Summary of Evidence
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.
Estrogen Replacement Therapy
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.
Oral Contraceptives
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
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.
Other Factors Associated with Increased and Decreased Risk of Endometrial Cancer
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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