Endometrial Cancer

Endometrial Cancer

Prevention Is Number One

Anita, a tall, thin, highly imaginative professional chef from Pennsylvania, was packing for a cross-country tour to promote her latest cookbook when she realized her period was overdue. In fact, now that she took the time to think about it, she might have missed more than one.

She'd had a little spotting here and there as well, she realized. Nothing major, but maybe she'd better stick a box of panty liners in her bag. And maybe she'd better make an appointment with her gynecologist.

It was probably nothing, Anita thought. The skipped periods were probably due to stress. But she'd make an appointment for after the tour and get everything checked out.

Two months and one biopsy later, Anita was sitting in her gynecologist's office wishing she'd gotten there faster. The problem behind the skipped periods and spotting?

Endometrial cancer.

Estrogen: Too Much of a Good Thing

A year after her diagnosis, Anita was declared cancer-free. The cancer was confined to the lining of her uterus--the endometrium--and since her uterus and ovaries were removed, along with some surrounding tissue, at such an early stage, her outlook for survival is excellent.

Not all women are as lucky as Anita. Although the death rate for endometrial cancer has dropped almost 50 percent over the past 30 years, approximately 31,000 women still get the disease every year, and nearly 6,000 women die from it.

"There are two types of endometrial cancer," explains Carolyn Runowicz, M.D., director of gynecologic oncology at Albert Einstein College of Medicine and Montefiore Medical Center in New York City. Type I, which occurs in obese women and is hormone-related, usually occurs after menopause. Type II occurs in underweight women and doesn't seem to be hormone-related at all. It can also occur anytime--either before or after menopause--and is known to produce what doctors respectfully call "a very aggressive tumor."

Doctors don't know what triggers type II, says Dr. Runowicz. But the cause of type I is fairly clear: continuously high levels of the hormone estrogen.

Excessive amounts of estrogen can be found in women who don't ovulate--frequently due to infertility, amenorrhea or polycystic ovaries--and in women who are overweight, says Dr. Runowicz. Women who don't ovulate generally have some type of chemical imbalance. But women who are overweight simply make a lot of estrogen--even after menopause.

"You'd think that at menopause estrogen levels go down," says Dr. Runowicz. "But in an overweight person--a person who is overweight by 20 percent of their body weight--they don't.

"The adrenal glands make androstenedione, a hormone that is converted in the fat cells of every woman to a weak estrogen called estrone," she explains. A weak estrogen in normal amounts is no danger--which is why women of normal weight don't generally get type I endometrial cancer. But if you're overweight, there's so much estrone being released from your fat cells that it acts as a powerful stimulant on the uterus. Cells begin to proliferate, one makes a mistake as it's growing, it mutates, and a tumor is off and running.

Progesterone, a hormone made by your body as it ovulates, can shut down the estrogen-stimulated cell machinery, says Dr. Runowicz. But once ovulation stops, progesterone's protection stops with it. That's why most endometrial cancer occurs after menopause.

There are ways to prevent endometrial cancer, says Dr. Runowicz.

Eat sensibly and use portion control. "The message I would get across to women in their thirties and forties is, don't let yourself get out of shape," says Dr. Runowicz." And if you've picked up some extra weight, get rid of it."

Change your diet. One of the best ways to trim the fat from your body is to adopt a low-fat, high-fiber diet, doctors agree. A study of 17 women conducted at the U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston found that reducing dietary fat to 25 percent of calories and increasing fiber to 40 grams a day reduced estrogen levels by an average of 36 percent.

Consider oral contraceptives. "There's definitely a decrease in endometrial cancer in women who have taken birth control pills," says Dr. Runowicz. Studies indicate that women who take currently available oral contraceptives that combine estrogen with progesterone throughout the cycle reduce the risk of endometrial cancer by approximately 50 percent. What's more, the protective effects may last for at least 15 years after the pills were taken. In contrast, the old type of oral contraceptives have had the opposite effect.

Think carefully about hormone replacement therapy. Studies show that taking estrogen in the years immediately preceding and following menopause increases your risk of endometrial cancer three to eight times. But there are many ways to take hormones, says Dr. Runowicz. So if you decide to use hormones after menopause, talk to your doctor about taking estrogen cyclically in combination with progesterone, she suggests. If the progesterone dose is adequate, adds Dr. Runowicz, it should prevent endometrial cancer.

See a gynecologic oncologist. If your doctor says you have endometrial cancer, get to a gynecologic oncologist as soon as possible, says Dr. Runowicz. There are only 600 of them in the United States, but cancer specialists say that the extra training and surgical expertise they have is significant.

Generally, gynecologic oncologists are affiliated with teaching hospitals in urban areas. To find the one closest to you, contact the Society of Gynecologic Oncologists at 401 North Michigan Avenue, Chicago, IL 60611; 1-800-444-4441.