Endometrial cancer occurs mostly after the menopause and has an excellent prognosis. The age-standardized incidence varies at least ten-fold across countries, suggesting the strong influence of modifiable risk factors. Risk reduction is conferred by current smoking, past oral contraceptive use, childbearing, lower weight and, tentatively, physical activity. The most compelling evidence that hormones determine the risk of endometrial cancer comes from studies of hormone therapy following menopause. Use of estrogens alone for ten years or more increases the risk about ten-fold. This excess risk may be counteracted substantially by combined use of estrogens and progestins. Hence, it should be possible to prevent a substantial fraction of all endometrial cancers through modification of lifestyle, maintaining normal weight, optimal use of oral contraceptives and postmenopausal hormones.
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