Hospital-based case-control study of the association between body mass index and endometrial cancer in Puerto Rican women

Obesity is an established risk factor for endometrial cancer. However, this association has not been studied in Puerto Rico, where overweight (33%) and obesity (27%) have achieved epidemic levels. A hospital based case-control study was designed to evaluate the association between body mass index (BMI) and endometrial cancer. Seventy-four prevalent endometrial cancer cases diagnosed from January 2004-August 2007 and a random sample of 88 healthy controls were recruited from the Medical Center of San Juan, Puerto Rico. Demographic, lifestyle, anthropometric and clinical information was obtained via structured telephone interviews and medical record review. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI). Mean age at diagnosis for cases was 56.3 ± 12.1 years. Cases were most likely than controls to be diabetic, hypertensive and less likely to be physically active; yet, none of the reproductive characteristics were associated with endometrial cancer. Increasing BMI was associated with increased odds of endometrial cancer in bivariate analysis (p- for trend <0.0001). Women with a BMI ≥ 30 kg/m2 had 4-fold greater possibility of endometrial cancer (OR=4.1; 95% CI: 1.8-8.6) than non-obese women (BMI< 30 kg/m2), after adjusting for age, education, employment status, hypertension diagnosis, use of oral contraceptives and consumption of turkey/chicken. Consistent with previous studies world-wide, adult obesity was a strong predictor for endometrial cancer in this sample of Puerto Rican women. Primary prevention programs to avoid obesity and promote healthy life styles are warranted to reduce endometrial cancer risk in this population.