Polycystic ovary syndrome increases the risk of endometrial cancer in women aged less than 50 years: An Australian case-control study

School of Population Health, The University of Queensland, Herston Road, Herston, QLD 4006, Australia.
Cancer Causes and Control (Impact Factor: 2.74). 10/2010; 21(12):2303-8. DOI: 10.1007/s10552-010-9658-7
Source: PubMed


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.

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    • "Among younger women who are diagnosed with endometrioid endometrial adenocarcinoma, chronic disorders of ovulation are common (Navaratnarajah et al., 2008). An Australian study of women younger than 50 with a diagnoses of endometrial adenocarcinoma found an increased likelihood that affected women reported a diagnosis of polycystic ovarian syndrome (PCOS) or symptoms of chronic oligo/anovulation (irregular menses, severe acne as an adult, hirsuitism), odds ratio 4.3, 95% confidence interval 1.8e10.2 in comparison to a control group without endometrial adenocarcinoma (Fearnley et al., 2010). A typical feature of PCOS is irregular or absent ovulation with prolonged exposure of the endometrium to the proliferative effects of ovarian estrogen without the counterbalancing effects of luteal progesterone. "
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    • "In the clinic, EC is usually preceded by, or associated with, endometrial hyperplasia [17], which is a proliferative process that results in an increased ratio of epithelial cells to stromal components in the endometrium [6]. Endometrial hyperplasia predisposes for the development of EC, and a case–control study showed that women with PCOS and endometrial hyperplasia have a four times greater risk of developing EC than non-PCOS women [10]. PCOS is a hyperandrogenic state that results in increased bioavailability of unopposed estrogens due to the increased peripheral conversion of endogenous androgens such as testosterone and androstenedione into estrogen [13,15]. "
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    • "PCOS and EC share many of the same risk factors and a recent population-based case-control study in 135 Australia found that women with PCOS have a four-fold increased risk of EC compared to women without PCOS (Fearnley, et al. 2010). This risk was elevated for type 1 cancers and had a greater association with symptoms of androgen excess such as hirsutism (OR 2.4, all EC cases) and irregular periods (OR 3.1, all EC cases) (Fearnley et al. 2010). "
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