Endometrial Cancer: Nutritional Considerations

As with many cancers, the risk for uterine cancers appears to be associated with greater intakes of foods found in Western diets (animal products, refined carbohydrates). Risk seems to be lower among women whose diets are high in fruits, vegetables, whole grains, and legumes. The lower risk in persons eating plant-based diets may be related to a reduced amount of free hormones circulating in the blood or to a protective effect of micronutrients found in these diets.

The following factors are under study for possible protective effects:

Eating less meat and fat. Studies found a 50% greater risk for endometrial cancer among women who consumed the greatest amount of processed meat and fish.⁵ Consumption of red meat and eggs is also associated with greater endometrial cancer risk.⁶

Higher intake of fat, particularly saturated fat, is associated with elevations of endometrial cancer risk on the order of 60% to 80%.^6,7 Some evidence indicates that this association is due to the influence of dietary fat on adiposity and, consequently, on circulating estrogens.

Fruits, vegetables, whole grains, and legumes. Although findings are limited, evidence suggests that vegetables, fruits, and the nutrients these foods contain (ie, vitamin C, various carotenoids, folate, phytosterols) are associated with reduced risk for endometrial cancer. The hypothesized risk reduction may be as high as 50% to 60%.^8,9

An inverse association between whole grain intake and endometrial cancer has been observed, although some data suggest that this benefit may be restricted to women who have never used hormones.¹⁰ Higher intakes of soy and other legumes may also decrease risk.⁶

Some whole grains and most legumes have a low glycemic index (a ranking of carbohydrate-containing foods, based on the food's effect on blood sugar compared with a standard reference food's effect). Women whose diets had the most high-glycemic-index foods had a roughly 50% greater risk for endometrial cancer than those whose diets had the lowest amount of these foods. Among obese women (BMI > 30), the risk for endometrial cancer in those eating the most high-glycemic-index foods was roughly 90% greater.¹¹ In nondiabetic women, those eating diets highest in glycemic load (glycemic index of a food times the number of grams of carbohydrates in the food serving) had a roughly 45% greater risk for endometrial cancer.¹²

Moderating alcohol consumption. Outcomes of studies on alcohol intake and risk for uterine cancers are conflicting, with various studies finding no association, a protective effect, or increased risk. Consistently high alcohol intake is associated with increased risk in young women (under age 50) and in African American women.^13,14

Orders

See Basic Diet Orders.

What to Tell the Family

The 5-year survival rate for uterine cancers is high, particularly with early detection and treatment. The family may support the patient's adherence to diet and exercise recommendations by adopting the same practices, which are likely to improve their health as well. Some evidence suggests that following a low-fat, plant-based diet, maintaining a healthy weight, and getting regular exercise may reduce the risk of this disease.