More research warns about the link between endometriosis and ovarian cancer risk.
- Endometriosis
is a complex condition that involves uterine-like tissue growing in other
areas outside the uterus.
- Researchers
are interested in understanding how endometriosis relates to risk for
other conditions, including cancer.
- Results
of a recent study found that individuals with endometriosis may be at an
increased risk for ovarian cancer. Those with ovarian endometriomas, deep
infiltrating endometriosis, or both were at the highest level of risk for
ovarian cancer.
- Individuals experiencing endometriosis and those potentially at risk for ovarian cancer can seek proper guidance and follow up with specialists.
Endometriosis is a chronic condition that can be
difficult to manage and may also increase risks for additional health problems.
It occurs when tissue similar to the uterine lining grows outside the uterus,
such as in the ovaries or fallopian tubes.
Endometriosis can
lead to symptoms like pelvic pain, pain during intercourse, and problems with
fertility.
Experts are still working
to understand the complexities of endometriosis and how it relates to risks for
other conditions, including how it may increase risk for certain cancers.
A study recently published
in
The study found that individuals with endometriosis
had a risk for ovarian cancer that was four times higher than that of women who
did not have endometriosis.
Those with specific
endometriosis types, like deep infiltrating endometriosis, had an almost 10
times higher risk for ovarian cancer than women without endometriosis.
The results highlight
another potential risk factor for ovarian cancer, making prompt follow-up with
specialists essential.
Endometriosis and ovarian cancer risk
This study was
a population-based cohort study. The research matched 78,476 women with
endometriosis with 372,430 women without known endometriosis. Researchers
included participants between the ages of 18 and 55 who had at least one
endometriosis diagnosis.
Researchers used data from
the Utah Population Database,
allowing data collection from multiple health records. They collected data on
several covariates, including information on reproductive and surgical
histories, body mass index (BMI), smoking history, and ethnicity.
The average age of women at
first endometriosis diagnosis was 36 years old, and the average follow-up time
with participants was 12 years.
Overall, those with
endometriosis were at a much higher risk for ovarian cancer than women who did
not have endometriosis.
Compared to women without endometriosis, those with
endometriosis were over seven times more at risk of developing type 1 ovarian
cancer, which included cancer types like endometrioid, clear cell, and
mucinous.
These women were also 2.7
times more at risk of developing high-grade serous ovarian cancer.
Women with deep
infiltrating endometriosis saw the most significant risk for ovarian cancer.
Those who had both deep infiltrating endometriosis and ovarian endometriomas
had the second highest risk.
Overall, women with deep infiltrating endometriosis,
ovarian endometriomas, or both were almost 10 times more at risk for developing
ovarian cancer.
Steve Vasilev, MD, a
board-certified integrative gynecologic oncologist and medical director of
Integrative Gynecologic Oncology at Providence Saint John’s Health Center and
Professor at Saint John’s Cancer Institute in Santa Monica, CA, who was not
involved in this research, commented with his thoughts on the study’s findings
to Medical
News Today.
According to him:
“This population-based cohort study adds substantial
evidence to a growing body of research, including epidemiologic and
histopathologic data, which indicates a strong association between
endometriosis and specific subtypes of ovarian cancer […] This helps solidify
the concern that, in any given individual, endometriosis may progress to
certain types of ovarian cancer or stimulate malignant degeneration. Even
though the absolute risk is felt to be very low among the millions of women
with endometriosis, it is very important to consider because the type of
surgery that may be required is different. When cancer is known to be present,
or strongly suspected, a cancer specialist (gynecologic oncologist) should be
involved.”
How
accurate is this study?
Nevertheless,
this research has several limitations that could have affected the study’s
results. First, it only included participants in a specific age range from one
state in the United States, making it difficult to generalize the results.
Second, there was a risk of
misclassification of endometriosis due to factors, such as the difficulty of
correctly diagnosing endometriosis. While the data compared women with
endometriosis to those with no known endometriosis, it is still possible that
some women in the control group had endometriosis and had just not been
diagnosed.
There is also the
possibility researchers misclassified ovarian cancer histotypes, body mass
index (BMI), and smoking. Researchers also lacked data on hysterectomies and
oophorectomies that happened outside of Utah facilities or other care that
occurred outside of the state. Researchers also lacked data on the use of oral
contraceptives and gonadotropin-releasing hormone agonists.
Because a diagnosis of endometriosis is often
delayed, researchers did assume that those who received an ovarian cancer
diagnosis on their index date had actually had an endometriosis diagnosis
before cancer onset.
Regardless, the results
highlight new questions and areas for research and another potential factor to consider
in clinical practice.
Diana Pearre, MD, a
board-certified gynecologic oncologist at The Roy and Patricia Disney Family
Cancer Center at Providence Saint Joseph Medical Center in Burbank, CA, who was
not involved in the research, noted that “[t]he problem with this study is that
we do not know the denominator.”
She cautioned that:
“There are plenty of people living with endometriosis
who are asymptomatic and may not be seeking treatment/having surgery. Studies
like this make us consider, as clinicians and surgeons, whether we should be
offering prophylactic surgery for women living with endometriosis. I think
without knowing the clear absolute risk of cancer with endometriosis —
evidenced by not knowing exactly how many people live with it — we cannot make
such a blanketed recommendation.”
“Our counseling for
surgical treatment for symptomatic endometriosis, however, should include a
very thoughtful discussion with the patient about this association that we are
seeing in these large population based studies that there is a definite
association between endometriosis and ovarian cancer,” Pearre advised.
How to reduce
ovarian cancer risk
Overall, the
study highlights endometriosis as a potential risk factor for ovarian cancer.
It highlights exploring ways to reduce risk and seeking proper follow-up with
specialists.
Unfortunately, there are no
“Currently, there is no reliable method recommended to
screen for any type of ovarian cancer. With the advent and growth of
understanding about molecular mechanisms underlying the disease, this will
hopefully change soon. However, the more there is a family history of cancer it
is prudent to consider genetic counseling and appropriate testing.”
Some possible ways to
There is also the option of
undergoing surgical removal of the ovaries or other organs in certain
situations. All options for reducing the risk of ovarian cancer should be
thoroughly discussed with appropriate specialists.
Rikki Baldwin, DO, an
obstetrician-gynecologist with Memorial Hermann, who was likewise not involved
in the recent study, also noted that self-care measures are “paramount” to
reducing any type of cancer risk.
She advised that “[w]omen
should eat a well-balanced diet, exercise regularly, avoid smoking and
excessive alcohol use, and have regular visits with their primary physician.”
“Symptoms of ovarian cancer
are vague, so it is very important to pay attention and notify your physician
if there are new and abnormal symptoms like abdominal pain, bloating, nausea,
decreased appetite, etc,” noted Baldwin.
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