INS and diabetes mellitus: Diets that protect against diabetes—low in refined carbohydrates, saturated fat and added sugar—also appear to reduce EC incidence.(27) The common denominator is insulin resistance, which amplifies estrogen signaling and creates a pro-tumor micro-environment.(28) Hyperinsulinaemia acts directly on endometrial epithelium via the insulin and IGF-I receptors to trigger mitogenic pathways (29) and indirectly by raising IGFs, altering sex-steroid availability and perturbing adipokine profiles that govern proliferation and apoptosis (30–33).