Pilot Project A: Pilot Case-Comparison Study of Insulin Resistance, Adiponectin and Endometrial Cancer in Puerto Rico
Co-Investigators
Karen Lu, M.D., Associate Professor, Department of Gynecology Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Guillermo Tortolero, M.D., Ph.D., Director, Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, Rio Piedras, Puerto Rico
Cancer of the uterine corpus is the most common gynecologic malignancy in the United States, with 40,100 new cases and 7,470 cancer-related deaths estimated for 2008. Endometrial cancer is the most common gynecologic cancer among Puerto Rican women with approximately 321 new cases diagnosed in 2003; the incidence rates have been increasing statistically significantly overtime, and the five-year survival rates are lower than among U. S. non-Hispanic Whites and Hispanic Whites (Dr. Ortiz, Personal Communication 2007; Manuscript in Preparation, 2008). Several U. S. epidemiologic studies were performed in the 1960s through the 1980s that identified risk factors for endometrial cancer, including obesity, diabetes, unopposed estrogen therapy and nulliparity. Many of these risk factors are highly correlated, and the inter-relationship between these factors and their underlying biologic mechanisms are incompletely understood. The associations between obesity and endometrial cancer have generally been explained by an increased aromatization of androstenedione to estrone in adipose tissue and hence, in circulating estrogen levels. However, the association between diabetes and endometrial cancer is not totally accounted for by obesity. Insulin resistance has been proposed as an additional factor that may contribute to the association involving obesity, diabetes and endometrial cancer risk. Despite current understanding of the role of these risk factors in endometrial carcinogenesis, research on endometrial cancer among Hispanic populations is scarce, and, to our knowledge, this will be the first analytical observational epidemiologic study of endometrial cancer among Puerto Rican women. In collaboration with MD Anderson's Department of Gynecologic Oncology, we will conduct a pilot study to assess the role of insulin resistance syndrome as a risk factor for endometrial cancer among Puerto Rican women. Our long-term goals are to develop a research program for the study of the epidemiology and carcinogenesis of endometrial cancer and other gynecologic cancers, and to identify biomarkers for susceptibility, early detection, treatment response and prognosis of these malignancies among Puerto Ricans and other Hispanic populations.
Primary Aims
- Assess the relationship between endometrial cancer and insulin resistance (IR) among Puerto Rican women aged 21 years and over
- Assess the relationship between serum adiponectin level and endometrial cancer among Puerto Rican women aged 21 years and over
- Determine the potential effect that modification of body mass index (BMI) has on the association of IR and adiponectin on endometrial cancer risk among the study population
Secondary Aims
- Evaluate the relationship between endometrial cancer and the other risk factors such as diabetes, BMI and reproductive history among Puerto Rican women aged 21 years and over
- To collect and store serum and tissue samples for future studies of risk including components of the IGF system (IGF-1, IGF-2, IGF-3 and IGFBP-3) and genetic polymorphisms