Emma Hitt, PhD

May 21, 2012

May 21, 2012 (Florence, Italy) — There does not appear to be a higher prevalence of endometrial cancer (EC) in women with polycystic ovarian syndrome (PCOS) or clinical/biochemical hyperandrogenism compared with EC prevalence in the general population, new research suggests.

Pernille Ravn, MD, from the Odense University Hospital in Denmark, and colleagues presented the findings here at Joint 15th International Congress of Endocrinology (ICE) and 14th European Congress of Endocrinology (ECE).

"Surprisingly, we found few cases of endometrial hyperplasia (1%) and endometrial cancer (0.1%) among women with PCOS, who a priori had several risk factors for endometrial hyperplasia and cancer," Dr. Ravn told Medscape Medical News during the conference.

According to Dr. Ravn, the study confirms the Danish evidence-based treatment guideline, which does not recommend routine endometrial screening. "Endometrial screening of all women with PCOS is not advised because the increased risk of endometrial hyperplasia and cancer may be restricted to specific subgroups," she said.

According to Dr. Ravn and colleagues, it is thought that PCOS may be associated with an increased risk for endometrial hyperplasia (EH) and EC, but substantial evidence remains to be established.

The researchers therefore investigated the prevalence of EH and EC in a group of 963 postmenopausal women with PCOS or clinical/biochemical hyperandrogenism. The Danish Data Bank of Pathology was also reviewed to determine in what proportion of patients endometrial histology was diagnosed between 1982 and 2011.

EH was diagnosed in 10 women (1.0%) and endometrial cancer was diagnosed in 1 (0.1%) woman.

Of note, the median body mass index in the EH/EC group was 30.6 kg/m2, compared with 26.8 kg/m2 overall; however, individual Rotterdam criteria were similar for the 2 groups. In Denmark, the overall prevalence of EC in the general population of women aged 40 to 55 years is 0.4% — in other words, EC occurs at a much higher rate than the 0.1% observed in the current cohort of women with PCOS.

"It is still unclear whether a potential risk of endometrial hyperplasia and cancer in women with PCOS only is related to specific subgroups," said Dr. Ravn. "Treatment with combined oral contraceptives, metformin or a cyclical gestagen along with lifestyle changes and awareness of changes in bleeding pattern is appropriate in order to reduce endometrial proliferation," she added.

Independent commentator Penelope M. Webb, PhD, from the Queensland Institute of Medical Research in Brisbane, Australia, told Medscape Medical News that it is difficult to interpret the results from the limited information available.

"These data appear to contradict previous reports suggesting that women with PCOS are at increased risk of developing endometrial cancer and further investigation of this inconsistency is warranted," she said.

The study was not commercially funded. The authors and independent commentator have disclosed no relevant financial relationships.

Joint 15th International Congress of Endocrinology (ICE) and 14th European Congress of Endocrinology (ECE). #P930. Presented May 6, 2011.

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