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Obesity as a potential risk factor for adenocarcinomas and squamous cell carcinomas of the uterine cervix†

  1. James V. Lacey Jr. Ph.D.1,¶,*,
  2. Christine A. Swanson Ph.D.1,‡,
  3. Louise A. Brinton Ph.D.1,
  4. Sean F. Altekruse D.V.M.1,
  5. Willard A. Barnes M.D.2,
  6. Patti E. Gravitt Ph.D.3,§,
  7. Mitchell D. Greenberg M.D.4,
  8. Olympia C. Hadjimichael M.S.5,
  9. Larry McGowan M.D.6,
  10. Rodrigue Mortel M.D.7,
  11. Peter E. Schwartz M.D.5,
  12. Robert J. Kurman M.D.8,
  13. Allan Hildesheim Ph.D.1

Article first published online: 14 JUL 2003

DOI: 10.1002/cncr.11567

Issue

Cancer

Cancer

Volume 98, Issue 4, pages 814–821, 15 August 2003

Additional Information

How to Cite

Lacey, J. V., Swanson, C. A., Brinton, L. A., Altekruse, S. F., Barnes, W. A., Gravitt, P. E., Greenberg, M. D., Hadjimichael, O. C., McGowan, L., Mortel, R., Schwartz, P. E., Kurman, R. J. and Hildesheim, A. (2003), Obesity as a potential risk factor for adenocarcinomas and squamous cell carcinomas of the uterine cervix. Cancer, 98: 814–821. doi: 10.1002/cncr.11567

Author Information

  1. 1

    Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland

  2. 2

    Department of Obstetrics and Gynecology, Lombardi Cancer Center, Georgetown University, Washington, DC

  3. 3

    Department of Human Genetics, Roche Molecular Systems, Inc., Alameda, California

  4. 4

    Department of Gynecology, Graduate Hospital, Philadelphia, Pennsylvania

  5. 5

    Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut

  6. 6

    Division of Gynecologic Oncology, George Washington University, Washington, DC

  7. 7

    Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, Pennsylvania

  8. 8

    Departments of Gynecology, Obstetrics and Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland

  1. §

    Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

  2. ‡

    Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, Maryland

  1. Fax: (301) 402-0916

*Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, MSC 7234, Rockville, MD 20852-7234

  1. †

    This article is a US Government work and, as such, is in the public domain in the United States of America.

Publication History

  1. Issue published online: 1 AUG 2003
  2. Article first published online: 14 JUL 2003
  3. Manuscript Accepted: 13 MAY 2003
  4. Manuscript Revised: 28 APR 2003
  5. Manuscript Received: 13 DEC 2002

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Keywords:

  • cervical adenocarcinoma;
  • cervical squamous cell carcinoma;
  • human papillomavirus (HPV);
  • obesity;
  • body weight

Abstract

BACKGROUND

Hormonal factors may play a more prominent role in cervical adenocarcinoma than squamous cell carcinoma. The authors evaluated whether obesity, which can influence hormone levels, was associated with adenocarcinoma and squamous cell carcinoma.

METHODS

This case–control study included 124 patients with adenocarcinoma, 139 matched patients with squamous cell carcinoma, and 307 matched community control participants. All participants completed interviews and provided cervicovaginal samples for human papillomavirus (HPV) testing. Polytomous logistic regression-generated odds ratios (ORs) and 95% confidence intervals (95% CIs) for self-reported height and weight, body mass index (BMI; kg/m2), and measured waist-to-hip ratio (WHR) for both histologic types were adjusted and stratified for HPV and other confounders.

RESULTS

Height, weight, BMI, and WHR were positively associated with adenocarcinoma. BMI ≥ 30 kg/m2 (vs. BMI < 25 kg/m2; OR, 2.1 and 95% CI, 1.1–3.8) and WHR in the highest tertile (vs. the lowest tertile; OR, 1.8 and 95% CI, 0.97–3.3) were associated with adenocarcinoma. Neither height nor weight was found to be associated with squamous cell carcinoma, and associations for BMI ≥ 30 kg/m2 (OR, 1.6) and WHR in the highest tertile (OR, 1.6) were weaker and were not statistically significant. Analyses using only HPV positive controls showed similar associations. The data were adjusted for and stratified by screening, but higher BMI and WHR were associated with higher disease stage at diagnosis, even among recently and frequently screened patients with adenocarcinoma. Thus, residual confounding by screening could not be excluded as an explanation for the associations.

CONCLUSIONS

Obesity and body fat distribution were associated more strongly with adenocarcinoma than with squamous cell carcinoma. Although questions about screening remain, obesity may have a particular influence on the risk of glandular cervical carcinoma. Cancer 2003;98:814–21. Published 2003 by the American Cancer Society.

DOI 10.1002/cncr.11567

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