Polycystic ovary syndrome increases the risk of endometrial cancer in women aged less than 50 years: an Australian case–control study
Tóm tắt
Although polycystic ovary syndrome (PCOS) is commonly cited as a risk factor for endometrial cancer, supporting epidemiological evidence is currently very limited. Our aim was to assess the associations between PCOS, PCOS symptoms, and risk of endometrial cancer in women aged less than 50 years. Data came from a national population-based case–control study in Australia. Cases with newly diagnosed histologically confirmed endometrial cancer were identified through treatment clinics and cancer registries Australia wide. Controls were randomly selected from the national electoral roll. Women were interviewed about their reproductive and medical history, including self-reported PCOS, and lifestyle. Current analyses were restricted to women aged under 50 (156 cases, 398 controls). We estimated odds ratios (OR) using logistic regression to adjust for confounding factors. Women with PCOS had a fourfold increased risk of endometrial cancer compared to women without PCOS (OR 4.0, 95% CI 1.7–9.3). This association was attenuated when additionally adjusted for body mass index (OR 2.2, 95% CI 0.9–5.7). Risk was slightly greater when restricted to Type I cancers. PCOS symptoms including hirsutism and very irregular periods were significantly associated with endometrial cancer risk. These data extend existing findings, including adjustment for confounders, suggesting PCOS is a risk factor for endometrial cancer.
Tài liệu tham khảo
Sankaranarayanan R, Ferlay J (2006) Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol 20(2):207–225
Wild S, Pierpoint T, Jacobs H, McKeigue P (2000) Long-term consequences of polycystic ovary syndrome: results of a 31 year follow up study. Hum Fertil 3:101–105
Hardiman P, Pillay OC, Atiomo W (2003) Polycystic ovary syndrome and endometrial carcinoma. Lancet 361(9371):1810–1812
Lo JC, Feigenbaum SL, Yang J, Pressman AR, Selby JV, Go AS (2006) Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab 91(4):1357–1363
Michelmore KF, Balen AH, Dunger DB, Vessey MP (1999) Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol 51:779–786
Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF (2000) A prospective study of the prevalence of the polycystic ovary syndrome in unselected caucasian women from Spain. J Clin Endocrinol Metab 85(7):2434–2438
Azziz R, Woods K, Reyna R, Key T, Knochenhauer ES, Yildiz BO (2004) The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89(6):2745–2749
Speert H (1949) Carcinoma of the endometrium in young women. Surg Gynaecol Obstet 88:332–336
Dockerty MB, Loveday SB, Foust GT (1951) Carcinoma of the corpus uteri in young women. Am J Obstet Gynecol 61:966–981
Jackson R, Dockerty MB (1957) The Stein–Leventhal syndrome: analysis of 43 cases with special reference to association with endometrial carcinoma. Am J Obstet Gynecol 73:161–173
Elliott JL, Hosford SL, Demopoulos RI, Perloe M, Sills ES (2001) Endometrial adenocarcinoma and polycystic ovary syndrome: Risk factors, management, and prognosis. South Med J 94(5):529–531
Jafari K, Javaheri G, Ruiz G (1978) Endometrial adenocarcinoma and the Stein-Leventhal syndrome. Obstet Gynecol 51:97–100
Gallup D, Stock R (1984) Adenocarcinoma of the endometrium in women 40 years of age or younger. Obstet Gynecol 64:417–420
Escobedo LG, Lee N, Peterson H, Wingo P (1991) Infertility associated endometrial cancer risk may be limited to specific subgroups in infertile women. Obstet Gynecol 77:124–128
Coulam C, Annegers J, Kranz J (1983) Chronic anovulation syndrome and associated neoplasia. Obstet Gynecol 61:403–407
Iatrakis G, Zervoudis S, Saviolakis A et al (2006) Women younger than 50 years with endometrial cancer. Eur J Gynaecol Oncol 27(4):399–400
Niwa K, Imai A, Hashimoto M et al (2000) A case–control study of uterine endometrial cancer of pre- and post-menopausal women. Oncology Rep 7(1):89–93
Pillay OC, Te Fong LFW, Crow JC et al (2006) The association between polycystic ovaries and endometrial cancer. Hum Reprod 21(4):924–929
Fader AN, Arriba LN, Frasure HE, von Gruenigen VE (2009) Endometrial cancer and obesity: Epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol 114(1):121–127
Pasquali R, Casimirri F (1993) The impact of obesity on hyperandrogenism and polycystic ovary syndrome in premenopausal women. Clin Endocrinol 39:1–16
Merritt MA, Green AC, Nagle CM, Webb PM (2008) Talcum powder, chronic pelvic inflammation and NSAIDs in relation to risk of epithelial ovarian cancer. Int J Cancer 122(1):170–176
Balen A (2001) Polycystic ovary syndrome and cancer. Hum Reprod Update 7(6):522–525
Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I (2005) Endometrial cancer. Lancet 366:491–505
Navaratnarajah R, Pillay OC, Hardiman P (2008) Polycystic ovary syndrome and endometrial cancer. Semin Reprod Med 26(1):62–71
Chittenden B, Fullerton G, Maheshawari A, Bhattacharya S (2009) Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online 19(3):398–405
Dahlgren E, Friberg LG, Johansson S et al (1991) Endometrial carcinoma; ovarian dysfunction - a risk factor in young women. Eur J Obstet Gynecol Reprod Biol 41:143–150
Balen AH, Conway GS, Kaltsas G et al (1995) Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 10(8):2107–2111
The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19(1):41–47
Jordan SJ, Green AC, Whiteman DC, Moore SP, Bain CJ, Gertig DM (2008) Serous ovarian, fallopian tube and primary peritoneal cancers: A comparative epidemiological analysis. Int J Cancer 122:1598–1603