Question

Endometrial Cancer

Researcher A conducts a case-control study to explore the consumption of fruits and vegetables and the risk of endometrial cancer. The results of the study indicate a lower risk of cancer with vegetable consumption.

Researcher B conducts a cross-sectional study to explore the consumption of fruits and vegetables and the risk of endometrial cancer. The results of the study indicate a higher risk of cancer with vegetable consumption.

Conduct research by reading the articles and journals on endometrial cancer. Based on your research and understanding, answer the following questions:

From the research information you have at hand, what do the above mentioned two case studies tell you about the risk of endometrial cancer?

Is there any common ground covered between the two studies? If so, list and explain them. If not, provide reasons why.

What is your opinion on each study in terms of design and demographics? Which method do you think has more merit? Why?

What additional information would be needed to arrive at a conclusion?

Answer 1

Introduction: Endometrial cancer is a disease that primarily affects postmenopausal women at an average age of 60 years at diagnosis. It is ranked fourth among all cancers in women and in the United States it is the most common cancer associated with the aged women. It has much of its risks modifiable indicated by the large variation age incidence rates. According to the results from American Cancer Society's, associations for vegetables and fruits are done separately among women and it has been noted that there are many cases of endometrial cancer matching results obtained in the year 2003.

Body: According to researcher B Results of the study about the consumption of fruits and vegetables and the risk of endometrial cancer indicates a higher risk of cancer with vegetable consumption. This has been supported through antioxidant activity whereby consuming fruit and vegetables contain numerous bioactive compounds which in return will influence cancer risk.

It has also been noted that women from a family with history of endometrialcancer are at increased risk. It has also been said that women with hereditary non polyposis colorectal cancer are also at risk compared with those who do not have. Countries like United States and Canada have the highest rates of endometrial cancer and also those who have migrated to these countries are in an increased risk of the disease. These countries have lifestyle factors including taking vegetables rich in high dietary fiber which in return influence metabolism process, and also excretion of estrogens.

On the other hand, smoking, full body mass index and multivitamin have been said to contribute immensely on the high risks of endometrial cancer. In addition, consumption of fruits and vegetables which are high in lutein and vitamin has actually contributed to the high risks of endometrial cancer. Salad contains the largest lutein and not to forget followed by broccoli and lastly spinach.

Among the citrus fruits, the largest contributor is orange juice and with current studies it has been found that all the other citrus fruits do not contribute to high risk of endometrial cancer. This argument however doesn’t include are citrus fruits like lemon which I think could contribute immensely to the high risks of endometrial cancer.

According to researcher A, case-control study show the consumption of fruits and vegetables indicates a lower risk of cancer with vegetable consumption. Total vegetable and dark green or dark yellow vegetable consumption are inversely associated with endometrial cancer risk. Many of us believe that increased intake of allium vegetables will lead to increased risk of endometrial cancer, however this is not the case, and it has been found that, there is no association between vegetable consumption and risk of endometrial cancer.

It has even been found that high intake of vegetables has led to reduced esophagus, lung, stomach, and colorectal cancer. This has motivated many people and encouraged them to continue taking more vegetables as this will not only make them healthier but also have reduced cases of endometrial cancer.

Conclusion: A recent study conducted in the United Kingdom in more than two million women aged 51 to 65years, obtained statistics showing a decreased risk of endometrial cancer which is associated with continuous combined estrogen-progestin therapy as compared to never-users. A similar study conducted by European Prospective Investigation gave the same results. European Prospective Investigation also found 15,000 cases of postmenopausal endometrial cancers associated with women.

Fruits and vegetables through studies show that they contain a wide variety of biologically active compounds including carotenoids, vitamin C, tocopherols, indoles, isothiocyanates, sulfurofane, isoflavones, phytosterols, and flavonoidswhich have been said to have the potential to affect the initiation and promotion ofdifferent epithelial cancers through a range of mechanisms. Through these results fruits have been found to have an association with the disease, however studies found no evidence that intake of all fruits or vegetables (dark green, leafy vegetables; orange vegetables, etc.) is associated with reduced risk of endometrial cancer.

There is no common ground between the two cases since Case-control studies support a reduced risk of endometrial cancer which is associated with greater vegetable consumption but not fruit consumption. However one prospective study conducted recently suggested an inverse association with fruits and vegetables combined. From the table results below, it is clear that vegetable consumption has many merits compared to fruit consumption and both.

baseline questionnaire (2004)	Baseline food frequency questionnaire (2010)	Follow-up food frequency questionnaire (2015)
Citrus fruits/juices	Oranges*,†	Oranges*,†
	Orange or grapefruit juice*,†	Orange juice*,†
		Grapefruit juice*
	Grapefruit*,‡	Grapefruit*,‡
Tomatoes	Tomatoes, tomato juice‡	Tomatoes‡
	Spaghetti, lasagna	Tomato sauce (e.g., spaghetti sauce)‡
Green leafy vegetables	Green salad**	Iceberg or head lettuce
	Spinach§,**	Spinach, cooked §,** Spinach, raw as in salad§,**
	Mustard greens, turnip greens, collards§,#,**	Kale, mustard, or chard greens§,#,**
Carrots	Carrots or mixed vegetables containing carrots§	Carrots, raw§ Carrots, cooked, or carrot juice§
	Sweet potato/yams§	Yams or sweet potatoes§
Squash, corn	green beans, corn, or peas	squash§

↵* Rutaceae (citrus) botanical family.

↵† Foods high in vitamin C (>50 mg/100 g).

↵‡ Foods high in lycopene (>750 μg/100 g).

↵§ Foods high in β-carotene (>1,900 μg 100 g).

↵¶ Campbell Soup Company, Camden, New Jersey.

↵# Cruciferae (mustard) botanical family.

↵** Foods high in lutein/zeaxanthin (>1,000 μg/ 100 g).

Reference:

Gennari R, Curigliano G, Rotmensz N, et al. Breast carcinoma in elderly women: features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer. 2004;101:1302–1310.

Thurlimann B, Keshaviah A, Coates AS, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med. 2005;353:2747–2757.

Ziller V, Kalder M, Albert US, et al. Adherence to adjuvant endocrine therapy in postmenopausal women with breast cancer. Ann Oncol. 2009;20:431–436.