| 1. |
- Friberg, Emilie, et al.
(författare)
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Coffee drinking and risk of endometrial cancer-A population-based cohort study
- 2009
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Ingår i: International Journal of Cancer. - : WILEY. - 0020-7136 .- 1097-0215. ; 125:10, s. 2413-2417
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Tidskriftsartikel (refereegranskat)abstract
- Coffee drinking has been reported to have beneficial effects on insulin resistance, which has been directly associated with endometrial cancer. Although I relationship between coffee consumption and endometrial cancer risk is biologically plausible, this hypothesis has been previously explored in only 2 prospective studies, with a small number of cases. We used data from the Swedish Mammography Cohort, a population-based prospective cohort study of 60,634 women. During 17.6 years of follow-up 677 participants were diagnosed with incident endometrial cancer (adenocarcinoma). We examined the association between self-reported coffee consumption (at baseline 1987-90 and in 1997) and endometrial cancer risk using Cox proportional hazards models. Each additional cut) (200 g) of coffee per day was associated with 11 rate ratio (RR) of 0.90 [95% confidence interval (CI), 0.83-0.97]. In women drinking 4 or more cups of coffee a day, file RR For the risk reduction of endometrial cancer was 0.75 (95% CL 0.58-0.97) when compared with those who drank I cup or less. The association seemed largely confined to overweight and obese women, who showed a respective risk reduction of 12% (95% Cl, 0-23%) and 20% (95% CI, 7-31%) for every cup or coffee. but was not observed among normal-weight women. There,vas I statistically significant interaction between coffee consumption and body mass index (p(interaction) < 0.001). These data indicate that coffee consumption may be associated with decreased risk of endometrial cancer. especially among women with excessive body weight. If confirmed by other prospective studies. these results are of major public health significance. (C) 2009 UICC
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| 2. |
- Friberg, Emilie, et al.
(författare)
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Diabetes and risk of endometrial cancer : A population-based prospective cohort study
- 2007
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - Karolinska Inst, Div Nutr Epidemiol, Natl Inst Environm Med, SE-17177 Stockholm, Sweden. Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Div Endocrinol Diabet & Metab,Dept Med, Boston, MA 02215 USA. : AMER ASSOC CANCER RESEARCH. - 1055-9965 .- 1538-7755. ; 16:2, s. 276-280
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Tidskriftsartikel (refereegranskat)abstract
- Although there is accumulating evidence that hyperinsulinemia in the context of insulin resistance is associated with carcinogenesis, only one prospective study of endometrial cancer incidence, in relation to diabetes, addressed this issue and showed no significant positive association. No previous study has investigated whether physical activity can modify the association between diabetes and endometrial cancer. We examined the association between diabetes and incidence of endometrial cancer and the potential effect modification by obesity and physical activity in the Swedish Mammography Cohort, a prospective cohort of 36,773 women, including 225 incident endometrial adenocarcinoma cases. After adjustments, the relative risk (RR) for endometrial cancer among women with diabetes comparing with nondiabetic women was 1.94 [95% confidence interval (95% CI), 1.23-3.08]. Among obese diabetics, the RR was 6.39 (95% CI, 3.28-12.06) compared with nonobese nondiabetic women. Among diabetics with low physical activity, the RR for endometrial cancer was 2.80 (95% CI, 1.62-4.85) compared with physically active nondiabetic women. Obese diabetics with low physical activity had a RR of 9.61 (95% CI, 4.66-19.83) compared with normal weight nondiabetic women with high physical activity. Diabetes was associated with a 2-fold increased risk, and combination of diabetes with obesity and low physical activity was associated with a further increased risk for endometrial cancer. Interventions to reduce body weight and increase physical activity may have important implications in terms of prevention of endometrial cancer and future management of diabetic subjects.
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| 3. |
- Friberg, Emilie
(författare)
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Diabetes, physical activity and endometrial cancer
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Accumulating evidence suggests that hyperinsulinemia, in the context of insulin resistance, is associated with carcinogenesis. Physical activity is involved in the regulation of metabolic and hormonal pathways and is an important factor affecting hyperinsulinemia, insulin resistance and body weight. The major modifiable determinants of insulin resistance, hyperinsulinemia, and diabetes such as obesity, and physical activity, have also been shown to be risk factors for endometrial cancer. No previous studies have investigated whether physical inactivity is a modifier of the association between diabetes and risk of endometrial cancer. No previous study has evaluated a combined effect of diabetes, obesity and physical inactivity as a predictor of endometrial cancer risk. No previous meta-analysis of diabetes and endometrial cancer risk has been performed. Moreover no previous study has investigated the effect of leisure time physical inactivity directly on endometrial cancer risk. We examined the association between diabetes and incidence of endometrial cancer in the Swedish Mammography Cohort. Given that the effect of diabetes may vary by risk factors for endometrial cancer we also examined the potential effect modification by obesity and physical activity. In this population-based prospective cohort of 36 773 women, 225 incident endometrial adenocarcinoma cases were diagnosed between 1997 and 2005. The relative risk (RR) for endometrial cancer among women with diabetes compared to non diabetic women was 1.94, 95% CI =1.23 to 3.08. Obese diabetics with low physical activity had a RR = 9.61, 95% CI=4.66 to 19.83, compared to non-obese, non-diabetic women with high physical activity. We performed a meta-analysis on diabetes and endometrial cancer, we identified 16 studies (3 cohort and 13 case-control studies), and found that diabetes was statistically significantly associated with an increased risk of endometrial cancer incidence, (summary RR = 2.10 95% CI= 1.75-2.53). Analysis of 2 studies of mortality found a summary RR= 1.58 95% CI 0.94-2.66 for diabetes and endometrial cancer mortality. We investigated the association of total physical activity and different types of physical activity with risk of endometrial cancer in the Swedish Mammography Cohort. After exclusions due to some missing physical activity estimates 33 723 women and 199 endometrial cancer cases were included in the analysis. Relative risks (RR) for endometrial cancer comparing the second to fourth quartiles of total physical activity to the lowest one were 0.80 (95% CI 0.541.18); 0.87 (95% CI 0.59-1.28); 0.79 (95% CI 0.53-1.17) respectively. High leisure time inactivity (watching TV/sitting 5 hours or more a day) compared to low was associated with increased risk of endometrial cancer RR=1.66 (95% CI 1.05-2.61). We observed a statistically significant association between diabetes and endometrial cancer in our cohort. Results from the meta-analysis support a relationship between diabetes and increased risk of endometrial cancer incidence. The similar point estimates from the cohort analysis and metaanalysis suggest that diabetes may be associated with a two-fold increased risk of endometrial cancer. Total physical activity was only weakly associated with a decreased risk of endometrial cancer, although leisure time inactivity was statistically significantly associated with increased risk for endometrial cancer. These findings support general health recommendations to reduce obesity and increase physical activity.
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| 4. |
- Friberg, Emilie
(författare)
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Diet and endometrial cancer : insulin related factors
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is accumulating evidence that insulin resistance and hyperinsulinemia are involved in the etiology of endometrial cancer. Dietary intake can influence insulin levels especially among individuals who are already insulin resistant. Coffee drinking has been reported to have beneficial effects on insulin sensitivity. Glycemic index and load are concepts developed to quantify the glycemic response and insulin demand to carbohydrates in different foods. A moderate alcohol intake has been shown to improve insulin sensitivity whereas a higher intake has been shown to increase estrogen levels which unbalanced by progesterone may increase the risk of endometrial cancer. In the analyses we used data from the Swedish Mammography Cohort, a populationbased prospective cohort study including over 60 000 women, born 1914-48, among whom 689 endometrioid adenocarcinoma cases were diagnosed through 2007 (17.6 years of followup). We examined the association between coffee consumption, carbohydrate intake, glycemic index, glycemic load and alcohol consumption at baseline 1987-90 and in 1997 and endometrial cancer risk using Cox proportional hazards models. To quantitatively summarize the association between alcohol, diabetes and the risk of endometrial cancer, we conducted meta-analyses of published studies. In the meta-analyses we identified studies by literature searches of the databases PubMed and Embase and by searching the reference lists of relevant articles. We summarized the relative risks (RRs) with 95% confidence intervals (CIs) using random-effects models and in the meta-analysis of alcohol also with a dose-response random-effect meta-regression model. Drinking four cups or more of coffee per day was overall associated with a 25% decreased risk of endometrial cancer as compared to one cup of coffee or less per day. The association seemed to be largely confined to overweight and obese women. We observed no overall association between carbohydrate intake, glycemic index, or glycemic load and the incidence of endometrial cancer. Among overweight and obese women with low physical activity, who completed the questionnaire in 1997, carbohydrate intake and glycemic load were positively related to endometrial cancer risk. In this subgroup, the RRs comparing extreme quartiles were 1.90 (95% CI 0.84-4.31) for carbohydrate intake and 2.99 (95% CI 1.17-7.67) for glycemic load. We observed no association between alcohol and endometrial cancer risk in the Swedish elderly study population with a generally low consumption. However, in the meta-analysis of alcohol and endometrial cancer incidence based on 7 cohort studies, we observed a statistically significant inverse association with low consumption as compared to nondrinkers and a higher risk associated with 2 drinks or more per day. In the meta-analysis of diabetes and endometrial cancer, based on 16 studies, we found that diabetes was significantly associated with an increased risk of endometrial cancer (summary RR 2.10 95% CI 1.75-2.53). The meta-analysis of type 1 diabetes and endometrial cancer was based on three studies and also found a significant positive association. In conclusion, our results indicate that dietary factors related to insulin resistance and hyperinsulinemia as well as diabetes may play an important role in the development of endometrial cancer. Hyperinsulinemia may stimulate proliferation of endometrial cells both through insulin-like growth factors and by increased levels of unbound estrogens.
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| 5. |
- Friberg, Emilie, et al.
(författare)
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Long-term Alcohol Consumption and Risk of Endometrial Cancer Incidence : A Prospective Cohort Study
- 2009
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - : AMER ASSOC CANCER RESEARCH. - 1055-9965 .- 1538-7755. ; 18:1, s. 355-358
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Tidskriftsartikel (refereegranskat)abstract
- Alcohol consumption has been hypothesized to increase the risk of endometrial cancer. We used data from the prospective population-based Swedish Mammography Cohort including 61,226 women to examine the association between alcohol and endometrial cancer incidence. Alcohol consumption was assessed with validated food frequency questionnaires at baseline 1.987 to 1.990 and at follow-up in 1997. During a mean follow-up of 17.6 years, 687 endometrial cancer cases were identified in the Swedish cancer registries. We found no association between alcohol consumption and endometrial cancer risk after adjustment for age, body mass index, and smoking, The multivariable rate ratios (95% confidence intervals) for the three upper categories of long-term alcohol consumption as compared with no consumption were 1.01 (0.84-1.22) for <3.4 g/d, 1.01 (0.80-1.27) for 3.4 to 9.9 g/d, and 1.09 (0.71-1.67) for >= 1.0 g/d, respectively. The association did not differ by age, body mass index, folic acid intake, or postmenopausal hormone use in stratified analysis. In conclusion, our results suggest that low alcohol consumption (up to one drink per day) is unlikely to substantially influence risk of endometrial cancer. (Cancer Epidemiol Biomarkers Prev 2009;18(1):355-8)
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| 6. |
- Friberg, Emilie, et al.
(författare)
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Physical activity and risk of endometrial cancer : A population-based prospective cohort study
- 2006
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - Karolinska Inst, Div Nutr Epidemiol, Natl Inst Environm Med, SE-17177 Stockholm, Sweden. Harvard Univ, Sch Med, Div Endocrinol Diabet & Metab, Dept Med,Beth Israel Deaconess Med Ctr, Boston, MA 02115 USA. : AMER ASSOC CANCER RESEARCH. - 1055-9965 .- 1538-7755. ; 15:11, s. 2136-2140
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Tidskriftsartikel (refereegranskat)abstract
- Physical activity is involved in the regulation of metabolic and hormonal pathways and is one of the factors important for the maintenance of body weight; obesity is a risk factor for endometrial cancer. A connection between physical activity and endometrial cancer risk through hormonal mechanisms, possibly mediated by body weight, is biologically plausible. Only one study has investigated total physical activity, and no previous study has examined leisure time inactivity directly. We investigated the association of total physical activity and different types of physical activity with risk of endometrial cancer in the Swedish Mammography Cohort, a population-based prospective cohort, including 33,723 women and 199 endometrial cancer cases. After adjustments for potential confounders (age, body mass index, parity, history of diabetes, total fruit and vegetable intake, and education), the relative risks for endometrial cancer for the second to fourth quartile of total physical activity compared with the lowest one were 0.80 [95% confidence interval (95% CI), 0.54-1.18], 0.87 (95% CI, 0.59-1.28), and 0.79 (95% CI, 0.53-1.17). High leisure time inactivity (watching TV/sitting >= 5 hours daily) compared with low was associated with increased risk of endometrial cancer (relative risk, 1.66; 95% CI, 1.05-2.61). The associations were not modified by body mass index. Findings from this study suggest that total physical activity is weakly inversely associated with endometrial cancer risk and that leisure time inactivity is statistically significantly associated with increased risk for endometrial cancer.
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| 7. |
- Larsson, Susanna C., et al.
(författare)
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Carbohydrate intake, glycemic index and glycemic load in relation to risk of endometrial cancer : A prospective study of Swedish women
- 2007
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Ingår i: International Journal of Cancer. - Karolinska Inst, Natl Inst Environm Med, Div Nutr Epidemiol, SE-17177 Stockholm, Sweden. : WILEY. - 0020-7136 .- 1097-0215. ; 120:5, s. 1103-1107
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Tidskriftsartikel (refereegranskat)abstract
- The associations of carbohydrate intake, glycemic index and glycemic load with endometrial cancer risk were examined among 61,226 participants of the Swedish Mammography Cohort who were cancer-free at enrollment between 1987 and 1990 and completed a food frequency questionnaire. During a mean follow-up of 15.6 years, through June 2005, 608 incident cases of endometrial adenocarcinoma were diagnosed. We observed no overall association between carbohydrate intake, glycemic index or glycemic load and incidence of endometrial cancer; the rate ratios (RRs) for the highest versus the lowest quintile were 1.12 (95% CI, 0.85-1.47) for carbohydrate intake, 1.00 (95% CI, 0.77-1.30) for glycemic index and 1.15 (95% CI, 0.88-1.51) for glycemic load. However, among obese women (body mass index, BMI >= 30 kg/m(2)), endometrial cancer incidence was nonsignificantly elevated in the top versus bottom quintiles of carbohydrate intake (RR, 1.68; 95% CI, 0.86-3.29) and glycemic load (RR, 1.57; 95% CI, 0.82-2.99). In a subanalysis of women who completed a follow-up questionnaire in 1997, which collected information on physical activity, carbohydrate intake and glycemic load were positively related to endometrial cancer risk among overweight women (BMI >= 25 kg/m(2)) with low physical activity. In this subgroup, the multivariate RRs comparing extreme quartiles were 1.90 (95% CI, 0.84-4.31) for carbohydrate intake and 2.99 (95% CI, 1.17-7.67) for glycemic load. Results from this cohort study suggest that a high carbohydrate intake and a high glycemic load may increase the risk of endometrial cancer among overweight women with low physical activity. (c) 2006 Wiley-Liss, Inc.
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