Diet and Endometrial Cancer

PictureRisk of Endometrial Cancer: Can it be Reduced?

She bleeds, she breeds, she births, she nurtures. She is a woman. Her biology blesses her with delicate femininity and the strength of a goddess. However, it is the same female biology which also makes her prone to certain types of cancers such as that of the breast and endometrium. In order to keep up with the already existing heightened awareness about breast cancer, it is time to become aware about endometrial cancer. The word “endometrium” comes from “endo” meaning within and “metra” meaning womb (i.e. uterus). So, the endometrium is the innermost lining of the uterus, which is shed by the female body every month during menstruation. Endometrial cancer is the cancer of endometrium and is the most common type of cancer affecting the female reproductive organs. Several risk factors, both modifiable and non-modifiable can put a woman at the risk of endometrial cancer. Age, genetics, and ethnicity constitute non-modifiable risk factors, while obesity, diet, and physical activity constitute the modifiable risk factors.

Different types of researches have focused on studying the relationship between dietary modifications and the risk of endometrial cancer. However, the first thing to reflect upon is how obesity and diet pose the threat of endometrial cancer. Being obese or overweight means having extra fat in the body. At the cellular level, fat cells (adipocytes) work as tools that release chemicals which promote propagation of the cells of the endometrium. Also, a source of stem cells (stem cells have the ability to differentiate into the specific types of cells), the extra adipose tissue acts as a source for enhanced tumor growth and progression1. As our lifestyles continue to westernize, the discussion for risk factors needs to include the element of metabolic syndrome as well. Metabolic syndrome comprises metabolic disorders such as central obesity, hyperglycemia, hypertension, and dyslipidemia. These disorders have now also been indicated as risk factors for endometrial cancer 2.

Therefore, the theme underlying the avoidance, control and treatment of the aforementioned conditions and endometrial cancer emphasizes upon the intake of balanced nutrition and active lifestyle.

1Positive nutrition habits specifically target healthy diet, a greater degree of physical activity, moderate consumption of alcohol and healthy body weight. Following an optimal diet pyramid (a pyramidal structure representative of an optimal number of servings to be consumed each day from primary food groups) can significantly help in achieving the goals of a healthy lifestyle. The Oldways Preservation and Exchange Trust through their work with many research organizations developed the four dietary pyramids in order to elaborate on the topic of dietary pyramids. Among the four dietary pyramids namely Mediterranean, Asian, Latin, and African, the Mediterranean pyramid shows an overall benefit in reducing the risk of endometrial cancer3,4. This diet pyramid promotes a well-rounded, healthy lifestyle while entailing the consumption of fresh fruits, vegetables, nuts, legumes, grains, and seeds. The primary fat source is olive oil, protein comes from fresh seafood instead of red meat, besides promotion of physical activity.

A traditional Mediterranean diet also contributes to a lower dietary inflammatory index (a measure of the inflammatory impact of food on body and organs) imparting a shielding effect from the risk of endometrial cancer. The high intake of vegetables results in more effective shielding than fruit intake. Enhanced consumption of foods rich in antioxidants, fibers, phytochemicals and unsaturated fatty acids as per the Mediterranean diet tends to produce a synergistic effect on health. A shift from Western dietary patterns rich in red meat consumption to the traditional Mediterranean diet could help reduce incidences of endometrial cancer by 10%.

The prominent risk factor of endometrial cancer is obesity which  affects premenopausal women and postmenopausal women differently. In premenopausal women, obesity can cause menstrual cycles with no discharge of egg and the endometrium continuous to be stimulated. This results in continuous secretion of estrogens. In postmenopausal women, the concentration of estrogens increases due to release from adipose tissue.

2How does the Mediterranean diet help in reducing the risk of endometrial cancer? The Mediterranean diet can help counter the adverse effects of such hormonal changes by means of anti-estrogenic effects in the body. It is also rich in vitamins, flavonoids, folates, and carotenoids which provide protection from endometrial cancer. As dietary fat is not sourced from animal sources in the Mediterranean diet, therefore it reduces the re-absorption of estrogen in the intestine5 thereby reducing the risk of endometrial cancer. Although certain researches do not confirm a direct link between Mediterranean diet and cancer risk, however, health benefits of the Mediterranean diet and its role in reducing weight have been indicated widely. Adherence to the Mediterranean diet has been shown to reduce obesity and result in greater weight loss6. Furthermore, associations between the Mediterranean diet and lower sexual dysfunction in females also been indicated7.

The key to prevention of endometrial cancer is practicing a healthy lifestyle, a balanced and wholesome diet and body-weight management. Extra fat gained in obesity functions as the machinery for the propagation of endometrial cancer by fluctuating the levels of estrogen hormone with dangerous repercussions. Mediterranean diet has been associated with healthy outcomes such as reduction of weight and anti-estrogenic effects. Therefore inclusion of Mediterranean ways in diet can surely provide women with their much-needed nutrition while protecting from cancer. What we eat is what we become, hence making wise choices in this age of increasing disease burdens ensures the health of future generations as well.

Yashika Kapoor

November 18, 2018


1. Onstad, M. A., Schmandt, R. E. & Karen, H. L. Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment. J Clin Oncol 34, 4225–4230 (2016).

2. Rosato, V. et al. Metabolic syndrome and endometrial cancer risk. Ann. Oncol. 22, 884–889 (2011).

3. Filomeno, M. et al. Mediterranean diet and risk of endometrial cancer: a pooled analysis of three Italian case-control studies. Br. J. Cancer 112, 1816 (2015).

4. Ricceri, F. et al. Diet and endometrial cancer: a focus on the role of fruit and vegetable intake, Mediterranean diet and dietary inflammatory index in the endometrial cancer risk. BMC Cancer 17, 757 (2017).

5. Filomeno, M. et al. Mediterranean diet and risk of endometrial cancer: a pooled analysis of three italian case-control studies. Br. J. Cancer 112, 1816 (2015).

6. Buckland, G., Bach-Faig, A. & Serra-Majem, L. Obesity and the Mediterranean diet: A systematic review of observational and intervention studies. Obes. Rev. 9, 582–93 (2008).

7. Shindel, A. Adherence to Mediterranean Diet and Sexual Function in Women with Type 2 Diabetes. Yearb. Urol. 7, 1883–1890 (2011).