Ovarian, Uterine Cancers Linked to High BMI Continue to Rise Among Women of Reproductive Age Worldwide

The global burden of ovarian and uterine cancers attributable to high body mass index (BMI) continues to rise among women of reproductive age, with significant disparities across sociodemographic index (SDI) levels, according to a study published in Frontiers in Oncology.1

Among women of reproductive age (15-49 years), high BMI is associated with adverse outcomes, including cardiovascular diseases, metabolic disorders, and various cancers. Increasing evidence identifies high BMI as a significant, modifiable risk factor for ovarian and uterine cancers.

Ovarian and uterine cancers linked to high BMI have steadily increased among women of reproductive age, with the greatest burden observed in low- and middle-SDI regions. | Image Credit: pyty - stock.adobe.com

Despite this recognition, global epidemiological assessments of the burden of ovarian and uterine cancers attributable to high BMI, particularly regarding long-term trends, age-specific impacts, and regional disparities, have been limited. To address this gap, the researchers analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021).

GBD 2021 offers a systematic evaluation of 371 diseases and injuries across 204 countries and territories, spanning 1990 to 2021.2 It includes a wide range of health metrics, such as prevalence, incidence, mortality, and disability-adjusted life-years (DALYs).

The researchers analyzed trends in age-standardized mortality and DALYs across SDI levels and age groups, with corresponding age-standardized rates (ASRs) calculated to assess disease burden.1 Age was categorized into 6 different 5-year intervals: 20 to 24 years; 25 to 29 years; 30 to 34 years; 35 to 39 years; 40 to 44 years; and 45 to 49 years.

The 204 countries and territories included in GBD 2021 were classified into 5 SDI levels: low, low-middle, middle, high-middle, and high. Looking ahead, the researchers projected the global burden through 2036 using a Bayesian age–period–cohort model to provide timely, actionable evidence for cancer prevention and control efforts.

In 2021, ovarian cancer attributable to high BMI resulted in 2022 deaths (95% uncertainty interval [UI], 473-3611) and 99,915 DALYs (95% UI, 22,387-178,579) among women of reproductive age worldwide. Eastern Europe had the highest age-standardized death rate (0.34; 95% UI, 0.08-0.59) and DALYs (16.16; 95% UI, 3.92-28.48). Similarly, uterine cancer associated with high BMI led to 2202 deaths (95% UI, 1545-2910) and 114,177 DALYs (95% UI, 80,122-150,221), with the Caribbean having the highest age-standardized uterine cancer death rate (0.49; 95% UI, 0.33-0.67) and DALYs (24.53; 95% UI, 16.38-33.80).

Mortality rates and DALYs for both cancers gradually increased with age globally, with the highest mortality rates and DALYs occurring in patients aged between 45 and 49. The highest ovarian cancer mortality rate and DALYs were 0.42 (95% CI, 0.099-0.75) and 4.42 (95% UI, 18.77-33.45), respectively, whereas those for uterine cancer were 0.48 (95% UI, 0.33-0.63) and 22.66 (95% UI, 15.93-30.00), respectively.

From 1990 to 2021, the ASRs of mortality and DALYs for ovarian cancer attributable to high BMI relatively increased among women of reproductive age. Mortality increased from 0.055 (95% CI, 0.0093-0.1) to 0.10 (95% CI, 0.024-0.19), while DALYs increased from 2.67 (95% CI, 0.44-5.08) to 5.13 (95% CI, 1.2-9.16).

Similar trends were observed for uterine cancer, as mortality rose from 0.079 (95% CI, 0.053-0.11) to 0.11 (95% CI, 0.079-0.15) and DALYs increased from 4 (95% CI, 2.7-5.43) to 5.86 (95% CI, 4.11-7.71).

Through the study period, the burden of ovarian and uterine cancers attributable to high BMI among women of reproductive age varied widely by SDI level. For ovarian cancer, age-standardized disability rates consistently exceeded mortality rates. While high-SDI regions experienced initial increases in both rates followed by sustained declines, middle- and low-SDI regions experienced steep increases, indicating an increase in early mortality.

Uterine cancer showed similar trends, though mortality remained very low across regions. The researchers explained that disease burden peaked in middle- to upper-middle SDI regions due to high-risk exposure and limited health care capacity. However, it declined in high-SDI regions, which have stronger health care infrastructure.

Over the next 15 years, the researchers projected a slight increase in mortality rates and DALYs among this patient population. Specifically, the ovarian cancer mortality rate is expected to rise modestly from 0.12 per 100,000 in 2021 to 0.18 per 100,000 in 2036. Meanwhile, the DALYs are projected to increase from 5.86 per 100,000 in 2021 to 8.25 per 100,000 in 2036.

As for uterine cancer, the death rate is estimated to increase slightly from 0.13 per 100,000 in 2021 to 0.15 per 100,000 in 2036. Lastly, DALYs are projected to rise from 6.67 per 100,000 in 2021 to 7.56 per 100,000 in 2036.

The researchers acknowledged their study’s limitations, including that the GBD 2021 framework does not allow for direct comparisons between individuals with high and normal BMIs, as it estimates disease burden using population-level exposures and relative risks rather than stratified outcomes. As a result, they could not evaluate or compare burden metrics across BMI categories.

Despite this, the researchers expressed confidence in their findings and suggested strategies to curb the global burden of ovarian and uterine cancers attributable to high BMI among women of reproductive age.

“To effectively address this growing challenge, comprehensive strategies are required,” the authors wrote. “Integrating cancer prevention into existing non-communicable disease frameworks, strengthening BMI surveillance, and expanding access to gynecological health education and screening programs are critical steps.”

References

1. Yin B, Zhou H. Burden and trends of ovarian and uterine cancer due to high body mass index from 1990 to 2021: an age-period-cohort study based on the GBD 2021, and projections through 2036. Front Oncol. 2025;15:1647757. doi:10.3389/fonc.2025.1647757
2. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2133-2161. doi:10.1016/S0140-6736(24)00757-8