Khazaei Z., Hasanpour Dehkordi A., Amiri M., Adineh H. A., Sohrabivafa M., Darvishi I., Dehghani S. L., Goodarzi E. The incidence and mortality of endometrial cancer and its association with body mass index and human development index in Asian population. World Cancer Res J 2018; 5 (4): e1174

Full text

1
THE INCIDENCE AND MORTALITY
OF ENDOMETRIAL CANCER AND ITS
ASSOCIATION WITH BODY MASS INDEX
AND HUMAN DEVELOPMENT INDEX
IN ASIAN POPULATION
WCRJ 2018; 5 (4): e1174
Corresponding Author: Elham Goodarzi, MD; e-mail: Elhamgoodarzi.1370@yahoo.com
Abst ract – Objective: Endometrial cancer is the most common malignancy in women in many
countries. Body mass index (BMI) is associated with an increased risk of endometrial cancer. The
aim of this study was to investigate the incidence and mortality of endometrial cancer and its cor-
relation with BMI and human development index (HDI) in Asia in 2012.
Materials and Methods: This study was conducted based on the world data of cancer and the
World Bank including the HDI and its components. In this population-based study, we derived pop-
ulation attributable fractions (PAFs) using BMI estimates in adults by age, gender, and country. The
incidence and mortality rate due to endometrial cancer in Asian countries were drawn. For data
analysis, correlation test was used to investigate the relationship between incidence and death rate
and two parameters BMI and HDI using the Stata software version 14. Significance level (p) was
considered < 0.05.
Results: The highest incidence of endometrial cancer in Asia was reported for Armenia (26.7
per 100,000 population), followed by Israel (15.4 per 100,000 population) in the age group of 60-64
years, and the highest mortality rate due to this cancer for Armenia (1.6 per 100,000 population),
followed by Afghanistan (1.4 at 100,00 population). The highest rate of endometrial cancer was re-
ported for Kuwait (56.3%). The results showed a positive correlation between incidence of cancer
and HDI (r= 0.44, p>0.001). We observed no significant association between cancer-related death
and HDI (r= 0.26, p>0.05).
Conclusions: Overweight and obesity are associated with the risk of endometrial cancer. There-
fore, to prevent this cancer and associated complications, the implementation of an intervention
program for controlling obesity and also routine endometrial cancer screening programs in obese
and overweight women is necessary.
KEYWORDS: Endometrial Cancer, Incidence, Mortality, Human Development Index, BMI, Asia.
LIST OF ABBREVIATION: Body mass index (BMI), Human Development Index (HDI), Relative risk
(RR), Population attributable fraction (PAF).
1Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
2Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of
Medical Sciences, Shahrekord, Iran
3Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
4Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, Iranshahr, Iran
5Department of Health and Community Medicine, Faculty of Medicine, Dezful University of Medical
Sciences, Dezful, Iran
6Surgical Technology Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences
and Healthcare Services, Shiraz, Iran
7Department of Public Health, Behbahan Faculty of Medical Sciences, Behbahan, Iran
8Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
Z. KHAZAEI
1
, A. HASANPOUR DEHKORDI
2
, M. AMIRI
3
, H. A. ADINEH
4
,
M. SOHRABIVAFA
5
, I. DARVISHI
6
, S. L. DEHGHANI
7
, E. GOODARZI
8

2
THE INCIDENCE AND MORTALITY OF ENDOMETRIAL CANCER
3. Estimates of national mortality by modeling, us-
ing incidence mortality rates obtained from data
in national cancer registries (13 countries);
4. Estimates of national mortality by modeling,
using incidence mortality ratios obtained from
data in local cancer registries in border-sharing
countries (9 European countries);
5. Estimates of national mortality by using mod-
eled survival (32 countries);
6. Estimates of mortality according to the weighted
average of the local rates (16 countries);
7. One cancer registry covering a part of the coun-
try considered to be representative of the coun-
try prole (11 countries);
8. Age/gender-specic rates due to all cancers par-
titioned using data on relative frequency of dif-
ferent cancers (according to age and gender) (12
co u nt r ies);
9. The rates of neighboring countries or registries
in the same region (33 countries).
Mortality
Based on the detail degree and precision of the coun-
trywide mortality data, six methods below were ap-
plied in the following order of priority:
1. Rates approximate to 2012 (69 countries);
2. The majority of recent rates are applicable to
2012 population (26 countries);
3. Estimates of mortality according to the weighted
average of the local rates (1 country);
4. Estimates of national incidence rates by mod-
elling, using country-specic survival (2 coun-
tries);
5. Estimates of national incidence rates by using
modelled survival (83 countries);
6. The rates of neighboring countries or registries
in the same region (33 countries)9.
Body Mass index (BMi)
We used BMI average values and corresponding
standard deviations based on age and gender for the
adults over 20 years in each country during 1982-
2002. The age groups included 20 – 34, 35 – 44, 45
– 54, 55 – 64, 65 – 74, and ≥ 75 years.
relative risk (rr) estiMates
Only the cancers for which sufcient evidence
with respect to BMI was reported by World Can-
cer Research Foundation (WCRF) were reported,
including adenocarcinoma and cancers of esoph-
agus, rectum, large intestine, kidney, pancreas,
bladder, and breast cancer following menopause,
uterus, and ovary. The relative risk of a specic
gender in various regions was derived from the
analysis of the published standard measurements
by the WCRF and its Constant Updating Project
(CU P).
INTRODUCTION
Endometrial cancer is the fth leading cancer among
women worldwide, with 320,000 new cases diag-
nosed in 2012, which accounts for 4.8% of all cancers
in women1,2. Endometrial cancer is the third leading
cancer in the Western world, accounting for 6-9% of
all cancers in women3-5. Endometrial cancer is often
detectable in the early stages due to the nature of
the disease and incidence of uterine and/or vaginal
bleeding, with the 5-year survival rate of 85-91% 6.
About 73% of patients with endometrial cancer are
diagnosed in stage I, and the diagnosis may be made
in the stage II of the disease for about 10% of patients.
It is, therefore, very important to identify risk factors
followed by primary diagnostic interventions to mod-
ify the factors effective on cancer. Epidemiological
studies3 ,7 have shown that body mass index (BMI)
is a major risk factor for endometrial cancer. Every
woman faces a 3% risk of developing cancers in her
lifetime that increases for obese women. Studies have
shown that about 57% of endometrial cancer cases in
the United States occur due to overweight and obesi-
ty8. In a meta-analysis of 26 studies conducted by the
American Cancer Research Institute, it was reported
that per every ve units of increase in body mass, the
risk of developing endometrial cancer increases by
50%9. In addition, BMI increases the mortality rate of
endometrial cancer. In a retrospective study in wom-
en with primary endometrial cancer, obese women
had higher mortality rates than women with normal
BMI8.
MATERIALS AND METHODS
ava ilaBili ty of data on incidence
and Mortality
The method by which the death prevalence is mea-
sured is specic to each country and its quality
is based on the comprehensiveness and quality of
available data in the country. In each country, there
are many methods to achieve this purpose and be-
cause these methods are complex and various, it is
relatively impossible to denitely determine a qual-
itative value of death prevalence. However, there is
an alphabetical, numerical scoring system that in-
dependently describes the death prevalence and its
associated information on national level
incidence
The age and gender-based incidence of endometrial
cancer in each country was assessed by using the
following category:
1. Rates approximate to 2012 (38 countries);
2. The majority of recent rates were applicable to
2012 population (20 countries);

3
THE INCIDENCE AND MORTALITY OF ENDOMETRIAL CANCER
PoPulation attr iButaBle fraction (Paf)
The PAF was calculated using the method suggested
by the Comparative Risk Assessment Collaborating
Group, according to the formula below:
Where P(x) represents the population distribu-
tion of BMI, P*(x) the distribution of the theoreti-
cal minimum BMI, and RR(x) the relative risk of
cancer related to a BMI of value x. The distribution
of the theoretical minimum BMI was dened as a
BMI distribution with a mean of 22 kg/m² and a
standard deviation of 1, where the disease burden is
assumed lowest at the population level. A log-logit
function was applied to characterize the shape of the
RR across BMI units. No risk 1 0,11 was assumed for
a BMI under 22 kg/m² and no risk increase for BMI
over 40 kg/m².
cancer incidence and attriButaBle
cancer Burden
Because of the slow effect of time on weight gain
and cancer development (supposedly 10 years), the
cancer load with respect to weight gain in adults
aged ≥ 20 years appears only in cancers that have
lasted 10 years or over. Accordingly, the number of
cancer cases was calculated according to age (over
30 years), gender, and country based on GLOBO-
CAN in 2012. Countries were classied into 12
geographical regions: Sub-Saharan countries (East,
Middle, South and West Africa), Middle East (West-
ern Asia), and North Africa; Latin America (Cen-
tral and South America), and the Caribbean; North
America; East Asia (including China), Southeast
Asia; South Central Asia (central and southern Asia
including India); Northern Europe, Eastern Europe;
Southern Europe; Western Europe, and Oceania (in-
cluding New Zealand and Australia).
Hdi
HDI is a combination index consisting of three di-
mensions: degree of studies, life expectancy, and
dominance over required sources for a proper sen-
sible life. All the regions and groups that have ex-
perienced a noticeable progress in all HDI compo-
nents have developed more quickly in comparison
with low or moderate HDI countries. According to
this index, the world is unequal because national av-
erage value hides most of the various experiences
in human life. Many inequalities exist in northern
and southern countries. Income inequality has been
intensied inside each country as well as between
many countries12,13.
statistical analysis
In this study, the correlation bivariate method was
used to assess the correlation between the incidence
and mortality rates of endometrial cancer and the
HDI. Linear regression models were also used to as-
sess the HDI effect on the incidence rate of endome-
trial cancer. Signicance level was considered low-
er than 0.05. Data analysis was conducted by Stata
software version 14.
RESULTS
According to the results recorded in GLOBOCAN
in 2012, 6763030 cases (152.21 per 100,000 popu-
lation) were registered in Asia, of whom 3694857
(174.1 per 100,000 population) were male and
3068173 (13.3 per 100 000 population) female. Be-
sides that, the mortality rates for men and women
were 2689472 (12.36 per 100,000 population) and
1810074 (77 per 100,000 population), respective-
ly. The incidence and mortality rates for women
due to endometrial cancer were 131819 (6 cases
per 100000 population) and 34247 cases (1.5 cases
per 100000 population), respectively. The highest
incidence rate of endometrial cancer in Asia was
reported for Armenia, followed by Israel and Geor-
gia with the rates of 26.7, 15.4, and 14.2 cases per
100000 population, respectively. In addition, the
highest mortality rate due to endometrial cancer
was reported for Armenia, followed by Afghani-
stan and Tajikistan with the rates of 6.1, 4.1, and 4
cases per 100000 populations, respectively (Table
1, Figure 1, and Figure 2).
Regarding the incidence of the disease in dif-
ferent age groups in ve countries with the highest
incidence rates, namely, Armenia, Israel, Georgia,
Singapore, Kyrgyzstan, the results showed that the
highest incidence was observed in the age group
of 60-64 years and the lowest incidence in the age
group under 40 years, with the incidence gradually
decreasing in the age group over 65 years old (Fig-
ure 3).
The results showed a positive correlation be-
tween incidence of cancer and HDI (r = 0.44, p >
0.001). We observed no signicant association be-
tween cancer-related death and HDI (r = 0.26, p >
0.05).
Regarding the status of BMI and the incidence
of cancer in Asia, the results showed that about
108900 cases in both genders were attributed to
BMI. In women, about 80,000 cases of cancer
were attributed to BMI. The highest percentages
of all cancers associated with BMI were reported
from the Western Asia, covering Kuwait (10.6%),
Jordan (9.9%), Israel (9.5%), and Armenia (9.5%).

4
THE INCIDENCE AND MORTALITY OF ENDOMETRIAL CANCER
TABLE 1. Incidence and mortality rates for endometrial cancer in females in Asia in 2012.
Country Incidence Mortality HDI
Number (%) ASR (W) Number (%) ASR (W)
Asia 131720 4.3 6.0 34247 1.9 1.5
Eastern Asia 89304 5.2 8.6 20823 2.1 1.9
China 73109 5.9 8.6 17160 2.2 1.9 0.907
Japan 11449 1.6 10.6 2783 0.7 16 0.894
Korea, Democratic Republic of 766 2.6 5.0 333 1.7 2.0 —
Korea, Republic of 2016 1.9 5.8 291 0.9 0.7 —
Mongolia 20 1.1 1.9 15 1.1 1.4 0.720
South-Eastern Asia 15329 3.8 5.1 4432 1.9 1.5
Brunei 26 9.0 12.6 4 3.7 2.2 0.860
Cambodia 161 1.9 2.5 56 1.0 1.0 0.546
Indonesia 6475 4.0 5.6 1947 2.1 1.7 0.677
Lao PDR 76 2.6 3.4 28 1.3 1.3 0.563
Malaysia 710 1.9 5.3 220 1.0 1.7 0.799
Myanmar 598 1.8 2.4 230 1.0 1.0 0.540
Philippines 2221 4.0 5.6 502 1.8 1.4 0.671
Singapore 539 7.0 13.9 77 2.4 1.8 0.920
Thailand 1852 3.0 3.9 512 1.4 1.1 0.733
Timor-Leste 32 6.3 9.3 12 3.5 3.8 0.620
Viet Nam 2639 2.1 5.4 844 0.9 1.8 0.668
South-Central Asia 19966 2.5 2.7 7227 1.5 1.0
Afghanistan 727 6.9 7.9 308 4.2 4.1 0.470
Bangladesh 929 1.5 1.5 357 0.8 0.6 0.565
Bhutan 0 0.0 0.0 0 0.0 0.0 0.589
India 12323 2.3 2.3 4773 1.5 0.9 0.599
Iran, Islamic Republic of 795 0.2 2.5 196 0.8 0.6 0.769
Kazakhstan 1259 5.8 12.9 280 2.6 2.7 0.782
Kyrgyzstan 198 6.3 8.4 60 3.2 2.8 0.647
Maldives 3 2.8 3.1 0 0.0 0.0 0.683
Nepal 98 0.9 0.9 38 0.5 0.3 0.545
Pakistan 2171 2.6 3.6 797 1.5 1.4 0.538
Sri Lanka 207 0.9 1.5 53 0.4 0.4 0.757
Tajikistan 349 12.0 12.2 106 5.8 4.0 0.617
Turkmenistan 145 4.7 6.1 37 2.0 1.7 0.678
Uzbekistan 762 6.0 5.8 222 3.0 1.8 0.681
Western Asia 7121 2.2 7.6 1765 0.9 1.9
Armenia 596 5.5 26.7 165 2.4 6.1 0.736
Azerbaijan 153 2.3 2.8 41 1.0 0.8 0.745
Bahrain 14 3.2 4.7 3 2.0 1.3 0.815
State of Palestine 88 2.5 7.8 27 1.2 2.7 0.684
Georgia 432 7.1 14.2 147 4.4 3.9 0.755
Iraq 144 1.0 1.5 47 0.5 0.5 0.659
Israel 830 2.8 15.4 131 1.2 2.0 0.891
Jordan 95 2.9 5.2 24 1.4 1.3 0.737
Kuwait 40 4.9 7.6 17 4.4 3.8 0.796
Lebanon 187 3.9 7.7 41 1.8 1.6 0.766
Oman 23 3.4 3.9 5 1.4 0.9 0.796
Qatar 13 1.3 5.7 1 0.2 1.0 0.843
Saudi Arabia 432 4.7 5.8 87 2.1 1.3 0.830
Syrian Arab Republic 239 1.1 3.3 69 0.5 1.0 0.635
Turkey 3787 6.1 10.1 951 2.9 2.5 0.754
United Arab Emirates 39 1.3 6.0 5 0.4 1.0 0.829
Yemen 9 0.1 0.1 4 0.1 0.1 0.498

5
THE INCIDENCE AND MORTALITY OF ENDOMETRIAL CANCER
Fig. 2. The highest incidence rates for endometrial cancer in women in Asia [extracted from GLOBOCAN 2012].
Fig. 3. Incidence of endometr ial cancer in Asian women in different age groups in 2012.
Fig. 1. Incidence of endometrial cancer in women in Asia in [extracted from GLOBOCAN 2012].

6
obesity was strongly associated with the incidence
of endometrial cancer. Adipose tissue produces a
lot of estrogen, and high estrogen levels increase
the risk of endometrial cancer. Obese people often
have high levels of insulin and insulin-like growth
factor (IGF) in the blood (IGF-1)29. This complica-
tion, called hyperinsulinemia or insulin resistance,
is a preliminary stage of type 2 diabetes. High lev-
els of insulin and IGF-1 play an important role in
the development of colon, kidney, prostate cancers
and endometrial cancer 30 -32. In the United States in
2013, approximately 49560 endometrial cancer cas-
es were detected, making this cancer recognized as
the fourth leading cancer in women 33. The study of
Esposito et al32 showed that the risk of endometrial
cancer is higher in people with high BMI. An im-
portant role of obesity was also reported by Frieden-
reich et al34, 35 In a large study by Bjorge et al30 on a
total of 287320 cases, high BMI was reported in 917
cases of endometrial cancer. Various studies have
shown the association between BMI and increased
risk of mortality in patients with endometrial cancer
35,36. In a meta-analysis of 221 databases, a signi-
cant association was found between BMI and endo-
metrial cancer37. Studies have shown that the risk of
endometrial cancer can be reduced by weight loss
through diet and physical activity strategies38.
CONCLUSIONS
Overweight and obesity are major contributors to
endometrial cancer and increase the risk of devel-
oping endometrial cancer. Therefore, to prevent this
cancer and associated complications, the implemen-
tation of an intervention program for controlling
obesity and also routine endometrial cancer screen-
ing programs in obese and overweight women is
necessary.
acknowledgeMents:
The authors gratefully thank the many cancer registries
worldwide and their staff for permitting us to use their
data in this work.
conflict of interest:
The authors declare no conict of interest
The lowest percentage of all cancers associated with
BMI was reported from Bangladesh (0.35%), Ne-
pal (0.61%) and Vietnam (0.65%). The results also
showed that 26,000 (21%) of endometrial cancer
cases in Asia were attributed to BMI. The highest
percentage of endometrial cancer associated with
BMI was observed in Kuwait (56.3%), followed by
Jordan (54.5%) and Saudi Arabia (52.8%). The most
preventable levels of endometrial cancer associated
with BMI were reported from Maldives (29.1%),
Lebanon (21.4%), Bahrain (21.1%), and Iran (21.1%)
(Table 2, Figure 2).
The results showed a positive correlation be-
tween the percentage of cancers associated with
BMI and HDI (r = 0.569, p < 0.05). The results
showed that the correlation between endometrial
cancer and BMI and HDI was 0.51 (p < 0.05) (Fig-
ure 4).
DISCUSSION
Obesity is one of the most common medical dis-
orders and also one of the most important public
health issues3. In 2016, the prevalence of obesity
(BMI: 25-29.9 kg/m2) and obesity (BMI > 29.9 kg/
m2) was 38% in men and 39.2% in women14. A study
(2015) showed that about 3.6% of patients with can-
cer in 2012 were overweight or obese. Previous
studies have shown that obesity is associated with
an increased risk of various types of cancers includ-
ing cancers of stomach15, 16, liver17, ovary18, pancre-
as19,20 and colon21. It has been estimated that 38.4%
of endometrial cancer cases in 2012 were associated
with diabetes and BMI22,23. The analysis of cohort
and case studies also conrms the positive correla-
tion between overweight and obesity and the risk of
developing endometrial cancer among both Asians
and non-Asians3, 24. Overweight is responsible for
about 30% of endometrial cancer in 30 European
countries25. With increasing prevalence of obesity
in the following years, endometrial cancer incidence
seems to increase. Evidence has shown that relative-
ly lean women with the BMI of 20 kg/m2 have the
lowest risk of developing endometrial cancer. Dif-
ferent epidemiological studies have investigated
obesity and the risk of developing endometrial can-
cer 26-28. In a large cohort study in American women,

7
TABLE 2. Fraction (%) of all cancer cases (at all anatomical sites), endometrial cancer and preventable fraction attributable to BMI in Asia in 2012 by country.
Sites Fraction (%) of all cancer cases
(at all anatomical sites) attributable to BMI )
Fraction (%) of all endometrial
Preventable
cancer attributable to BMI
fraction (%)
Female Male Both Sexes
(%) Number (%) Number (%) Number (%) Number
Asia 10890 0
Eastern Asia
China 49000 1.7
Japan 15000 2.2
Korea, Republic of 4600 2.2
Mongolia 49 1.3
South-Eastern Asia
Brunei 15 2.9
Cambodia 66 0.48
Indonesia 3600 1.3
Lao PDR 38 0.68
Malaysia 1100 3.2
Myanmar 439 0.72
Philippines 1600 1.8
Singapore 521 3.4
Thailand 2400 2
Timor-Leste 8 0.84
Viet Nam 368 0.31
South-Central Asia
Afghanistan 109 0.64
Bangladesh 249
Bhutan 3 0.76
India 7000 0.73
Iran 2400 3.1
Kazakhstan 1700 4.5
29600
14000
5800
180 0
13
4
6
481
4
308
43
300
154
416
1
37
12
45
1
956
681
353
80000
36000
9400
2800
36
10
61
3200
35
810
395
1300
376
2000
7
330
96
204
2
6000
170 0
140 0
26000
14000
1900
458
7
2800
5
16
1200
10
237
80
455
131
539
4
181
3200
50
29
140 0
310
479
0.76
1.4
0.8
0.65
2.0
0.09
0.37
0.13
1.8
0.15
0.76
2.0
0.69
0.22
0.06
0.16
0.08
0.48
0.22
1.6
2.0
3.0
3.2
2.8
1.9
3.7
0.8
2.1
1.3
4.5
1.3
2.6
4.9
3.4
1.5
0.65
1.1
0.35
1.1
1.2
4.7
6.6
21
20
16.7
23.1
34.8
18.8
10.3
18.4
12.9
33.9
13.6
21.8
24.6
29.3
11.1
7.1
7.4
3.3
0.0
11.7
40
39.2
3.0
4.4
9.6
8.8
1.0
0.0
0.0
0.0
19.7
0.0
0.0
0.0
13.4
0.0
0.0
0.0
0.0
0.0
0.0
21.1
4.5
Continued

THE INCIDENCE AND MORTALITY OF ENDOMETRIAL CANCER
8
TABLE 2 (Continued). Fraction (%) of all cancer cases (at all anatomical sites), endometrial cancer and preventable fraction attributable to BMI in Asia in 2012 by country.
Sites Fraction (%) of all cancer cases
(at all anatomical sites) attributable to BMI )
Fraction (%) of all endometrial
Preventable
cancer attributable to BMI
fraction (%)
Female Male Both Sexes
(%) Number (%) Number (%) Number (%) Number
Kyrgyzstan 189 3.5
Maldives 6 2.7
Nepal 69 0.4
Pakistan 2300 1.7
Sri Lanka 283 1.2
Tajikistan 128 2.6
Turkmenistan 120 2.2
Uzbekistan 622 2.2
Western Asia
Armenia 580 5.5
Azerbaijan 336 2.6
Bahrain 43 5.2
Georgia 403 3.3
Iraq 834 3.7
Israel 1900 6.6
Jordan 417 7.2
Kuwait 107 7.2
Lebanon 464 5.4
Oman 50 3.8
Qatar 45 4.9
Saudi Arabia 1000 6.8
Syrian Arab Republic 1100 5.5
Turkey 6600 4.8
United Arab Emirates 126 4.8
Yemen 220 2.5
29
1
10
193
26
22
35
111
71
81
14
63
176
571
127
30
91
17
20
290
287
170 0
45
59
160
5
59
2100
257
106
85
510
510
255
29
340
659
1300
290
77
372
33
25
742
802
4900
81
161
69
1
5
494
44
71
38
226
17000
246
70
7
159
67
393
51
23
91
9
6
225
120
1900
21
3
1.1
0.43
0.14
0.35
0.27
0.96
1.3
1.3
1.4
1.2
3.3
1.0
1.8
3.9
4.5
3.9
2.2
2.4
3.5
4.0
3.0
2.1
3.4
1.5
5.5
5.1
0.61
2.7
2.0
4.1
3.0
4.4
9.5
4.0
7.1
5.6
5.3
9.5
9.9
10.6
8.3
5.5
7.3
9.2
7.7
8.5
6.3
3.3
35.4
45.4
5.3
23.5
21.2
21.9
26.2
30
41.3
45.8
48.1
36.9
47. 5
47. 5
54.5
56.3
48.8
40.4
48.8
52.8
50.8
50.7
52.7
36.2
1.2
29.1
0.0
9.4
0.0
0.0
1.2
10.5
8.0
2.9
21.1
0.61
12.1
19.7
9.4
15.1
21.4
12.2
8.8
15.6
16. 3
13.4
11.0
15.8

9
THE INCIDENCE AND MORTALITY OF ENDOMETRIAL CANCER
Fig. 5. Fraction (%) of all endometrial cancer cases among women in Asia in 2012 attributable to excess body mass index by
countr y [Extracted from GLOBOCAN 2012].
Fig. 4. Correlation bet ween the HDI and incidence and mortality rates of endometrial cancer in Asia in 2012.
Fig. 6. Cor relation between the Human Development Index and Fraction (%) of all cancer cases (at all anatomical sites) and
endometrial cancer in Asia in 2012.

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