Q Assignment is about role of obesity in the development and prognosis of uterine cancer among Australian Aboriginal Women Home, - THE ROLE OF OBESITY IN THE DEVELOPMENT AND PROGNOSIS OF UTERINE CANCER 1. Introduction In particular, obesity among Australian aboriginals is quite common with almost 40% of adults being obese which has been greatly associated with substantial health issues. Health bulletin in the year 2015 suggested that Australian aboriginals suffer from uterine cancer almost 1.9 times more as compared to non-indigenous people. Socioeconomic disadvantage along with health inequality have considerably raise obesity percentage which could be marked as body mass index of more than 30kg/m2. Based on this research finding, the researcher shall enumerate possible recommendations that could improve health profile and subsequently lower occurrence of uterine cancer among Australian aboriginal community. 1.1 Research background Reproductive factors like early menarche, nulliparity and anovulation greatly contribute to women’s exposure to estrogen. Lee & Ride (2018) reported that almost 2 in 3 indigenous people have been suffering from obesity that impacted their health profile. Shu et al. (2016) opined that obesity among post-menopausal women contributes to increased predominance of uterine cancer by variety of mechanisms. Haigh et al. (2018) added that socioeconomic issues have contributed towards their ill health which has triggered gynecological diseases. The transcription of proliferative genes increases uterine growth which manifests as endometrial cancer. 1.2. Aims & objectives This proposed research aims at undermining the role of obesity in prognosis of uterine cancer among Australian aboriginals. This research will highlight the relationship between high adiposity and development of endometrial cancer along with risk factor of obesity triggering uterine cancer. The key objectives of this proposed research study are- • To develop awareness and knowledge regarding obesity that likely causes endometrial cancer among Australian aboriginal women • To understand the attributable risk factors behind obesity in prognosis of endometrial carcinoma among Australian women aboriginals • To compare the impact of obesity on endometrial cancer and other types of carcinomas among Australian aboriginals • To critically evaluate the impact of BMI on endometrial cancer among indigenous women • To provide support to Australian aboriginal women population regarding changes • To recommend measures that could be undertaken by Australian aboriginals for minimizing risk factor behind obesity and subsequently lower high prevalence of uterine cancer 1.3 Research question The following are some of the research questions that will be resolved in this research study- • How to develop awareness and knowledge regarding obesity that could result in endometrial cancer among Australian aboriginal women? • What attributing factors behind obesity results in prognosis of endometrial carcinoma among Australian women aboriginals? • What is the impact of obesity on endometrial cancer and other types of carcinomas among Australian aboriginals? • What is the impact of BMI on endometrial cancer among indigenous women? • What support could be given to Australian aboriginal women population regarding changes? • What recommending measures that could be undertaken by Australian aboriginals for minimizing risk factor behind obesity and subsequently lower high prevalence of uterine cancer? 1.4 Rationale The main issue that has been addressed in this research study is the high predominance of uterine cancer among Australian aboriginal women due to obesity. Attributable factors like inadequate awareness and socio-economic factors have contributed towards prognosis of uterine cancer. Akison et al. (2017) commented that increased proliferation of endometrial cells and hormone therapy also results in high rate of endometrial cancer development among Australian aboriginals. It is essential to critically undermine that relationship between obesity and uterine cancer to lessen this increased predominance of uterine cancer among aboriginals. This is an issue because around 60% of Australian aboriginals have been suffering from this dreaded illness. Every year, approximately 1279 uterine cancer prevalence occur among aboriginals. Lennon et al. (2017) commented that during childhood period, health adversities and inequalities could impact the overall health structure of an individual. Miller et al. (2016) added that lower socio-economic profile often results in high predominance of overweight. Around 8% of islander children suffer from obesity as compared to only 5% of non-indigenous child. This is an issue now as above 50% of Australian aboriginals are obese. As per statistical findings, almost 1321 indigenous women have uterine cancer having 50% of survival rate. This evidence suggests the need for clinical research study in order to aware Australian women regarding this link between obesity and uterine cancer so that they could take preventative measures and combat this situation. [Refer to Appendix 1] This research study sheds light on understanding the role of obesity in elevating the predominance of uterine cancer among Australian aboriginal women. In this proposed research, the learner will highlight detailed information regarding the linkage between obesity and uterine cancer among this indigenous people. Attributable risk factors behind this increased predominance of obesity among aboriginals would also be enumerated in this proposed research study. 1.5 Research significance This proposed research will help the learner to gain an insight regarding the potential relationship between uterine cancer and increased adiposity among aboriginal women. The research findings will help learner to recommend strategies that would create awareness among this indigenous group of people regarding their health status thereby lowering their high prevalence of uterine cancer. 2. Literature review 2.1 Introduction Globally, obesity is an epidemic that increased the prognosis of several illnesses and greatly affected the health scenario of the affected patients. This section will provide an in depth information regarding the underlying relationship between obesity and uterine cancer. Modifiable risk factors behind this high prevalence of uterine cancer among obese Australian aboriginals will also be highlighted in this current segment. Finally, suggestive treatment options along with screening methods will be explored that shall help indigenous group of people to cope up their current issue and improve their health profile. 2.2 Risk factor of obesity to uterine cancer development among indigenous women Based on various experimental and epidemiological study, International Agency for Research on Cancer (IRAC) in the year 2002 established a link between uterine cancer prognosis and obesity (Fukumura et al. 2016). This cancer is manifested by severe pelvic pain, profuse vaginal bleeding and pain during intercourse. Hardy et al. (2019) opined that risk factors like late menopause and early menstruation increase the likelihood of developing uterine cancer among indigenous women. IRAC report found out that women on gaining 55 pounds at the age 18 are at 50% greater risk of developing uterine cancer after their menopause in comparison with women who tends to maintain their obesity index. Thurber et al. (2018) opined that inadequate knowledge and awareness are predisposing factors behind obesity and uterine cancer among indigenous women. Increased peripheral fat interferes with the normal metabolic functioning of the body while in case of obesity, is would definitely results in development of uterine cancer if left unchecked. 2.3 Clinical impact of body mass index on prognosis of uterine cancer among indigenous group Uterine malignant growth tends to get adverse with increasing body weight. Browne et al. (2018) commented that endometrial tumor occurrence is positively connected to high BMI. It can be further speculated that obese females are greatly expanded towards endometrial malignancy due to the mutagenic effect of unopposed estrogen. Esler et al. (2016) added that increase ovulation rate among premenopausal obese women leads to accumulation of unopposed estrogen and lack of progesterone. This accumulated estrogen as opposed by progesterone leads to increased endometrial cell proliferation by hindering apoptosis. This expanded number of replicated DNA leads to substantial transformation thereby resulting in malignant growth. Among obese women, unopposed estrogen plays a significant role triggering uterine cellular transformation into malignancy under the absence of adequate progesterone. 2.4 Impact of obesity on uterine and other type of cancer Obesity serves as a positive prognostic factor for numerous types of carcinomas. As commented by O'Brien & Sali (2017), increased body mass index directly affects the hormonal metabolism and give rise to series of health issues. High BMI alters secretion of thyroxine thereby resulting in thyroid cancer. Renal cancer and ovarian cancer among aboriginals are also quite common alongside uterine cancer due to obesity. Similarly, obesity also contributes in increased predominance of colorectal and ovarian cancer. Lennon et al. (2016) opined that intermittent uterine cancer also results due to obesity that affects an individual’s health profile. The malignant growth could return back and affect lymph node, abdomen or several other body parts. This justifies the necessity of undertaking proper care pathways that could help managing this onset of health problem. 2.5 Treatment and screening methods options available for endometrial cancer There occurs no specific screening tests for detecting uterine cancer however, several clinical trial methods are available that might uncover uterine malignancy. Collecting vaginal cells using Pap test and vaginal ultrasound could help clinicians detect growing tumour within uterus (National Cancer Institute, 2019). Ivers et al. (2019) opined that screening procedure should be undertaken by experts as thee might lead to increased discomfort, bleeding and could even result in puncture of uterus. Chemotherapeutic drugs are also used by professionals to hinder advancements and proliferation of cancerous cells. The most fundamental surgical option of endometrial cancer involves hysterectomy with single salpingo-oophorectomy (National Cancer Institute, 2019). Commonly surgical patients will have obesity-comorbidity thereby putting them at greater threat towards surgical complexities. Mirena usage is legalised in Australia which is one of the most effective contraceptive drug that could lower endometrial cancer. However, its potential efficacy in minimizing the beginning interval of endometrial cancer is yet to uncover. Several weight lowering agents are ingested among indigenous women as a medical procedure for endometrial cancer. It is however suggested to create awareness among Australian aboriginals with the help of campaigns that would portrait the preventive measures of uterine cancer and obesity. 2.6 Gap in literature Previous researchers have conducted studies stating the pathophysiology of uterine cancer. Significant role of obesity behind gynaecological cancer have also been evidence in previous studies. However, in this particular study, risk factors behind obesity in triggering uterine cancer among Australian aboriginals will be studied. Screening methods along with surgical methods will also be illustrated in details in this research study which shall help indigenous women to cope up with their situation and avoid prognosis of this illness. 2.7 Conceptual framework 3. Research methodology 3.1 Introduction This section of proposed research will catalogue a list of methods that will be selected by the learner for accomplishing this research study. An apprehensive justification of these selected research methodologies will also be enlisted in this section that could rationalize the reliability of research methodology for this study. 3.2 Research methods Following Saunders research onion, the researcher will choose positivism research philosophy for conducting this study. In this research philosophy, factual data regarding Australia aboriginal women suffering from obesity and uterine cancer will be presented that could help in staging an effective conclusion (Influenced by Saunders, Lewis and Thornhill, 2010). Deductive approach will be selected for deducing authenticated information regarding the link between obesity and uterine carcinoma. Similarly, descriptive research design shall be followed as this will allow the learner to present a detailed analysis of uterine cancer prevalence among these indigenous women (Influenced by Yin, 2013). This clearly justifies the relevance of selected methodologies that will definitely enable the researcher to present information related to the selected topic in a productive way. 3.3 Data collection methods Secondary research method will be selected by the learner for obtaining genuine and relevant information related to the researched topic. Authenticated journals and books will be collected from Google Scholar, SCOPUS and ProQuest which will enable the learner to present enough evidence regarding the link between obesity and the occurrence of uterine cancer. 3.4 Data analysis The learner will carry out thematic analysis in this research study. Themes relevant to the research topic will be presented which will help the learner to corroborate the relationship between obesity and uterine cancer. 3.5 Ethical considerations Ethics should be followed by any learner while conducting any research project. As per the Copyrights Act 1968, the researcher required acknowledging every authors while interpreting their data within this study. This will ensure privacy and subsequent follow up of ethics thereby confirming unbianess while researching this selected topic. 4. Research timeline The researcher will select topic and set up aims and objectives within 1 week. In corresponding 6 weeks, research methodology and journal selection will be done. Finally, in the last 3 weeks, data analysis and final proofing will be done. 5. Conclusion There has been abundant research demonstrating the underlying relationship between obesity and cancer, multiple studies have shown unawareness of indigenous women regarding this link. Since last 3 decades, obesity has high prevalence among aboriginals that affected their health status. It has been one of the most significant and triggering factors for developing endometrial cancer that has been focused in this proposed research study. Additionally, early-life obesity increases the risk factor of developing uterine malignancies during the later stage of their lives. Factors like late menopause and early menstruation allows ovaries to remain under the influence of estrogen for longer period of time that aggravates tendency of developing uterine cancer among aboriginals. Although lifestyle modification has shown no effect on the recurrence of cancer, it is requisite to prevent cancer at an early stage. A proper follow-up of diet and physical exercise could lower high level of adiposity thereby preventing uterine cancer among this disadvantaged people.