Estrogen Replacement Therapy
Oral Contraceptives
Tamoxifen Use
Other Factors Associated with Increased and Decreased Risk of Endometrial Cancer

Note: Separate PDQ summaries on Screening for Endometrial Cancer; Endometrial Cancer Treatment; and Uterine Sarcoma Treatment are also available.

There is an association between estrogen replacement therapy and the subsequent development of endometrial cancer or precursor lesions such as atypical hyperplasia. There is evidence that progestins can be used to prevent the development of endometrial cancer associated with estrogen replacement.

Levels of Evidence

1aii: Evidence obtained from at least one well-designed and conducted randomized controlled trial that has a cancer incidence endpoint.

2aii: Evidence obtained from well-designed and conducted nonrandomized controlled trials that have a cancer incidence endpoint.

3aii: Evidence obtained from well-designed and conducted cohort or case-control analytic studies, preferably from more than one center or research group, that have a cancer incidence endpoint.

5: Opinions of respected authorities based on clinical experience or reports of expert committees.

The use of combination oral contraceptives (estrogen plus a progestin) is associated with a decreased risk of developing endometrial cancer.

Levels of Evidence

3aii: Evidence obtained from well-designed and conducted cohort or case-control analytic studies, preferably from more than one center or research group, that have a cancer incidence endpoint.

5: Opinions of respected authorities based on clinical experience or reports of expert committees.

Tamoxifen use is a cause of endometrial cancer.

Levels of Evidence

1aii: Evidence obtained from at least one well-designed and conducted randomized controlled trial that has a cancer incidence endpoint.

3aii: Evidence obtained from well-designed and conducted cohort or case-control analytic studies, preferably from more than one center or research group, that have a cancer incidence endpoint.

5: Opinions of respected authorities based on clinical experience or reports of expert committees.

There are several other potentially modifiable factors which have been associated with increased risk of endometrial cancer including obesity, diabetes, hypertension, and a diet high in fat. Breast feeding and physical activity are associated with decreased risk of endometrial cancer.

Level of evidence

3aii: Evidence obtained from well-designed and conducted cohort or case-control analytic studies, preferably from more than one center or research group, that have a cancer incidence endpoint.

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