In this context, “prevention” means taking steps that can lower the chance of developing cancer. Prevention starts with understanding what may increase your risk and knowing how you can protect yourself.

What puts someone at risk of endometrial cancer?

The things that put someone at risk of developing endometrial cancer can be placed into 4 categories:

• Obesity: this is the strongest risk factor because it increases estrogen levels without enough progesterone to balance it (this is called “unopposed estrogen”). This can stimulate the lining of the uterus, leading to the growth of cancer cells. Obesity can be linked to over 40% of cases of endometrial cancer, and endometrial cancer risk is 10-15% for people with a body mass index (BMI) greater than 40.
• Reproductive and metabolic:
  • Having higher estrogen levels over a long period of time can increase the risk of endometrial cancer. For example, in people who have never been pregnant, have irregular periods, or go through menopause later in life.
  • Type 2 diabetes and polycystic ovarian syndrome (PCOS) increase the risk of endometrial cancer. This is because both conditions affect hormone levels, particularly estrogen and insulin, which can cause the lining of the uterus to grow more than it should.
  • Some medications, like tamoxifen, can also increase endometrial cancer risk because they act like estrogen in the uterus. People who take tamoxifen may have about four times the risk of developing endometrial cancer compared to those who do not take it.
• Genetic: Lynch Syndrome increases the lifetime risk of endometrial cancer up to 50% (more on Lynch Syndrome below). In addition, risk is doubled for those with a first degree relative who have had endometrial cancer.
• Age: the risk of endometrial cancer increases after age 50.

What is Lynch Syndrome?

Lynch Syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), is an inherited condition that puts people at increased risk for certain types of cancer at a younger age, including but not limited to endometrial, ovarian, and colorectal cancers. Mutations in the following genes are associated with Lynch Syndrome: MLH1, MSH2, MSH6, PMS2, EPCAM.

Lynch Syndrome increases a person’s lifetime risk of endometrial cancer up to 50%.

Populations at risk for having Lynch Syndrome have:

• Three or more relatives with a Lynch Syndrome-related cancer, and one relative must be a first-degree relative (such as a parent, sibling, or child) of the other two.
• At least two generations with cancer (such as a parent and child).
• One or more cases of cancer diagnosed younger than age 50.

If you have been diagnosed with endometrial cancer, it is important to talk to your doctor about whether you may have Lynch Syndrome so that you can assess your risk for other cancers, including ovarian and colorectal.

If you do have Lynch Syndrome, talk to your biological relatives so that they are aware that they are also at risk. This will give them the opportunity to pursue genetic testing and prevention opportunities, if relevant.

How can I reduce my risk for endometrial cancer?

Given the risk factors described above, some strategies for reducing risk include:

• Prevent type 2 diabetes: maintain a healthy weight, exercise regularly, and eat a nutritious diet. For support and strategies, talk to your doctor
• Exposure to progesterone: Progesterone can help balance estrogen and prevent the lining of the uterus from growing too much. The body makes progesterone naturally during menstrual cycles and pregnancy, and it can also be provided through medications like birth control pills or hormonal IUDs.
• Preventative hysterectomy: the uterus can be surgically removed to prevent endometrial in cancer for women with Lynch Syndrome (if they do not plan to get pregnant in the future). During this surgery, both ovaries and both fallopian tubes would also be removed, which significantly reduces the risk of ovarian cancer. This surgery is called a total hysterectomy and bilateral salpingo-oophorectomy