Risk factors for developing endometrial cancer
Early menarche, nulliparity, late menopause, obesity and family history of endometrial cancer.
KTA: Notice that these RFs have to do with an extended exposure of the uterus to estrogen and female hormonal changes that happen throughout the menstrual cycle.
Early menarche and late menopause mean that you have more menstrual cycles in between. Nulliparity means you don’t get the 9-month break that comes when one is pregnant. Fat cells make estrogen (so obese people may have more).
The following is from the ABFM
“There is currently no recommended screen for endometrial cancer, but knowing the risk factors is important for counseling patients. Endometrial cancer is associated with obesity, hyperinsulinemia, and chronic anovulation, which are all characteristics of polycystic ovary syndrome (SOR B). Obesity leads to higher estrogen levels, increasing the risk for endometrial cancer; physical activity has been shown to reduce the risk of endometrial cancer (SOR A).
Estrogen levels are lower in women who are breastfeeding, and having decreased levels of estrogen for extended periods of time is associated with a lower risk of endometrial cancer (SOR B). As longer exposure to estrogen increases the risk of endometrial cancer, the combination of early menarche and nulliparity increases the risk because of uninterrupted high estrogen levels (SOR B).
Oral contraceptives have been found to reduce the risk of endometrial cancer. The protective effect increases with the length of time they are used, and benefits can last years after a woman has stopped taking them (SOR A). Although raloxifene has estrogen-like effects on the uterus, it has not been shown to increase the risk of endometrial cancer (SOR A).
Tamoxifen is a selective estrogen receptor modulator that has estrogen-like effects. While it has a protective effect on breast tissue, its effect on the uterus increases the risk of endometrial cancer (SOR A). Hereditary nonpolyposis colon cancer is an inherited disorder linked to certain genes. Women with this cancer have a much higher risk of developing endometrial cancer (SOR B).” ABFM
Need to verify this ABFM points with new research, their citation seem old.
Abnormal uterine bleeding in a perimenopausal woman
“A 47-year-old female is concerned about a change in her menstrual pattern. Her monthly periods continue, but for the past several months they have been heavier than usual and have been lasting a few days longer. Last month she also noted some spotting for several days prior to the onset of her menses. Her pelvic examination is normal.
Which one of the following would be most appropriate at this time?
- A) Observation only, and reexamination in 3 months
- B) A serum FSH level
- C) Transvaginal ultrasonography
- D) Progestin-only therapy to normalize bleeding
- E) Cyclic estrogen-progestin therapy to normalize bleeding
Abnormal uterine bleeding can be a sign of endometrial cancer in premenopausal women, who account for 20% of cases of endometrial cancer. The American College of Obstetricians and Gynecologists recommends that women with abnormal uterine bleeding should be evaluated for endometrial cancer if they are older than 45 years or if they have a history of unopposed estrogen exposure (SOR C). Most guidelines recommend either transvaginal ultrasonography or endometrial biopsy as the initial study in the evaluation of endometrial cancer. Transvaginal ultrasonography is often preferred as the initial study because of its availability, cost-effectiveness, and high sensitivity. If bleeding persists despite normal transvaginal ultrasonography a tissue biopsy should be performed. The listed hormonal treatment options may be appropriate once cancer is ruled out. An FSH level can help determine whether someone is menopausal or approaching menopause, in which case they will likely be missing periods. Continued observation would only delay the diagnosis.” ABFM question and critique.
Am Fam Physician 2016;93(6):468-474. Diagnosis and management of endometrial cancer.
Endometrial cancer prevention (PDQ). National Cancer Institute, 2009.
http://www.cancer.gov/cancertopics/pdq/prevention/endometrial/Patient/page3
Contemporary clinical management of endometrial cancer. Obstet Gynecol Int 2013;2013:583891.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707260/pdf/OGI2013-583891.pdf