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Inflammation and Endometrial Cancer: A Hypothesis

¹ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh; ² University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; ³ Program in Epidemiology, Public Health Sciences Division, Fred Hutchinson Cancer Research Center; ⁴ Department of Otolaryngology: Head and Neck Surgery; and ⁵ Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington

Requests for reprints: Francesmary Modugno, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 516A Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261. Phone: 412-383-2601; Fax: 412-383-2653. E-mail: modugno+{at}pitt.edu

Endometrial cancer is the most common gynecologic malignancy in the United States. Substantial epidemiologic data implicate an imbalance of estrogens and progestogens in the etiology of this disease. We propose that inflammation also plays a role in endometrial cancer development. Emerging laboratory data suggest that elevated levels of prostaglandin E₂ may underlie the transformation of normal endometrium to neoplastic tissue and that in vitro nonsteroidal anti-inflammatory drugs may inhibit endometrial cancer cell growth. In this review, we suggest that the risk factors for endometrial cancer—unopposed estrogens, anovulation, polycystic ovary syndrome, excessive menstruation, early menarche, and late menopause—may be viewed as factors increasing the exposure of the endometrium to inflammation, whereas pregnancy and smoking, two likely protective factors, have the opposite effect. Chronic inflammation can induce rapid cell division, increasing the possibility for replication error, ineffective DNA repair, and subsequent mutations. A proinflammatory milieu can also directly increase estrogen production. Hence, inflammation may work in conjunction with or in addition to estrogen exposure in the development of endometrial cancer. (Cancer Epidemiol Biomarkers Prev 2005;14(12):2840–7)

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