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      Long-term and baseline recreational physical activity and risk of endometrial cancer: the California Teachers Study

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          Abstract

          Background:

          Physical activity may be associated with decreasing endometrial cancer risk; it remains unclear whether the association is modified by body size.

          Methods:

          Among 93 888 eligible California Teachers Study participants, 976 were diagnosed with incident endometrial cancer between 1995–1996 and 2007. Cox proportional hazards regression methods were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for endometrial cancer associated with long-term (high school through age 54 years) and baseline (3 years prior to joining the cohort) strenuous and moderate recreational physical activity, overall and by body size.

          Results:

          Increased baseline strenuous recreational physical activity was associated with decreased endometrial cancer risk ( P trend=0.006) with approximately 25% lower risk among women exercising >3 h per week per year than among those exercising <1/2 h per week per year (RR, 0.76; 95% CI, 0.63–0.92). This inverse association was observed among overweight/obese women (body mass index ≥25 kg m −2; P trend=0.006), but not among thinner women ( P trend=0.12). Baseline moderate activity was associated with lower risk among overweight/obese women.

          Conclusion:

          Increasing physical activity, particularly strenuous activity, may be a lifestyle change that overweight and obese women can implement to reduce their endometrial cancer risk.

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          Most cited references43

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          Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review.

          Endometrial cancer is a disease of the affluent, developed world, where epidemiological studies have shown that > or =40% of its incidence can be attributed to excess body weight. An additional proportion may be because of lack of physical activity. Alterations in endogenous hormone metabolism may provide the main links between endometrial cancer risk, and excess body weight and physical inactivity. Epidemiological studies have shown increased endometrial cancer risks among pre- and postmenopausal women who have elevated plasma androstenedione and testosterone, and among postmenopausal women who have increased levels of estrone and estradiol. Furthermore, there is evidence that chronic hyperinsulinemia is a risk factor. These relationships can all be interpreted in the light of the "unopposed estrogen" hypothesis, which proposes that endometrial cancer may develop as a result of the mitogenic effects of estrogens, when these are insufficiently counterbalanced by progesterone. In our overall synthesis, we conclude that development of ovarian hyperandrogenism may be a central mechanism relating nutritional lifestyle factors to endometrial cancer risk. In premenopausal women, ovarian hyperandrogenism likely increases risk by inducing chronic anovulation and progesterone deficiency. After the menopause, when progesterone synthesis has ceased altogether, excess weight may continue increasing risk through elevated plasma levels of androgen precursors, increasing estrogen levels through the aromatization of the androgens in adipose tissue. The ovarian androgen excess may be because of an interaction between obesity-related, chronic hyperinsulinemia with genetic factors predisposing to the development of ovarian hyperandrogenism.
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            The epidemiology of serum sex hormones in postmenopausal women.

            Serum sex hormones may be related to the risk of several diseases in postmenopausal women. In the current report, the authors examined the epidemiology of serum sex hormones in 176 healthy, white postmenopausal women (mean age 58 years) recruited from the metropolitan Pittsburgh, Pennsylvania, area. The data were collected during 1982-1983; none of the women were on estrogen replacement therapy. Serum concentrations of estrone, estradiol, testosterone, and androstenedione were measured by a combination of extraction, column chromatography, and radioimmunoassay. Neither age nor time since menopause was a significant predictor of sex hormones. The degree of obesity was a major determinant of estrone and estradiol. The estrone levels of obese women were about 40% higher than the levels of nonobese women. There was a weak relation between obesity and the androgens. Cigarette smokers had significantly higher levels of androstenedione than nonsmokers, with little difference in serum estrogens between smokers and nonsmokers. Both estrone and estradiol levels tended to decline with increasing alcohol consumption. Physical activity was an independent predictor of serum estrone. More active women had lower levels of estrone. There was a positive relation of muscle strength with estrogen levels. The data suggest interesting relations between environmental and lifestyle factors and serum sex hormones. These environmental and lifestyle factors are potentially modifiable and, hence, if associations between sex hormones and disease exist, modification of these factors could affect disease risks.
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              Adipose tissue as a source of hormones

              P Siiteri (1987)
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                Author and article information

                Journal
                Br J Cancer
                Br. J. Cancer
                British Journal of Cancer
                Nature Publishing Group
                0007-0920
                1532-1827
                06 August 2013
                16 July 2013
                : 109
                : 3
                : 761-768
                Affiliations
                [1 ]Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of City of Hope, 1500 East Duarte Road , Duarte, California 91010, USA
                [2 ]Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300 , Fremont, California 94538, USA
                [3 ]Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 Soto Street , Los Angeles, California 90032, USA
                Author notes
                Article
                bjc201361
                10.1038/bjc.2013.61
                3738142
                23860525
                862c2747-2ce9-4226-a235-9dd675628e16
                Copyright © 2013 Cancer Research UK

                From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

                History
                : 20 July 2012
                : 02 January 2013
                : 28 May 2013
                Categories
                Epidemiology

                Oncology & Radiotherapy
                cohort study,physical activity,endometrial cancer,postmenopausal women
                Oncology & Radiotherapy
                cohort study, physical activity, endometrial cancer, postmenopausal women

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