Risk Factors

Estrogen is the major risk factor for the most common type of endometrial cancer. Exposures involving estrogen such as estrogen only replacement therapy, tamoxifen, starting menstruation early in life, late menopause, never having children, and a history of failure to ovulate have all been associated with an increased risk of endometrial cancer. Now, estrogen replacement therapy often is combined with progesterone to offset the effect of the estrogens. Women with Stein-Leventhal syndrome (a rare condition with multiple ovarian cysts, excessive production of estrogen, and infertility) are at high risk for endometrial cancer.

Obesity is a risk factor, as are certain diseases related to obesity: diabetes, high blood pressure, and gallbladder disease. There is some evidence that a diet high in fat increases the risk of endometrial cancer. Many births (4 or more children) and the use of oral contraceptives appear to protect against the development of endometrial cancer.

Prevention and Control

The American Cancer Society recommends that women age 40 and over have an annual pelvic examination by a health professional. Women at high risk of getting endometrial cancer should have counseling on how to reduce their risk and should have annual pelvic examinations with immediate intervention for postmenopausal or irregular bleeding. Appendix I has recommendations for screening for endometrial cancer.

Incidence and Mortality in the U.S.

About 36,100 newly diagnosed cases of endometrial cancer are estimated for 1998 among women in the U.S. and it is the fourth most common cancer among women. The incidence rate for endometrial cancer has been stable since the mid 1980's. Before that there was a steady increase in the incidence rate until 1975 and then a decline. This incidence pattern is believed to be due to the widespread use of estrogen replacement therapy among post-menopausal women in the late 1960s and early 1970s and then a modification of estrogen replacement therapy in the late 1970s to include progesterone which is believed to offset the increased risk of using only estrogen. Endometrial cancer is rare in women younger than age 45, but the risk rises greatly among women in their late 40s to mid 60s. White women have about twice the rate of endometrial cancer as do black women. The one-year survival rate for endometrial cancer is 92 percent. The five-year survival rate if diagnosed at an early stage is 96 percent; if diagnosed at the later, regional stage the five-year survival rate is 66 percent. Six thousand three hundred (6,300) deaths due to endometiral cancer are estimated among U.S. women for 1998. The mortality rates have been constant since 1989.

Incidence in New Jersey - 1986-1996

Tables 21 through 23 show the incidence data by county for endometrial cancer for the years 1986 through 1996. Figure 9 shows statewide trends. Statewide, white women had higher rates than black women (see Figure 9). This was true for each county (see Table 23). In general, the rates increased over the years for both white and black women (see Figure 9).

Conclusion

The increase in endometrial cancer in New Jersey since 1986 points to the continued need for screening for endometrial cancer and for continued research on the use of hormone replacement therapy in post-menopausal women.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	24	19.9	26	22.6	23	17.4	15	14.2	27	22.9	33	24.5	30	24.2	37	31.2	35	27.9	26	21.4	22	18.0
Bergen	123	20.6	136	24.1	121	20.6	115	20.2	98	16.7	161	29.2	135	23.9	125	22.3	139	24.6	126	22.6	138	23.9
Burlington	26	13.7	41	22.1	31	15.9	40	19.2	42	21.3	38	19.3	35	18.0	59	28.9	57	26.8	57	28.2	47	22.3
Camden	50	18.8	43	15.1	50	19.3	61	22.2	61	23.0	61	23.8	55	21.9	45	18.3	55	22.0	64	26.7	54	22.6
Cape May	14	18.4	11	12.5	17	20.8	19	23.5	11	14.8	20	31.6	19	26.2	16	22.6	17	21.5	17	24.6	9	12.4
Cumberland	18	23.2	17	22.7	13	15.7	13	16.3	24	29.8	19	27.1	28	34.4	30	39.1	15	24.0	11	15.0	31	44.0
Essex	83	23.5	80	21.8	97	27.3	82	23.8	62	18.4	60	18.7	76	24.2	87	28.8	81	26.4	72	21.6	69	24.2
Gloucester	21	20.4	25	22.9	33	30.8	16	13.0	23	19.7	19	15.7	27	21.3	23	18.9	36	32.6	35	31.9	28	24.0
Hudson	60	19.1	65	19.1	74	23.5	65	21.6	79	26.2	74	25.1	72	23.3	65	21.0	53	18.3	55	18.9	65	22.2
Hunterdon	15	25.7	10	18.9	10	17.7	11	19.7	16	27.9	23	38.8	17	28.6	13	22.0	17	29.5	15	27.0	17	28.7
Mercer	41	22.1	35	19.0	44	24.8	43	24.7	54	32.2	48	26.5	47	28.3	53	33.0	47	29.7	52	28.6	42	26.4
Middlesex	78	22.3	77	21.5	109	29.8	81	21.8	90	23.9	77	19.5	77	21.4	88	23.7	99	26.7	93	24.2	99	26.7
Monmouth	66	21.6	64	21.3	72	22.3	74	23.0	72	22.7	87	28.4	69	21.9	62	18.6	69	21.4	92	27.9	76	24.9
Morris	60	25.5	35	14.6	53	22.6	50	21.0	59	24.4	52	22.3	74	29.5	65	27.5	59	24.6	71	31.8	61	25.3
Ocean	78	24.7	74	22.4	73	21.0	87	23.1	96	28.3	83	23.9	94	23.7	85	19.2	119	31.3	98	27.0	107	29.9
Passaic	52	18.8	56	22.0	64	24.1	58	24.3	57	23.9	58	22.2	66	27.7	55	20.6	60	23.2	67	26.1	60	24.5
Salem	6	16.8	8	24.2	9	22.3	---	---	11	30.4	5	12.4	11	24.9	7	16.6	7	15.3	14	40.8	8	19.7
Somerset	23	19.1	31	24.6	21	16.8	25	19.8	43	32.9	36	27.5	25	19.1	25	19.1	34	23.9	21	14.7	35	25.2
Sussex	12	19.4	19	31.0	14	22.0	21	35.1	21	31.9	17	28.9	23	37.5	28	43.3	16	27.2	21	39.5	21	27.1
Union	76	24.8	76	23.8	64	19.5	73	23.7	86	27.9	70	22.6	79	26.9	70	24.7	64	21.7	67	22.7	82	28.6
Warren	21	37.4	23	41.0	17	29.3	9	12.2	21	38.8	21	37.4	17	35.4	27	42.3	19	31.4	23	41.6	16	24.8
STATE	948	21.4	953	21.5	1010	22.4	959	21.4	1053	23.8	1062	24.2	1076	24.4	1065	24.0	1098	24.8	1100	25.2	1087	24.8

¹Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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