Skip to main content
British Journal of Cancer logoLink to British Journal of Cancer
. 1996 May;73(10):1284–1290. doi: 10.1038/bjc.1996.246

Dietary factors and the risk of endometrial cancer: a case--control study in Greece.

A Tzonou 1, L Lipworth 1, A Kalandidi 1, A Trichopoulou 1, I Gamatsi 1, C C Hsieh 1, V Notara 1, D Trichopoulos 1
PMCID: PMC2074517  PMID: 8630294

Abstract

In a hospital-based case-control study of endometrial cancer undertaken in Athens (1992-94), 145 women residents of Greater Athens with confirmed cancer of the endometrium were compared with 298 control patients with orthopaedic diseases. Personal interviews were conducted in the hospital setting, and diet was assessed using a validated semiquantitative food frequency questionnaire. Nutrient intakes for individuals were calculated by multiplying the nutrient intake of a typical portion size for each specified food item by the frequency at which the food was consumed per month and summing these estimates for all food items. Data were modelled through logistic regression, controlling for demographic, reproductive and somatometric risk factors for endometrial cancer as well as for total energy intake. No macronutrient was significantly associated with endometrial cancer risk, but increasing intake of monounsaturated fat, mostly olive oil, by about one standard deviation was associated with a 26% risk reduction (odds ratio = 0.74; 95% confidence interval 0.54-1.3). Among micronutrients, only calcium intake was significantly inversely associated with endometrial cancer risk, whereas there was evidence against retinol and zinc imparting protection against the disease. With respect to food groups, there was weak and non-significant evidence that vegetables are protective, whereas consumption of pulses was positively associated with disease possibly because they contribute substantially in Greece to energy intake in excess of physical activity-dependent requirements.

Full text

PDF
1284

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson J. E., Litzow M. R., Appelbaum F. R., Schoch G., Fisher L. D., Buckner C. D., Petersen F. B., Crawford S. W., Press O. W., Sanders J. E. Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease: the 21-year Seattle experience. J Clin Oncol. 1993 Dec;11(12):2342–2350. doi: 10.1200/JCO.1993.11.12.2342. [DOI] [PubMed] [Google Scholar]
  2. Armstrong B., Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer. 1975 Apr 15;15(4):617–631. doi: 10.1002/ijc.2910150411. [DOI] [PubMed] [Google Scholar]
  3. Barbone F., Austin H., Partridge E. E. Diet and endometrial cancer: a case-control study. Am J Epidemiol. 1993 Feb 15;137(4):393–403. doi: 10.1093/oxfordjournals.aje.a116687. [DOI] [PubMed] [Google Scholar]
  4. Bierman P. J., Bagin R. G., Jagannath S., Vose J. M., Spitzer G., Kessinger A., Dicke K. A., Armitage J. O. High dose chemotherapy followed by autologous hematopoietic rescue in Hodgkin's disease: long-term follow-up in 128 patients. Ann Oncol. 1993 Nov;4(9):767–773. doi: 10.1093/oxfordjournals.annonc.a058662. [DOI] [PubMed] [Google Scholar]
  5. Carella A. M., Congiu A. M., Gaozza E., Mazza P., Ricci P., Visani G., Meloni G., Cimino G., Mangoni L., Coser P. High-dose chemotherapy with autologous bone marrow transplantation in 50 advanced resistant Hodgkin's disease patients: an Italian study group report. J Clin Oncol. 1988 Sep;6(9):1411–1416. doi: 10.1200/JCO.1988.6.9.1411. [DOI] [PubMed] [Google Scholar]
  6. Chopra R., McMillan A. K., Linch D. C., Yuklea S., Taghipour G., Pearce R., Patterson K. G., Goldstone A. H. The place of high-dose BEAM therapy and autologous bone marrow transplantation in poor-risk Hodgkin's disease. A single-center eight-year study of 155 patients. Blood. 1993 Mar 1;81(5):1137–1145. [PubMed] [Google Scholar]
  7. Crump M., Smith A. M., Brandwein J., Couture F., Sherret H., Sutton D. M., Scott J. G., McCrae J., Murray C., Pantalony D. High-dose etoposide and melphalan, and autologous bone marrow transplantation for patients with advanced Hodgkin's disease: importance of disease status at transplant. J Clin Oncol. 1993 Apr;11(4):704–711. doi: 10.1200/JCO.1993.11.4.704. [DOI] [PubMed] [Google Scholar]
  8. Dales L. G., Friedman G. D., Ury H. K., Grossman S., Williams S. R. A case-control study of relationships of diet and other traits to colorectal cancer in American blacks. Am J Epidemiol. 1979 Feb;109(2):132–144. doi: 10.1093/oxfordjournals.aje.a112668. [DOI] [PubMed] [Google Scholar]
  9. Fortes C., Forastiere F., Anatra F., Schmid G. Re: Consumption of olive oil and specific food groups in relation to breast cancer risk in Greece. J Natl Cancer Inst. 1995 Jul 5;87(13):1020–1022. doi: 10.1093/jnci/87.13.1020-a. [DOI] [PubMed] [Google Scholar]
  10. Garland C. F., Garland F. C., Gorham E. D. Can colon cancer incidence and death rates be reduced with calcium and vitamin D? Am J Clin Nutr. 1991 Jul;54(1 Suppl):193S–201S. doi: 10.1093/ajcn/54.1.193S. [DOI] [PubMed] [Google Scholar]
  11. Gianni A. M., Siena S., Bregni M., Lombardi F., Gandola L., Di Nicola M., Magni M., Peccatori F., Valagussa P., Bonadonna G. High-dose sequential chemo-radiotherapy with peripheral blood progenitor cell support for relapsed or refractory Hodgkin's disease--a 6-year update. Ann Oncol. 1993 Dec;4(10):889–891. doi: 10.1093/oxfordjournals.annonc.a058399. [DOI] [PubMed] [Google Scholar]
  12. Gnardellis C., Trichopoulou A., Katsouyanni K., Polychronopoulos E., Rimm E. B., Trichopoulos D. Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers. Epidemiology. 1995 Jan;6(1):74–77. doi: 10.1097/00001648-199501000-00015. [DOI] [PubMed] [Google Scholar]
  13. Graham S., Dayal H., Swanson M., Mittelman A., Wilkinson G. Diet in the epidemiology of cancer of the colon and rectum. J Natl Cancer Inst. 1978 Sep;61(3):709–714. [PubMed] [Google Scholar]
  14. Harding M., Selby P., Gore M., Perren T., Treleavan J., Mansi J., Zulian G., Milan S., Meldrum M., Viner C. High-dose chemotherapy and autologous bone marrow transplantation for relapsed and refractory Hodgkin's disease. Eur J Cancer. 1992;28A(8-9):1396–1400. doi: 10.1016/0959-8049(92)90528-a. [DOI] [PubMed] [Google Scholar]
  15. Howe G. R., Ghadirian P., Bueno de Mesquita H. B., Zatonski W. A., Baghurst P. A., Miller A. B., Simard A., Baillargeon J., de Waard F., Przewozniak K. A collaborative case-control study of nutrient intake and pancreatic cancer within the search programme. Int J Cancer. 1992 May 28;51(3):365–372. doi: 10.1002/ijc.2910510306. [DOI] [PubMed] [Google Scholar]
  16. Hsieh C. C., Maisonneuve P., Boyle P., Macfarlane G. J., Roberston C. Analysis of quantitative data by quantiles in epidemiologic studies: classification according to cases, noncases, or all subjects? Epidemiology. 1991 Mar;2(2):137–140. doi: 10.1097/00001648-199103000-00008. [DOI] [PubMed] [Google Scholar]
  17. Jagannath S., Armitage J. O., Dicke K. A., Tucker S. L., Velasquez W. S., Smith K., Vaughan W. P., Kessinger A., Horwitz L. J., Hagemeister F. B. Prognostic factors for response and survival after high-dose cyclophosphamide, carmustine, and etoposide with autologous bone marrow transplantation for relapsed Hodgkin's disease. J Clin Oncol. 1989 Feb;7(2):179–185. doi: 10.1200/JCO.1989.7.2.179. [DOI] [PubMed] [Google Scholar]
  18. Jones R. J., Piantadosi S., Mann R. B., Ambinder R. F., Seifter E. J., Vriesendorp H. M., Abeloff M. D., Burns W. H., May W. S., Rowley S. D. High-dose cytotoxic therapy and bone marrow transplantation for relapsed Hodgkin's disease. J Clin Oncol. 1990 Mar;8(3):527–537. doi: 10.1200/JCO.1990.8.3.527. [DOI] [PubMed] [Google Scholar]
  19. Kelsey J. L., LiVolsi V. A., Holford T. R., Fischer D. B., Mostow E. D., Schwartz P. E., O'Connor T., White C. A case-control study of cancer of the endometrium. Am J Epidemiol. 1982 Aug;116(2):333–342. doi: 10.1093/oxfordjournals.aje.a113417. [DOI] [PubMed] [Google Scholar]
  20. Koumantaki Y., Tzonou A., Koumantakis E., Kaklamani E., Aravantinos D., Trichopoulos D. A case-control study of cancer of endometrium in Athens. Int J Cancer. 1989 May 15;43(5):795–799. doi: 10.1002/ijc.2910430509. [DOI] [PubMed] [Google Scholar]
  21. La Vecchia C., Decarli A., Fasoli M., Gentile A. Nutrition and diet in the etiology of endometrial cancer. Cancer. 1986 Mar 15;57(6):1248–1253. doi: 10.1002/1097-0142(19860315)57:6<1248::aid-cncr2820570631>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  22. Levi F., Franceschi S., Negri E., La Vecchia C. Dietary factors and the risk of endometrial cancer. Cancer. 1993 Jun 1;71(11):3575–3581. doi: 10.1002/1097-0142(19930601)71:11<3575::aid-cncr2820711119>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  23. Linch D. C., Winfield D., Goldstone A. H., Moir D., Hancock B., McMillan A., Chopra R., Milligan D., Hudson G. V. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet. 1993 Apr 24;341(8852):1051–1054. doi: 10.1016/0140-6736(93)92411-l. [DOI] [PubMed] [Google Scholar]
  24. Lohri A., Barnett M., Fairey R. N., O'Reilly S. E., Phillips G. L., Reece D., Voss N., Connors J. M. Outcome of treatment of first relapse of Hodgkin's disease after primary chemotherapy: identification of risk factors from the British Columbia experience 1970 to 1988. Blood. 1991 May 15;77(10):2292–2298. [PubMed] [Google Scholar]
  25. Longo D. L., Duffey P. L., Young R. C., Hubbard S. M., Ihde D. C., Glatstein E., Phares J. C., Jaffe E. S., Urba W. J., DeVita V. T., Jr Conventional-dose salvage combination chemotherapy in patients relapsing with Hodgkin's disease after combination chemotherapy: the low probability for cure. J Clin Oncol. 1992 Feb;10(2):210–218. doi: 10.1200/JCO.1992.10.2.210. [DOI] [PubMed] [Google Scholar]
  26. Martin-Moreno J. M., Willett W. C., Gorgojo L., Banegas J. R., Rodriguez-Artalejo F., Fernandez-Rodriguez J. C., Maisonneuve P., Boyle P. Dietary fat, olive oil intake and breast cancer risk. Int J Cancer. 1994 Sep 15;58(6):774–780. doi: 10.1002/ijc.2910580604. [DOI] [PubMed] [Google Scholar]
  27. Miller A. B., Hoogstraten B., Staquet M., Winkler A. Reporting results of cancer treatment. Cancer. 1981 Jan 1;47(1):207–214. doi: 10.1002/1097-0142(19810101)47:1<207::aid-cncr2820470134>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  28. Parazzini F., La Vecchia C., Bocciolone L., Franceschi S. The epidemiology of endometrial cancer. Gynecol Oncol. 1991 Apr;41(1):1–16. doi: 10.1016/0090-8258(91)90246-2. [DOI] [PubMed] [Google Scholar]
  29. Philip T., Armitage J. O., Spitzer G., Chauvin F., Jagannath S., Cahn J. Y., Colombat P., Goldstone A. H., Gorin N. C., Flesh M. High-dose therapy and autologous bone marrow transplantation after failure of conventional chemotherapy in adults with intermediate-grade or high-grade non-Hodgkin's lymphoma. N Engl J Med. 1987 Jun 11;316(24):1493–1498. doi: 10.1056/NEJM198706113162401. [DOI] [PubMed] [Google Scholar]
  30. Phillips G. L., Wolff S. N., Herzig R. H., Lazarus H. M., Fay J. W., Lin H. S., Shina D. C., Glasgow G. P., Griffith R. C., Lamb C. W. Treatment of progressive Hodgkin's disease with intensive chemoradiotherapy and autologous bone marrow transplantation. Blood. 1989 Jun;73(8):2086–2092. [PubMed] [Google Scholar]
  31. Potischman N., Swanson C. A., Brinton L. A., McAdams M., Barrett R. J., Berman M. L., Mortel R., Twiggs L. B., Wilbanks G. D., Hoover R. N. Dietary associations in a case-control study of endometrial cancer. Cancer Causes Control. 1993 May;4(3):239–250. doi: 10.1007/BF00051319. [DOI] [PubMed] [Google Scholar]
  32. Rapoport A. P., Rowe J. M., Kouides P. A., Duerst R. A., Abboud C. N., Liesveld J. L., Packman C. H., Eberly S., Sherman M., Tanner M. A. One hundred autotransplants for relapsed or refractory Hodgkin's disease and lymphoma: value of pretransplant disease status for predicting outcome. J Clin Oncol. 1993 Dec;11(12):2351–2361. doi: 10.1200/JCO.1993.11.12.2351. [DOI] [PubMed] [Google Scholar]
  33. Reece D. E., Barnett M. J., Connors J. M., Fairey R. N., Fay J. W., Greer J. P., Herzig G. P., Herzig R. H., Klingemann H. G., LeMaistre C. F. Intensive chemotherapy with cyclophosphamide, carmustine, and etoposide followed by autologous bone marrow transplantation for relapsed Hodgkin's disease. J Clin Oncol. 1991 Oct;9(10):1871–1879. doi: 10.1200/JCO.1991.9.10.1871. [DOI] [PubMed] [Google Scholar]
  34. Reece D. E., Connors J. M., Spinelli J. J., Barnett M. J., Fairey R. N., Klingemann H. G., Nantel S. H., O'Reilly S., Shepherd J. D., Sutherland H. J. Intensive therapy with cyclophosphamide, carmustine, etoposide +/- cisplatin, and autologous bone marrow transplantation for Hodgkin's disease in first relapse after combination chemotherapy. Blood. 1994 Mar 1;83(5):1193–1199. [PubMed] [Google Scholar]
  35. Shu X. O., Zheng W., Potischman N., Brinton L. A., Hatch M. C., Gao Y. T., Fraumeni J. F., Jr A population-based case-control study of dietary factors and endometrial cancer in Shanghai, People's Republic of China. Am J Epidemiol. 1993 Jan 15;137(2):155–165. doi: 10.1093/oxfordjournals.aje.a116655. [DOI] [PubMed] [Google Scholar]
  36. Tourani J. M., Levy R., Colonna P., Desablens B., Leprise P. Y., Guilhot F., Brahimi S., Belhani M., Ifrah N., Sensebe L. High-dose salvage chemotherapy without bone marrow transplantation for adult patients with refractory Hodgkin's disease. J Clin Oncol. 1992 Jul;10(7):1086–1094. doi: 10.1200/JCO.1992.10.7.1086. [DOI] [PubMed] [Google Scholar]
  37. Trichopoulos D., Tzonou A., Katsouyanni K., Trichopoulou A. Diet and cancer: methodological complexities and case-control studies in Greece. Prog Clin Biol Res. 1990;346:45–53. [PubMed] [Google Scholar]
  38. Trichopoulou A., Katsouyanni K., Stuver S., Tzala L., Gnardellis C., Rimm E., Trichopoulos D. Consumption of olive oil and specific food groups in relation to breast cancer risk in Greece. J Natl Cancer Inst. 1995 Jan 18;87(2):110–116. doi: 10.1093/jnci/87.2.110. [DOI] [PubMed] [Google Scholar]
  39. Tzonou A., Hsieh C. C., Polychronopoulou A., Kaprinis G., Toupadaki N., Trichopoulou A., Karakatsani A., Trichopoulos D. Diet and ovarian cancer: a case-control study in Greece. Int J Cancer. 1993 Sep 30;55(3):411–414. doi: 10.1002/ijc.2910550314. [DOI] [PubMed] [Google Scholar]
  40. Willett W., Stampfer M. J. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. 1986 Jul;124(1):17–27. doi: 10.1093/oxfordjournals.aje.a114366. [DOI] [PubMed] [Google Scholar]
  41. Yahalom J., Gulati S. C., Toia M., Maslak P., McCarron E. G., O'Brien J. P., Portlock C. S., Straus D. J., Phillips J., Fuks Z. Accelerated hyperfractionated total-lymphoid irradiation, high-dose chemotherapy, and autologous bone marrow transplantation for refractory and relapsing patients with Hodgkin's disease. J Clin Oncol. 1993 Jun;11(6):1062–1070. doi: 10.1200/JCO.1993.11.6.1062. [DOI] [PubMed] [Google Scholar]
  42. Zheng W., Kushi L. H., Potter J. D., Sellers T. A., Doyle T. J., Bostick R. M., Folsom A. R. Dietary intake of energy and animal foods and endometrial cancer incidence. The Iowa women's health study. Am J Epidemiol. 1995 Aug 15;142(4):388–394. doi: 10.1093/oxfordjournals.aje.a117646. [DOI] [PubMed] [Google Scholar]
  43. Ziegler R. G. A review of epidemiologic evidence that carotenoids reduce the risk of cancer. J Nutr. 1989 Jan;119(1):116–122. doi: 10.1093/jn/119.1.116. [DOI] [PubMed] [Google Scholar]
  44. Zulian G. B., Selby P., Milan S., Nandi A., Gore M., Forgeson G., Perren T. J., McElwain T. J. High dose melphalan, BCNU and etoposide with autologous bone marrow transplantation for Hodgkin's disease. Br J Cancer. 1989 Apr;59(4):631–635. doi: 10.1038/bjc.1989.128. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES