Supporting women who have or are at risk of endometrial cancer can mean more than simply medical interventions. It is often difficult to raise the topic on obesity and more important to provide the help needed. Consultant gynaecologists Dr Wendy McMullen and Dr Kalpana Ragupathy from NHS Tayside provide a lens on some of the practical issues they have experienced over the last five years.
Uterine (womb) cancer is now the most common gynaecological cancer, with 3 in 100 women developing this cancer in their lifetime. Being overweight increases the probability of developing many cancers, but the effect is most striking in womb cancer where the risk increases almost sixfold in women with a Body Mass Index (BMI) greater than 351. This is largely due to excess adipose (fat) tissue generating the hormone oestrogen, which causes thickening of the lining of the womb which in turn can lead to cancer.
We are already seeing a worldwide obesity epidemic. This has been reflected in a greater than 50% increase in the rates of endometrial cancer over the last 20 years and, within our womb cancer population in Tayside the proportion of women with a BMI >40 has increased from 9 to 22% over five years. These types of hormone-driven womb cancers are unlikely to spread and can therefore potentially be cured by hysterectomy (now usually performed keyhole or laparoscopically.) However undertaking such surgery can be extremely challenging in women with high BMI; this is due to technical challenges of performing surgery and anaesthesia safely, often compounded by other health problems associated with obesity ( e.g. type 2 diabetes, cardio-vascular problems and sleep apnoea.) Such women are particularly at risk during the pandemic where availability of high dependency and intensive care support cannot always be guaranteed.
Fortunately, we can the use hormone progestogen (usually in the form of an intra-uterine progestogen system) which can reverse the effects of oestrogen, hence control endometrial cancer whilst women are given the opportunity to lose weight 2. There is however an unmet need for weight reduction services for women with established or potential cancer. Women feel very vulnerable disclosing their medical details in a public group and much prefer one to one or group sessions with other women in the same situation, which we have successfully piloted alongside psychological support services through our local Maggie’s centre. Many of these women were previously unaware that being overweight put them at such increased risk of womb cancer and are keen to spread this message to other women. It is however essential that obesity is recognised as a risk factor for womb and other cancers and that resources are allocated to the prevention, recognition, and treatment of obesity from childhood to adulthood. Otherwise, progress made in cancer research and treatment will be diluted by the adverse effects of obesity.
1.Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Lancet. 2014 Aug 30;384(9945):755-65. doi: 10.1016/S0140-6736(14)60892-8. Epub 2014 Aug 13. PMID: 25129328; PMCID: PMC4151483.
2 MacKintosh ML, Crosbie EJ. Prevention Strategies in Endometrial Carcinoma. Curr Oncol Rep. 2018 Nov 13;20(12):101. doi: 10.1007/s11912-018-0747-1. PMID: 30426278; PMCID: PMC6244901.