Research Protocol

Risk of Endometrial Hyperplasia and Carcinomain Marathon Runners: A Cross Sectional Survey

Donna Session, MD

Michelle Roach, MD

Mali Schneiter, DO

Background and Significance:

In 2016, over 60,050 women were diagnosed with endometrial carcinoma and approximately 10,000 women died from the disease. Endometrial cancer is the fourth most common malignancy and is the most common gynecologic malignancy in the United States. Theincidence has been increasing steadily since the 1990’s for black women and since the mid-2000’s for white women (1). The main risk factor for development of endometrial hyperplasia is long-term exposure to unopposed estrogen which can occur from anovulatory processes such as polycystic ovarian syndrome, early menarche, nulliparity and obesity (2). In one prospective study, obesity demonstrated an increase of 50% cancer risk for every 5 BMI unit increase (3). Due to this large risk factor, it is logical that extreme exercise such as marathon running, which can cause functional hypothalamic amenorrhea, could potentially have a protective quality against endometrial hyperplasia and carcinoma. Although there has been research demonstrating the role of exercise in decreasing morbidity and increasing quality of life in endometrial cancer survivors (4), no studies to date have specifically evaluated the effects of extreme exercise on the incidence of endometrial carcinoma.

Significance:

There has been no study to date specifically determining the significance of intense exercise such as marathon running and its effect on decreasing a women’s lifetime endometrial cancer risk in women.

Specific Aims:

Hypothesis: Women who are marathon runners will have a decreased incidence of endometrial cancer compared to the general population.

Primary aim:

To assess and compare incidence of endometrial cancer among marathon runners and the general population.

Research Design and Methods:

Study Design:

We will use a multiple choice style Red Cap survey to assess the incidence of endometrial cancer among marathon runners. The survey will be distributed on popular running and marathon websites as well as through local running groups. The survey will be anonymous and voluntary. The survey will be available for 3 months. We will then collect the results and determine the incidence of endometrial cancer as well as risk factors for endometrial cancer among our population as compared to the WHO reported incidence.

Inclusion Criteria:

Women >18 years old

Women currently training for or who have previously run a marathon

English speaking

Exclusion criteria:

Women with a diagnosis of PCOS

Women with a Mirena IUD in place or have ever had a Mirena IUD in place

Family history of HNPCC

Data Collection:

The survey will be conducted through Red Cap survey. Results will be complied through Red Cap survey website after 3 months.

Statistical Analysis:

Need to discuss

Sample size:

To be determined according to statistical need

References

  1. Siegel, R. L., Miller, K. D. and Jemal, A. (2016), Cancer statistics, 2016. CA: A Cancer Journal for Clinicians, 66: 7–30. doi:10.3322/caac.21332
  2. Brinton LA, Berman ML, Mortel R, et al. Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study. Am J ObstetGynecol 1992; 167:1317.
  3. Aune D, Navarro Rosenblatt DA, Chan DS, et al. Anthropometric factors and endometrial cancer risk: a systematic review and dose-response meta-analysis of prospective studies. Ann Oncol. 2015;26:1635-1648
  4. Zhang X, Haggerty AF, Brown JC, Giuntoli R, Lin L, Simpkins F, et al. The prescription or proscription of exercise in endometrial cancer care. Gynecol.Oncol. 2015; 139:155–159. doi: 10.1016/j.ygyno.2015. 08.007 PMID: 26307400