Evaluating the Association Between Endometrial Cancer and Polycystic Ovary Syndrome

Zeina Haoula; Maisa Salman; William Atiomo


Hum Reprod. 2012;27(5):1327-1331. 

In This Article


Out of a total of 265 studies initially identified, 219 were excluded either due to duplication or following review of the abstracts. A total of 46 papers on the association of PCOS with endometrial hyperplasia/carcinoma were therefore included for thorough review. After detailed review, all review articles and those that were not in English were excluded. A total of 14 studies comparative and non-comparative studies were identified (Fig. 2) of which five comparative studies (studies with a control group) were eligible for use in the meta-analysis. Observational studies without a control arm, studies with no data on EC prevalence specifically presented for PCOS women and retrospective cross-sectional studies were excluded from the meta-analysis.

Figure 2.

Study selection process for systematic review of PCOS and endometrial cancer.

Data from five studies were used in the updated meta-analysis with a total of 4605 women Table I. Of these, 88 women had PCOS of whom 47 had EC and 4517 did not have PCOS of whom 773 had endometrial cancer. Escobedo et al. (1991) utilized data from the Cancer and Steroid Hormone Study. The subject group comprised women between the ages of 20 and 54 years with newly diagnosed endometrial cancer. The control groups were from the same age range selected by random-digit telephone dialling from the same geographic area where cancer patients resided. They identified PCOS based upon patient recall of the diagnosis being given to them by a physician. Niwa et al. (2000) in a case–control study selected 136 women with histologically proven EC. The age range was 40–70 years. The control group consisted of 376 healthy women who were randomly selected from the same population as the cases. They were sampled from healthy women attending a health promotion centre. PCOS was diagnosed by a physician. Pillay et al. (2006), looked at the prevalence of polycystic ovaries (PCOs), as a marker of PCOS and was investigated in ovarian sections from 128 women with EC (EC) and 83 women in the control group with benign gynaecological conditions. PCOS was diagnosed based on histological criteria. Iatrakis et al. (2006), included a group of women with a mean age of 46.3 years diagnosed with histologically EC. The control group was randomly selected from women between the ages of 43 and 48 years attending the gynaecology clinic without any EC diagnoses. PCOS was diagnosed by a physician. In the study by Fearnley et al. (2010), data came from a national population-based case–control study in Australia in which 156 cases with histologically confirmed newly diagnosed EC were identified and 398 controls were randomly selected from the national electoral roll. PCOS was diagnosed based on self-reported diagnosis.

Analysis of the aggregated data showed that the odds of developing EC was almost three times higher in women with PCOS as compared with women without PCOS (Fig. 3) with the CIs clearly >1 (OR: 2.89, 95% CI: 1.52–5.48). Given that the background risk of developing EC in Caucasian women is somewhere in the order of a 3% lifetime risk (McCann et al., 2000; Greenlee et al., 2001) this would give an absolute lifetime risk of EC of ~9% in women with PCOS.

Figure 3.

Meta-analyses of EC risk in women with PCOS.

It was not possible to determine the exact strength of the association between PCOS and EC from the nine studies (Speert, 1949; Dockerty et al., 1951; Jackson and Dockerty, 1957; Ramzy and Nisker, 1979; Coulam et al., 1983; Gallup and Stock, 1984; Dahlgren et al., 1991; Ho et al., 1997; Wild et al., 2000) excluded from the meta-analysis, although PCOS was thought to be linked with EC in most of these studies.


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