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

Authors

  • James V. Lacey Jr. Ph.D.,

    Corresponding author
    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
    • Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, MSC 7234, Rockville, MD 20852-7234
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    • Fax: (301) 402-0916

  • Christine A. Swanson Ph.D.,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
    Current affiliation:
    1. Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, Maryland
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  • Louise A. Brinton Ph.D.,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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  • Sean F. Altekruse D.V.M.,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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  • Willard A. Barnes M.D.,

    1. Department of Obstetrics and Gynecology, Lombardi Cancer Center, Georgetown University, Washington, DC
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  • Patti E. Gravitt Ph.D.,

    1. Department of Human Genetics, Roche Molecular Systems, Inc., Alameda, California
    Current affiliation:
    1. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Mitchell D. Greenberg M.D.,

    1. Department of Gynecology, Graduate Hospital, Philadelphia, Pennsylvania
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  • Olympia C. Hadjimichael M.S.,

    1. Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
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  • Larry McGowan M.D.,

    1. Division of Gynecologic Oncology, George Washington University, Washington, DC
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  • Rodrigue Mortel M.D.,

    1. Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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  • Peter E. Schwartz M.D.,

    1. Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
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  • Robert J. Kurman M.D.,

    1. Departments of Gynecology, Obstetrics and Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Allan Hildesheim Ph.D.

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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  • This article is a US Government work and, as such, is in the public domain in the United States of America.

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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