A 45-year-old woman with a BMI of 42 kg/m2 and Type 2 diabetes undergoes endometrial biopsy that shows complex atypical hyperplasia (endometrial intraepithelial neoplasia). Hysterectomy specimen on final pathology reveals a 1 cm focus of grade 1 endometrioid adenocarcinoma with superficial myometrial invasion. What is the most significant risk factor in her history for progression from hyperplasia to carcinoma?
- A Nulliparity
- B Type 2 diabetes mellitus
- C Obesity (BMI > 35 kg/m2) ✓
- D Chronic anovulation
Correct answer: C. Obesity (BMI > 35 kg/m2)
Explanation
Obesity is the strongest modifiable risk factor for endometrial cancer. Adipose tissue converts androgens to estrogens via aromatase, creating a state of chronic unopposed estrogen. Each 5 kg/m2 increase in BMI raises endometrial cancer risk by approximately 50-60%. While diabetes, nulliparity, and anovulation are independent risk factors, obesity carries the highest relative risk and is most strongly associated with progression from atypical hyperplasia to carcinoma.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.