High cadmium intake linked to shorter OS among women with endometrial cancer
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High daily dietary cadmium intake appeared associated with shorter OS among women with endometrial cancer, according to study results published in Nutrition and Cancer.
However, researchers observed no association between dietary cadmium intake and PFS.
Factors associated with endometrial cancer risk include hypertension, diabetes and certain conditions linked to excess estrogen exposure, such as early menarche, late menopause and high BMI. Environmental factors that mimic estrogen also may be linked to higher endometrial cancer incidence, according to study background.
Cadmium — a heavy metal and environmental contaminant classified as a group 1 carcinogen — mimics estrogen in the human body.
“Medical professionals know a lot about the role of estrogen in gynecological cancers; however, the influence of exogenous hormone-like substances on the cancer process is often underestimated. We aimed to narrow this gap,” Zoia Razumova, MD, PhD, researcher in the department of women’s and children’s health at Karolinska Institute in Sweden, told Healio. “We presume that clinicians should carefully evaluate patients’ food behaviors and recommend avoiding food products with high cadmium levels during and after endometrial cancer treatment.”
Razumova and colleagues evaluated the effect of dietary cadmium intake on PFS and OS among 416 Swedish women (median age, 67 years; median BMI, 26 kg/m²) with endometrial cancer treated at Karolinska University Hospital Solna in Sweden between 2007 and 2012.
Early-stage diploid endometroid carcinoma was the most common tumor type. All women underwent hysterectomy and bilateral salpingo-oophorectomy, during which tumor tissue samples were obtained.
Women completed two questionnaires — one covered lifestyle and dietary habits and the other covered selected socioeconomic and reproductive factors.
Researchers assessed median dietary cadmium intake in relation to different tumor characteristics and clinical outcomes. They last reviewed survival data in February 2019.
Median follow-up was 8.5 years.
According to study results, median daily dietary cadmium intake was 13.1 g and median weekly intake was 1.3 g/kg of body weight, with cereal products and vegetables as the dominant source of cadmium intake (75.3%).
Researchers observed a significant association between high daily dietary cadmium intake and shorter OS (HR = 0.956; 95% CI, 0.914-1.001).
Of note, physical activity was associated with a decreased probability of death (P < .0001).
Cadmium intake did not appear to be associated with PFS (HR = 0.975; 95% CI, 0.924-1.028). However, a significantly higher number of PFS events occurred among those in the middle tertile of median daily dietary cadmium intake (11.3 g-14.9 g, 18.1%) compared with the lowest tertile (< 11.3 g, 12.9%) and highest tertile (> 14.9 g, 7.9%) combined (HR = 1.804; 95% CI, 1.056-3.079).
Researchers also observed shorter PFS among women with type 2 endometrial cancer and more advanced-stage disease (P < .0001 for both).
“We have shown that high cadmium intake from food and tobacco products are correlated with lower survival rates among patients with endometrial cancer,” Razumova said. “The need for ceasing tobacco usage should be discussed jointly with the previous recommendation. It could also be potentially applied to women with certain hereditary syndromes known to increase a woman’s lifetime risk for endometrial cancer.”
The researchers noted that the Panel on Contaminants in the Food Chain stated that a tolerable weekly cadmium intake is 2.5 g/kg of body weight, which suggests that the patients in the current cohort benefited from a high level of consumer protection. Moreover, due to Swedish regulations, Swedish women overall do not belong to a vulnerable group regarding cadmium exposure. For this reason, the results of the current study may be applicable to countries with similar strict regulations.
“Although we investigated the prognostic role of cadmium in endometrial cancer in a relatively big cohort, population-based studies are still needed,” Razumova said. “It is also essential to explore the role of cadmium and other metals with estrogen-like activity on the risk for developing hormone-depended cancers and long-term survival rates.”
For more information:
Zoia Razumova, MD, PhD, can be reached at Karolinska Institute, Solnavagen 1, 171 77 Solna, Sweden; email: zoia.razumova@ki.se.
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