Adverse childhood experiences, obesity, and endometrial cancer: A case series and scoping review

To evaluate self-reported adverse childhood experiences (ACEs) in patients with endometrial cancer and class 3 obesity undergoing a preoperative weight loss protocol, and summarize the existing literature surrounding ACEs, endometrial cancer, and obesity.

We performed a retrospective chart review of 92 gynecologic oncology patients enrolled in a preoperative weight loss program from 2020 to 2022. Patients included in the case series had endometrioid carcinoma or atypical endometrial hyperplasia, class 3 obesity (body mass index ≥ 40 kg/m²), and at least one self-reported ACE. The scoping review followed PRISMA guidelines and included peer-reviewed studies evaluating ACEs in individuals with endometrial cancer or obesity.

Seventeen of 92 patients (18.5%) with class 3 obesity and endometrial cancer self-disclosed a history of ACEs. The most frequent ACE types were psychological abuse (7/15, 15 46.7%), sexual abuse (6/15, 40%), and physical abuse (4/15, 26.7%). Patients had a mean of 6.4 ± 2.5 comorbidities, with 13/17 (76.5%) patients having at least one mental health disorder. The scoping review identified three studies that investigated ACEs in endometrial cancer patients and found that ACEs may negatively impact gynecologic care. Various ACE types are linked to obesity, with a stronger association between ACEs and obesity in women versus men.

Patients with endometrial cancer, class 3 obesity, and ACEs in our study reported a high degree of abuse and medical comorbidities. ACEs appear to increase the risk of endometrial cancer via obesity and complicate patient care, but a formal association cannot be established.