A Spoonful of Sugar: The Link between Diet and Uterine Cancer

Over the past decade, rates of cancer diagnoses have decreased, and rates of cancer survival have increased. However, cases of cancer that affect the female reproductive system, such as uterine cancer, continue to rise. According to the American Cancer Society, uterine cancer is the most commonly diagnosed gynecological cancer in the US. Uterine cancer includes both endometrial cancer (cancer of the uterine lining) and uterine sarcoma (cancer of the uterus muscles or other tissues). The American Cancer Society also estimates that 68,270 new cases of endometrial cancer will be diagnosed in 2026, and by the end of the year, about 14,450 people are expected to die. As uterine cancer is most commonly diagnosed after the age of 50, all premenopausal women should be told of the risks and symptoms of endometrial and uterine cancer.

The factors that impact the likelihood of developing uterine cancer over our lifetime are complex. One such factor that may seem unrelated is diet; however, what we eat plays a large role in determining risk for this disease. Diet is not always about personal lifestyle choices; it is inextricably tied to people’s neighborhood environment, financial constraints, and other structural barriers we call social determinants of health. While balancing work, child care, healthcare appointments, and maintaining a home, thinking deeply about our food choices or cooking healthy meals can easily fall to the wayside. As a part-time masters student, I typically have classes from 6:00 to 9:00 p.m. following my full-time job. On these late nights, I decide to get off the train one stop early near the local fast food restaurant. Despite knowing the negative impacts of fast food on my health, I find it difficult to pass up the opportunity to grab a quick, hot meal before going home.

Food Injustice
While my specific challenges are time and competing priorities, many people face more complex barriers to eating healthy through no fault of their own. Black communities in particular are more likely to experience food insecurity due to the long-term effects of redlining and the recent impacts of gentrification. Redlining has isolated Black communities from resources such as grocery stores, especially premium grocery stores. Premium grocery stores like Trader Joe’s and Whole Foods offer a large variety of fresh and organic food but are less likely to be located in neighborhoods where the Black population is greater than 10%. To learn more about historical redlining and food access, please click here.

However, proximity is only one barrier to accessing healthy options. Even if we have access to premium stores, financial constraints can impact where we can shop and what we can afford to purchase. For example, the US Department of Agriculture reports organic food can cost anywhere from 7% to 82% more than conventional items. Oftentimes, these conventional products, such as fast food, canned food, processed meat, pasta, and many brands of cereal, can be the most affordable options, but they are often highly processed and less healthy, potentially leading to higher risks of disease and other serious conditions.

What are Processed Foods?
In navigating the structural barriers of food security, we often put our trust in grocery stores, convenience stores, and popular food chains to offer options that are safe and healthy for ourselves and our families. Unfortunately, due to industrialization and mass production, nearly all of the food we find in the grocery store or on a fast food menu has undergone some level of processing. Processed food is any food that has undergone a process to change it from its original form. It is a term that has negative connotations, but not all processed foods are created equal. Processing can include washing, trimming, and cutting to make produce more convenient to purchase or adding sugar to improve taste or texture. Highly-processed foods go beyond the addition of salt, sugar, and fat—these items can incorporate preservatives to keep canned food fresh longer, artificial colors to enhance appearance, and artificial sweeteners to lengthen shelf life.

To help us cut through the confusion, the Harvard School of Public Health organized common foods and ingredients into four categories of processing, making it easier to determine which products are the healthiest option:

1. Unprocessed or minimally processed foods
2. Processed culinary ingredients
3. Processed foods
4. Highly-processed foods

According to the US National Health and Nutrition Examination Survey, about 60% of our daily intake is in the form of highly-processed foods. If you are interested in more information about the different types of processed foods, please click here.

Hidden Sugar
Sugar occurs naturally in many foods, and it can be a source of energy when consumed in moderation. However, processed and highly processed foods may contain large amounts of “added sugar.” According to Harvard Medical School, some of the top sources of added sugar in the American diet are soft drinks, fruit drinks, flavored yogurts, and milkshakes. However, it may surprise us that this list also includes breads and breakfast cereals. Additionally, a surprising amount of sugar is added to common products like frozen meals, condiments (i.e. ketchup and salad dressing), and canned soup.

Regularly consuming these common products with too much added sugar can lead to weight gain, obesity, and malnourishment. Excess sugar consumption has also been linked to heart disease, type 2 diabetes, fatty liver disease, and cancers of the uterus. All of these diseases are also more common among Black populations when compared to White populations.

Impacts among Black Women
Not only is uterine cancer more common among Black women when compared to White women, Black women are also twice as likely to die from the disease. According to a group of experts convened by the Centers for Disease Control (CDC), Black women have worse outcomes when compared to White women at every stage of the disease. These experts also found that Black women often present to their doctor at more advanced stages, therefore receiving delayed diagnoses and treatment. Late stage diagnosis makes the disease harder to treat and decreases the likelihood of survival. Odds continue to worsen among Black women of lower socio-economic status due to factors like a lack of health insurance and other social determinants of health.

Cancer Linked to Excess Sugar
An article published in the Journal for Obstetrics and Gynecology by Sara Whetstone, MD, notes key factors that put people at higher risk for developing many gynecological cancers. Diabetes, obesity, and estrogen exposure are all linked to an increased likelihood of developing endometrial cancer. How these factors increase your risk has a lot to do with location, budget, availability of transportation, and other factors that can affect health and shape a person’s lifestyle and eating patterns. Many of these factors may be out of our control, but if you understand how diet, and more specifically sugar and artificial sweeteners, can impact your overall health you may be able to lower your risk of developing uterine cancer and other illnesses.

Diet-Related Risk Factors We May Be Able to Control
Type 2 diabetes and obesity are two health factors that demonstrate how excess sugar consumption can lead to increased risk for developing uterine cancer.

Type 2 diabetes occurs when our bodies can no longer respond to sugar appropriately. In many cases, too much sugar in our diet over time causes hormones like insulin to stop responding. This bodily response is called insulin resistance. Insulin resistance can lead to irregularities in cell-to-cell communication and cell multiplication. Uncontrolled multiplication of cells in our body is how cancer typically forms. This type of diabetes is also linked to obesity, which is another factor connected to uterine cancer.

Obesity, which can be exacerbated by increased sugar intake, can cause a similar sequence of events in our bodies. Carrying excess body fat harms cells, but it also causes them to act harmfully. This is because fat cells help convert androgen to estrogen in women. Androgen and estrogen are sex hormones. Androgen is produced in large amounts in men but smaller amounts in women, while estrogen is produced in large amounts in women but small amounts in men. The excess estrogen created by fat cells also causes cell multiplication (similar to insulin resistance). Dr. Vicky Makker, MD, revealed in a study published in Nature Reviews Disease Primers that obesity is associated with approximately 50% of endometrial cancer cases. Dr. Makker also found that if postmenopausal women reduced their body fat by more than 5% they could reduce their risk by about 30%.

Tips For Making Healthy Choices
Although the risk factors may seem daunting, there are some relatively simple ways to incorporate changes into your life that may lower your risk for developing certain diseases like uterine cancer.

Quick Modifications

• Swap soda or juice for unsweetened alternatives. The American Association for Cancer Research found that regardless of your weight or exercise habits, drinking more sugar-sweetened beverages increases risk of developing endometrial cancer among postmenopausal women. Now-common artificial sweeteners like aspartame and sucralose that appear in “sugar-free” and “diet” products may seem like a healthy replacement, but according to Michelle Pearlman, MD., artificial sweeteners that replace sugar in products can contribute to weight gain, obesity, and type 2 diabetes as well. Try to avoid artificial sweeteners when thinking about what you could use to replace sugar-sweetened beverages. For instance, try out a seltzer, which comes in a variety of flavors.

Shopping Smart

• Check nutrition facts specifically for “added sugar.” The Dietary Guidelines for Americans suggest limiting added sugar to fewer than 50 grams per day based on a 2,000 calorie diet. The American Heart Association recommends fewer than 25 grams for women. Some nutrition labels will even include a sentence to let you know how much one serving represents out of your allotted sugar. For maple syrup this might read as “one serving adds 24 grams of sugar to your diet and represents 48% of the Daily Value for Added Sugars.”
• Perimeter shopping. If you are unsure how to shop while making an effort to stay away from highly-processed foods, shop the perimeter of the store. The perimeter, or edges, of the grocery store typically contains fresh produce, meats, eggs, and dairy products while aisles contain more processed foods like cereals, canned goods, cookies, sodas, and other highly processed options that can be filled with preservatives like sugar. This is not to say that there is nothing healthy in the aisles; you just need to read the labels when you get there to determine the best choices for you.

Resources for Finding Healthy Food

• Explore the African Heritage Diet. Check out the Urban Farming Institute. Every other weekend, I go to Trader Joe’s for my grocery haul. Before going, I like to pick two recipes for meal preparation to help limit my purchases to what I really need and avoid wasting food. While at the store, I check the nutrition labels of yogurt, granola, protein bars, cereal, etc. and try to stick with products that have fewer than 10 grams of added sugar. Once I know which brands are best, it's easier to re-purchase the next time. On weeks that are busier than usual, I, like many others, may skip this task. Instead, I might opt for pre-made breakfast and catch up on laundry, running other errands, or even going back to sleep (because some weeks feel longer than others). At the end of the day, none of us are immune to the allure of convenience when juggling life’s responsibilities. But I feel empowered with the knowledge I have, and I know that the small choices I make today will have a big impact on my lifelong reproductive health.