AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025390412
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ORIGINAL RESEARCH ARTICLE

Epidemiological analysis of obesity-related comorbidities and mortality among postmenopausal women with endometrial cancer: Findings from the Women’s Health Initiative randomized controlled trials and observational study

Cynthia Thomson1* ,  Karen Basen-Engquist2 ,  Rogelio Robles-Morales3 ,  Denise Roe4 ,  Jennifer Erdrich5 ,  Britton Trabert6 ,  Nazmus Saquib7 ,  Michele Cote8 ,  Lihong Qi8 ,  Dorothy Lane10 ,  Tracy Crane11
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1 Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
2 Department of Health Disparities Research, MD Anderson Cancer Center, Houston, Texas, United States of America
3 Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
4 Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
5 Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
6 Department of Obstetrics and Gynecology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States of America
7 Department of Clinical Sciences, College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Al Qasim, Saudi Arabia
8 Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
9 Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, California, United States of America
10 Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
11 Department of Medicine, Miller School of Medicine, Sylvester Cancer Center, University of Miami, Miami, Florida, United States of America
EJMO, 025390412 https://doi.org/10.36922/EJMO025390412
Received: 23 September 2025 | Revised: 15 October 2025 | Accepted: 16 October 2025 | Published online: 24 November 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Obesity is a well-established risk factor for endometrial cancer (EC). Postmenopausal women with EC frequently present with obesity-related comorbidities or develop them after diagnosis, which may impact survival.

Objectives: This study aimed to identify modifiable comorbidities (diabetes, cardiovascular disease, hypertension, and fractures) among postmenopausal EC survivors and evaluate the relationship between obesity-related comorbidities and all-cause mortality after an EC diagnosis.

Design: Prospective cohort analysis of overall mortality risk in relation to obesity-related comorbidities in women diagnosed with EC.

Population and Setting: Postmenopausal women recruited across 40 clinical sites within the Women’s Health Initiative (WHI) observational and clinical trials and experiencing a new diagnosis of EC.

Methods: Adjusted Cox proportional hazards regression models were used to evaluate the relationship between comorbidities and all-cause mortality among women with incident EC.

Results: A total of 1,661 incident cases of EC were identified. The overall mortality rate was 55.5%. The prevalence of each comorbidity increased from baseline to 18 years of follow-up. Regression analyses for incident EC indicated that severe obesity (hazard ratio [HR] = 2.13; 95% confidence interval [CI]: 1.52–2.97), cardiovascular disease (HR = 1.50; 95% CI: 1.26–1.78), and fracture (HR = 1.17; 95% CI: 1.07–1.27) were associated with greater overall mortality.

Conclusion: Obesity-associated comorbidities are common and associated with higher mortality in postmenopausal women diagnosed with EC. Interventions to reduce the risk of comorbidity among EC survivors may improve survival and should be evaluated (ClinicalTrial.gov identifier: NCT00000611).

Keywords
Obesity
Endometrial cancer
Women’s Health Initiative
Risk
Comorbidity
Funding
The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00001, and 75N92021D00005. The funding of the manuscript was supported by the University of Arizona Cancer Center (P30CA023074).
Conflict of interest
The authors declare that they have no conflicts of interest.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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