Endometrial Cancer Risk Research Suggests Earlier Intervention Across Age Groups

In this interview, guest cancer epidemiologists share their findings on endometrial cancer risk in younger women, highlighting the powerful role of obesity and metabolic health, shared risk patterns across age groups, and the importance of starting prevention conversations early in life.

Noah C Peeri, PhD, MPH: My name is Noah C Peeri, and I am a research associate at the Memorial Sloan-Kettering Cancer Center. I attended the University of South Florida College of Public Health for my master’s in epidemiology, where I completed a predoctoral fellowship at Moffitt Cancer Center. From there, I went on to obtain my PhD in epidemiology at the University of North Texas Health Science Center at Fort Worth. I became closely involved with the Texas Center for Health Disparities, which ignited my passion for conducting cancer health disparities research, and led me to Memorial Sloan-Kettering for my postdoctoral fellowship in cancer health disparities and epidemiology working with Dr Du.

Mengmeng Du, ScD, MSc: My name is Mengmeng Du, and I am an associate attending epidemiologist at Memorial Sloan Kettering Cancer Center and Associate Professor at Weill Cornell Medicine. As a cancer epidemiologist, I collaborate with international teams to reduce the burden of endometrial, colorectal, and pancreatic cancers. My research centers on understanding the biology of these cancers and informing prevention strategies, with a particular focus on underserved populations who experience disproportionately poor outcomes. I lead the Data Coordinating Center and co-chair the Executive Committee for the Epidemiology of Endometrial Cancer Consortium (E2C2). I earned my doctorate in epidemiology from Harvard University and completed postdoctoral training at the Fred Hutchinson Cancer Center.
What were your key findings concerning endometrial cancer risk factors for young women?

Peeri and Du: We identified largely common risk patterns in women younger and older than 50 years, including positive associations with body mass index and diabetes and inverse associations with age at menarche, oral contraceptive use, and parity. We observed an age-specific association for smoking, where current smoking was only associated with reduced risk in women 50 years or older.

In women younger than 50 years, body mass index was the strongest risk factor: those with BMI>=35 kg/m2 possessed a nearly 6-fold higher risk of endometrial cancer compared with women with BMI<25 kg/m2. 

When we combined across risk factors, younger women with at least 4 of the 6 examined risk factors possessed a 9-fold increased risk of endometrial cancer. In terms of population impact, we estimated that the 6 risk factors collectively explained approximately 59% of endometrial cancer cases in women under 50.

Your study showed that younger and older women share many common risk factors for endometrial cancer. How should this influence how and when clinicians begin conversations with patients about risk and prevention?

Peeri and Du: Our study suggests it can be beneficial to frame endometrial cancer prevention as a lifelong conversation beginning in young adulthood, along with other personal health considerations.

The American Cancer Society currently recommends that all women be informed at menopause about endometrial cancer risks and symptoms and report any unexpected bleeding. Women at increased risk should be counseled on their risk and advised to see a doctor for any abnormal vaginal bleeding.

Our study suggests younger and older women share many of the same risk factors for endometrial cancer, meaning prevention conversations don’t necessarily need to be delayed until later life.

Instead, clinicians can consider:

• Starting discussions earlier, weaving risk into routine care for younger women.
• Emphasizing modifiable factors like weight management and diabetes control across all ages.
• Tailoring counseling by life stage (contraceptive use and reproductive planning in younger women; ongoing risk management and symptom vigilance in older women).

Since obesity and diabetes were identified as significant risk factors, what role should weight and metabolic health management play in early prevention strategies for endometrial cancer?

Peeri and Du: Weight and metabolic health management should be central to early prevention strategies, given the associations of obesity and diabetes with endometrial cancer risk in both younger and older women. Clinicians can present healthy weight, physical activity, and diabetes prevention/control as dual-benefit strategies that reduce not only cardiovascular and metabolic disease but also cancer risk. Integrating weight and metabolic health counseling into routine primary and gynecologic care, starting in younger women, offers an opportunity to lower the lifetime burden of endometrial cancer along with other much more common chronic conditions.

How should the findings on protective factors like oral contraceptive use and parity be contextualized when counseling younger patients who may be making reproductive or contraceptive decisions?

Peeri and Du: When counseling younger patients, the potential risk reduction associated with oral contraceptive use and parity can be presented as potential added benefits rather than primary drivers of reproductive or contraceptive choices. Physicians can acknowledge that both factors may lower endometrial cancer risk, but emphasize that decisions around contraception and family planning should be guided first by many personal, medical, and lifestyle considerations. Framing any potential risk reduction as secondary health benefits helps patients make informed choices without creating pressure around reproductive timing or contraceptive use.

Given the rising incidence of endometrial cancer in women under 50, what do you believe are the most pressing research questions that need to be addressed next? 

Peeri and Du: Given the rapid rise in endometrial cancer in young women, we need a better understanding of how detection and symptom recognition can be improved for these individuals. It’s also important to know if tumors in younger patients exhibit distinct clinical or molecular characteristics, which may have implications for the most beneficial treatment options. We’ll need to know how lifestyle, reproductive, and inherited factors interact to influence cancer development in younger women. Do genes or environment play a larger role? And if we’re thinking about potential interventions, we first need to know the safety and efficacy of early prevention strategies such as weight management, diabetes control, and hormonal interventions. We also need to understand disparities and high-risk populations to guide any targeted interventions.