title: An epidemiological model for prediction of endometrial cancer risk in Europe.
abstract: Endometrial cancer (EC) is the fourth most frequent cancer in women in Europe, and as its incidence is increasing, prevention strategies gain further pertinence. Risk prediction models can be a useful tool for identifying women likely to benefit from targeted prevention measures. On the basis of data from 201,811 women (mostly aged 30-65 years) including 855 incident EC cases from eight countries in the European Prospective Investigation into Cancer and Nutrition cohort, a model to predict EC was developed. A step-wise model selection process was used to select confirmed predictive epidemiologic risk factors. Piece-wise constant hazard rates in 5-year age-intervals were estimated in a cause-specific competing risks model, five-fold-cross-validation was applied for internal validation. Risk factors included in the risk prediction model were body-mass index (BMI), menopausal status, age at menarche and at menopause, oral contraceptive use, overall and by different BMI categories and overall duration of use, parity, age at first full-term pregnancy, duration of menopausal hormone therapy and smoking status (specific for pre, peri- and post-menopausal women). These variables improved the discriminating capacity to predict risk over 5 years from 71% for a model based on age alone to 77% (overall C statistic), and the model was well-calibrated (ratio of expected to observed cases = 0.99). Our model could be used for the identification of women at increased risk of EC in Western Europe. To achieve an EC-risk model with general validity, a large-scale cohort-consortium approach would be needed to assess and adjust for population variation.
authors.affiliation: Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany. a.huesing@dkfz.de.
authors.forename: Anika
authors.initials: A
authors.lastname: Hüsing
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, 94805, Villejuif, France.|UnivParis Sud, UMRS 1018, 94805, Villejuif, France.|IGR, 94805, Villejuif, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Dossus
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Hansen
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, 94805, Villejuif, France.|UnivParis Sud, UMRS 1018, 94805, Villejuif, France.|IGR, 94805, Villejuif, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Fagherazzi
authors.affiliation: Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, 3053, Australia.|Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, 3010, Australia.
authors.forename: Laura
authors.initials: L
authors.lastname: Baglietto
authors.affiliation: Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
authors.forename: Helena
authors.initials: H
authors.lastname: Schock
authors.affiliation: Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.affiliation: German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Steffen
authors.affiliation: Hellenic Health Foundation, 13 Kaisareias Street, 115 27, Athens, Greece.|Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, 115 27, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M. Asias Street, Goudi, 115 27, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.affiliation: Hellenic Health Foundation, 13 Kaisareias Street, 115 27, Athens, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Katsoulis
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.affiliation: Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
authors.forename: N Charlotte
authors.initials: NC
authors.lastname: Onland-Moret
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
authors.forename: Petra H
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.|National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, UiT The Arctic University of Norway, Tromsø, Norway.|Department of Research, Cancer Registry of Norway, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Samfundet Folkhälsan, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Inger T
authors.initials: IT
authors.lastname: Gram
authors.affiliation: Navarre Public Health Institute, Pamplona, Spain.|CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Unit of Nutrition, Environment and Cancer. Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Obón-Santacana
authors.affiliation: CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.|Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.|Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Navarro
authors.affiliation: CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.|Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Sánchez-Cantalejo
authors.affiliation: CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.|Public Health Division of Gipuzkoa-BIODONOSTIA, Basque Regional Health Department, San Sebastián, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Etxezarreta
authors.affiliation: CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Allen
authors.affiliation: School of Clinical Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Kay Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Sabina
authors.initials: S
authors.lastname: Rinaldi
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Merritt
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Gunter
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008593:Menopause; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: Endometrial cancer; Epidemiology; Prevention; Risk model