30. Mourits MJ, De Vries EG, Willemse PH, et al. Tamoxifen treatment and gynecologic side effects: a review. Obstet Gynecol 2001; 97:855.
  31. Goldstein SR. The effect of SERMs on the endometrium. Ann N Y Acad Sci 2001; 949:237.
  32. Chin J, Konje JC, Hickey M. Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen. Cochrane Database Syst Rev 2009; :CD007245.
  33. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG committee opinion. No. 336: Tamoxifen and uterine cancer. Obstet Gynecol 2006; 107:1475.
  34. Horn-Ross PL, John EM, Canchola AJ, et al. Phytoestrogen intake and endometrial cancer risk. J Natl Cancer Inst 2003; 95:1158.
  35. Unfer V, Casini ML, Costabile L, et al. Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study. Fertil Steril 2004; 82:145.
  36. Bandera EV, Williams MG, Sima C, et al. Phytoestrogen consumption and endometrial cancer risk: a population-based case-control study in New Jersey. Cancer Causes Control 2009; 20:1117.
  37. Ollberding NJ, Lim U, Wilkens LR, et al. Legume, soy, tofu, and isoflavone intake and endometrial cancer risk in postmenopausal women in the multiethnic cohort study. J Natl Cancer Inst 2012; 104:67.
  38. North American Menopause Society. The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Translational Science Symposium in Chicago, IL (October 2010). Menopause 2011; 18:732.
  39. Myung SK, Ju W, Choi HJ, et al. Soy intake and risk of endocrine-related gynaecological cancer: a meta-analysis. BJOG 2009; 116:1697.
  40. Siiteri PK. Adipose tissue as a source of hormones. Am J Clin Nutr 1987; 45:277.
  41. Zeleniuch-Jacquotte A, Akhmedkhanov A, Kato I, et al. Postmenopausal endogenous oestrogens and risk of endometrial cancer: results of a prospective study. Br J Cancer 2001; 84:975.
  42. Lukanova A, Lundin E, Micheli A, et al. Circulating levels of sex steroid hormones and risk of endometrial cancer in postmenopausal women. Int J Cancer 2004; 108:425.
  43. Nyholm HC, Nielsen AL, Lyndrup J, et al. Plasma oestrogens in postmenopausal women with endometrial cancer. Br J Obstet Gynaecol 1993; 100:1115.
  44. Potischman N, Hoover RN, Brinton LA, et al. Case-control study of endogenous steroid hormones and endometrial cancer. J Natl Cancer Inst 1996; 88:1127.
  45. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371:569.
  46. Pellerin GP, Finan MA. Endometrial cancer in women 45 years of age or younger: a clinicopathological analysis. Am J Obstet Gynecol 2005; 193:1640.
  47. Gredmark T, Kvint S, Havel G, Mattsson LA. Adipose tissue distribution in postmenopausal women with adenomatous hyperplasia of the endometrium. Gynecol Oncol 1999; 72:138.
  48. Folsom AR, Kaye SA, Potter JD, Prineas RJ. Association of incident carcinoma of the endometrium with body weight and fat distribution in older women: early findings of the Iowa Women's Health Study. Cancer Res 1989; 49:6828.
  49. Lindemann K, Vatten LJ, Ellstrøm-Engh M, Eskild A. Body mass, diabetes and smoking, and endometrial cancer risk: a follow-up study. Br J Cancer 2008; 98:1582.
  50. Potischman N, Swanson CA, Siiteri P, Hoover RN. Reversal of relation between body mass and endogenous estrogen concentrations with menopausal status. J Natl Cancer Inst 1996; 88:756.
  51. Amant F, Moerman P, Neven P, et al. Endometrial cancer. Lancet 2005; 366:491.
  52. Everett E, Tamimi H, Greer B, et al. The effect of body mass index on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 2003; 90:150.
  53. Fader AN, Arriba LN, Frasure HE, von Gruenigen VE. Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol 2009; 114:121.
  54. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348:1625.
  55. Abu-Abid S, Szold A, Klausner J. Obesity and cancer. J Med 2002; 33:73.
  56. Schouten LJ, Goldbohm RA, van den Brandt PA. Anthropometry, physical activity, and endometrial cancer risk: results from the Netherlands Cohort Study. J Natl Cancer Inst 2004; 96:1635.
  57. McPherson CP, Sellers TA, Potter JD, et al. Reproductive factors and risk of endometrial cancer. The Iowa Women's Health Study. Am J Epidemiol 1996; 143:1195.
  58. Xu WH, Xiang YB, Ruan ZX, et al. Menstrual and reproductive factors and endometrial cancer risk: Results from a population-based case-control study in urban Shanghai. Int J Cancer 2004; 108:613.
  59. La Vecchia C, Franceschi S, Decarli A, et al. Risk factors for endometrial cancer at different ages. J Natl Cancer Inst 1984; 73:667.
  60. Karageorgi S, Hankinson SE, Kraft P, De Vivo I. Reproductive factors and postmenopausal hormone use in relation to endometrial cancer risk in the Nurses' Health Study cohort 1976-2004. Int J Cancer 2010; 126:208.
  61. Berek JS, Hacker NF. Nonepithelial ovarian and fallopian tube cancers. In: Practical Gynecologic Oncology, 3rd, Berek JS, Hacker NF (Eds), Lippincott Williams & Wilkins, Philadelphia 2000. p.539.
  62. Schumer ST, Cannistra SA. Granulosa cell tumor of the ovary. J Clin Oncol 2003; 21:1180.
  63. Zanagnolo V, Pasinetti B, Sartori E. Clinical review of 63 cases of sex cord stromal tumors. Eur J Gynaecol Oncol 2004; 25:431.
  64. Evans AT 3rd, Gaffey TA, Malkasian GD Jr, Annegers JF. Clinicopathologic review of 118 granulosa and 82 theca cell tumors. Obstet Gynecol 1980; 55:231.
  65. Soliman PT, Oh JC, Schmeler KM, et al. Risk factors for young premenopausal women with endometrial cancer. Obstet Gynecol 2005; 105:575.
  66. Schmeler KM, Soliman PT, Sun CC, et al. Endometrial cancer in young, normal-weight women. Gynecol Oncol 2005; 99:388.
  67. Lachance JA, Everett EN, Greer B, et al. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 2006; 101:470.
  68. Ollikainen M, Abdel-Rahman WM, Moisio AL, et al. Molecular analysis of familial endometrial carcinoma: a manifestation of hereditary nonpolyposis colorectal cancer or a separate syndrome? J Clin Oncol 2005; 23:4609.
  69. Lucenteforte E, Talamini R, Montella M, et al. Family history of cancer and the risk of endometrial cancer. Eur J Cancer Prev 2009; 18:95.
  70. Sandles LG, Shulman LP, Elias S, et al. Endometrial adenocarcinoma: genetic analysis suggesting heritable site-specific uterine cancer. Gynecol Oncol 1992; 47:167.
  71. Lancaster JM, Powell CB, Kauff ND, et al. Society of Gynecologic Oncologists Education Committee statement on risk assessment for inherited gynecologic cancer predispositions. Gynecol Oncol 2007; 107:159.
  72. Kwon JS, Scott JL, Gilks CB, et al. Testing women with endometrial cancer to detect Lynch syndrome. J Clin Oncol 2011; 29:2247.
  73. Thompson D, Easton DF, Breast Cancer Linkage Consortium. Cancer Incidence in BRCA1 mutation carriers. J Natl Cancer Inst 2002; 94:1358.
  74. Beiner ME, Finch A, Rosen B, et al. The risk of endometrial cancer in women with BRCA1 and BRCA2 mutations. A prospective study. Gynecol Oncol 2007; 104:7.
  75. Biron-Shental T, Drucker L, Altaras M, et al. High incidence of BRCA1-2 germline mutations, previous breast cancer and familial cancer history in Jewish patients with uterine serous papillary carcinoma. Eur J Surg Oncol 2006; 32:1097.
  76. Hornreich G, Beller U, Lavie O, et al. Is uterine serous papillary carcinoma a BRCA1-related disease? Case report and review of the literature. Gynecol Oncol 1999; 75:300.
  77. Lavie O, Hornreich G, Ben Arie A, et al. BRCA1 germline mutations in women with uterine serous papillary carcinoma. Obstet Gynecol 2000; 96:28.
  78. Goshen R, Chu W, Elit L, et al. Is uterine papillary serous adenocarcinoma a manifestation of the hereditary breast-ovarian cancer syndrome? Gynecol Oncol 2000; 79:477.
  79. Lavie O, Hornreich G, Ben-Arie A, et al. BRCA germline mutations in Jewish women with uterine serous papillary carcinoma. Gynecol Oncol 2004; 92:521.
  80. Heald B, Mester J, Rybicki L, et al. Frequent gastrointestinal polyps and colorectal adenocarcinomas in a prospective series of PTEN mutation carriers. Gastroenterology 2010; 139:1927.
  81. Riegert-Johnson DL, Gleeson FC, Roberts M, et al. Cancer and Lhermitte-Duclos disease are common in Cowden syndrome patients. Hered Cancer Clin Pract 2010; 8:6.
  82. Pilarski R, Stephens JA, Noss R, et al. Predicting PTEN mutations: an evaluation of Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome clinical features. J Med Genet 2011; 48:505.
  83. Bandera EV, Kushi LH, Moore DF, et al. Consumption of animal foods and endometrial cancer risk: a systematic literature review and meta-analysis. Cancer Causes Control 2007; 18:967.
  84. Mulholland HG, Murray LJ, Cardwell CR, Cantwell MM. Dietary glycaemic index, glycaemic load and endometrial and ovarian cancer risk: a systematic review and meta-analysis. Br J Cancer 2008; 99:434.
  85. Loerbroks A, Schouten LJ, Goldbohm RA, van den Brandt PA. Alcohol consumption, cigarette smoking, and endometrial cancer risk: results from the Netherlands Cohort Study. Cancer Causes Control 2007; 18:551.
  86. Setiawan VW, Monroe KR, Goodman MT, et al. Alcohol consumption and endometrial cancer risk: the multiethnic cohort. Int J Cancer 2008; 122:634.
  87. Sun Q, Xu L, Zhou B, et al. Alcohol consumption and the risk of endometrial cancer: a meta-analysis. Asia Pac J Clin Nutr 2011; 20:125.
  88. Løchen ML, Lund E. Childbearing and mortality from cancer of the corpus uteri. Acta Obstet Gynecol Scand 1997; 76:373.
  89. Parazzini F, Negri E, La Vecchia C, et al. Role of reproductive factors on the risk of endometrial cancer. Int J Cancer 1998; 76:784.
  90. Parazzini F, Pelucchi C, Talamini R, et al. Use of fertility drugs and risk of endometrial cancer in an Italian case-control study. Eur J Cancer Prev 2010; 19:428.
  91. Venn A, Watson L, Bruinsma F, et al. Risk of cancer after use of fertility drugs with in-vitro fertilisation. Lancet 1999; 354:1586.
  92. Althuis MD, Moghissi KS, Westhoff CL, et al. Uterine cancer after use of clomiphene citrate to induce ovulation. Am J Epidemiol 2005; 161:607.
  93. Lerner-Geva L, Rabinovici J, Lunenfeld B. Ovarian stimulation: is there a long-term risk for ovarian, breast and endometrial cancer? Womens Health (Lond Engl) 2010; 6:831.
  94. Furberg AS, Thune I. Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int J Cancer 2003; 104:669.
  95. Noto H, Osame K, Sasazuki T, Noda M. Substantially increased risk of cancer in patients with diabetes mellitus: a systematic review and meta-analysis of epidemiologic evidence in Japan. J Diabetes Complications 2010; 24:345.
  96. Friberg E, Orsini N, Mantzoros CS, Wolk A. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia 2007; 50:1365.
  97. Shoff SM, Newcomb PA. Diabetes, body size, and risk of endometrial cancer. Am J Epidemiol 1998; 148:234.
  98. Soler M, Chatenoud L, Negri E, et al. Hypertension and hormone-related neoplasms in women. Hypertension 1999; 34:320.
  99. Soliman PT, Wu D, Tortolero-Luna G, et al. Association between adiponectin, insulin resistance, and endometrial cancer. Cancer 2006; 106:2376.
  100. Zendehdel K, Nyrén O, Ostenson CG, et al. Cancer incidence in patients with type 1 diabetes mellitus: a population-based cohort study in Sweden. J Natl Cancer Inst 2003; 95:1797.
  101. Weiderpass E, Persson I, Adami HO, et al. Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 2000; 11:185.
  102. La Vecchia C, Negri E, Franceschi S, et al. A case-control study of diabetes mellitus and cancer risk. Br J Cancer 1994; 70:950.
  103. Parazzini F, La Vecchia C, Negri E, et al. Diabetes and endometrial cancer: an Italian case-control study. Int J Cancer 1999; 81:539.
  104. Friberg E, Mantzoros CS, Wolk A. Diabetes and risk of endometrial cancer: a population-based prospective cohort study. Cancer Epidemiol Biomarkers Prev 2007; 16:276.
  105. Lucenteforte E, Bosetti C, Talamini R, et al. Diabetes and endometrial cancer: effect modification by body weight, physical activity and hypertension. Br J Cancer 2007; 97:995.
  106. Zhang Y, Liu Z, Yu X, et al. The association between metabolic abnormality and endometrial cancer: a large case-control study in China. Gynecol Oncol 2010; 117:41.
  107. Hale GE, Hughes CL, Cline JM. Endometrial cancer: hormonal factors, the perimenopausal "window of risk," and isoflavones. J Clin Endocrinol Metab 2002; 87:3.
  108. Giovannucci E. Nutrition, insulin, insulin-like growth factors and cancer. Horm Metab Res 2003; 35:694.
  109. Session DR, Kalli KR, Tummon IS, et al. Treatment of atypical endometrial hyperplasia with an insulin-sensitizing agent. Gynecol Endocrinol 2003; 17:405.
  110. Gehrig PA, Bae-Jump VL, Boggess JF, et al. Association between uterine serous carcinoma and breast cancer. Gynecol Oncol 2004; 94:208.
  111. Liang SX, Pearl M, Liang S, et al. Personal history of breast cancer as a significant risk factor for endometrial serous carcinoma in women aged 55 years old or younger. Int J Cancer 2011; 128:763.
  112. Parslov M, Lidegaard O, Klintorp S, et al. Risk factors among young women with endometrial cancer: a Danish case-control study. Am J Obstet Gynecol 2000; 182:23.
  113. Tao MH, Xu WH, Zheng W, et al. Oral contraceptive and IUD use and endometrial cancer: a population-based case-control study in Shanghai, China. Int J Cancer 2006; 119:2142.
  114. Vessey M, Painter R. Oral contraceptive use and cancer. Findings in a large cohort study, 1968-2004. Br J Cancer 2006; 95:385.
  115. Mueck AO, Seeger H, Rabe T. Hormonal contraception and risk of endometrial cancer: a systematic review. Endocr Relat Cancer 2010; 17:R263.
  116. Cullins VE. Noncontraceptive benefits and therapeutic uses of depot medroxyprogesterone acetate. J Reprod Med 1996; 41:428.
  117. Kaunitz AM. Depot medroxyprogesterone acetate contraception and the risk of breast and gynecologic cancer. J Reprod Med 1996; 41:419.
  118. Montz FJ, Bristow RE, Bovicelli A, et al. Intrauterine progesterone treatment of early endometrial cancer. Am J Obstet Gynecol 2002; 186:651.
  119. Soini T, Hurskainen R, Grénman S, et al. Cancer risk in women using the levonorgestrel-releasing intrauterine system in Finland. Obstet Gynecol 2014; 124:292.
  120. Setiawan VW, Pike MC, Karageorgi S, et al. Age at last birth in relation to risk of endometrial cancer: pooled analysis in the epidemiology of endometrial cancer consortium. Am J Epidemiol 2012; 176:269.
  121. Zhou B, Yang L, Sun Q, et al. Cigarette smoking and the risk of endometrial cancer: a meta-analysis. Am J Med 2008; 121:501.
  122. Moore SC, Gierach GL, Schatzkin A, Matthews CE. Physical activity, sedentary behaviours, and the prevention of endometrial cancer. Br J Cancer 2010; 103:933.
  123. Friedenreich CM, Orenstein MR. Physical activity and cancer prevention: etiologic evidence and biological mechanisms. J Nutr 2002; 132:3456S.
  124. Bravi F, Scotti L, Bosetti C, et al. Coffee drinking and endometrial cancer risk: a metaanalysis of observational studies. Am J Obstet Gynecol 2009; 200:130.
  125. Yu X, Bao Z, Zou J, Dong J. Coffee consumption and risk of cancers: a meta-analysis of cohort studies. BMC Cancer 2011; 11:96.
  126. Tang NP, Li H, Qiu YL, et al. Tea consumption and risk of endometrial cancer: a metaanalysis. Am J Obstet Gynecol 2009; 201:605.e1.
  127. Butler LM, Wu AH. Green and black tea in relation to gynecologic cancers. Mol Nutr Food Res 2011; 55:931.
  128. McCullough ML, Bandera EV, Moore DF, Kushi LH. Vitamin D and calcium intake in relation to risk of endometrial cancer: a systematic review of the literature. Prev Med 2008; 46:298.
  129. Neill AS, Nagle CM, Protani MM, et al. Aspirin, nonsteroidal anti-inflammatory drugs, paracetamol and risk of endometrial cancer: a case-control study, systematic review and meta-analysis. Int J Cancer 2013; 132:1146.