Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis

Abstract

BackgroundTo inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required. MethodsWe identified studies up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis. Random-effects meta-analyses produced pooled estimates and 95% confidence intervals (CIs). ResultsA total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% (95% CI: 24.1%, 42.4%) while no studies evaluated concurrent cancer in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% CI 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia (annual incidence rate = 2.6%, 95% CI: 0.6%, 10.6%). ConclusionsOverall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to

Analysis of the results of invasive diagnostic procedures in patients referred to gynecologic department due to abnormal uterine bleeding

“…Endometrial hyperplasia is a common gynecologic diagnosis, histologically defined as the presence of proliferation of the endometrial glands resulting in an increase in gland-to-stroma ratio [ 21 ]. It is also recognized as precursor lesion of endometrial cancer (endometrioid type).…”

“…It is also recognized as precursor lesion of endometrial cancer (endometrioid type). Doherty et al ., in their metanalysis, reported the risk of non-atypical hyperplasia progression to cancer at annual incidence rate at 2.6% and atypical hyperplasia at 8.2% [ 21 ]. Abnormal uterine bleeding is the most common symptom of endometrial hyperplasia and cancer [ 22 , 23 ].…”

Levonorgestrel-Releasing Intrauterine System Use in Perimenopausal Women

“…Therefore, treatment for endometrial hyperplasia is more important in perimenopausal women. In the endometrial hyperplasia without atypia, the progression rate to cancer was reported 2.6% per year [ 26 ]. Therefore, the use of LNG-IUS, which is recognized as the most effective drug treatment, has numerous aspects to be considered as the first-line treatment.…”

Analysis of the objective and preventative treatment and efficacy of therapeutic approaches in women with non-atypical endometrial hyperplasia

“…The incidence of benign hyperplastic endometrial pathology in premenopausal women decreased 3.4-fold at the time close to menopause, due to a gradual reduction in menstrual function and the effect of sex-steroide hormones on cell proliferation in the endometrium. At the same time, the rate of detection of precancerous pathology and EC increased shortly before menopause, probably due to the accumulation of genomic alterations that affect the way cells differentiate and the mechanisms of elimination of transformed cells [2]. The data we obtained do not contradict the data of the National Cancer Registry of Ukraine over the last ten years that indicate that EC ranks 3 in the age structure of the disease among women aged 30-54 years and 2 in those aged 55-74 years [13].…”

“…Furthermore, the optimal treatment duration and follow-up regime for patients after completion of treatment has not been confirmed yet [1,7,15,16]. The rate of progression of EH to atypicality either with monitoring or with treatment by various types of progestins and varying durations of use has also not been measured; the data range from 5% over 20 years to 1.5-2% per year, which is already quite significant [2,4,8,10,17]. An ever-increasing number of reports of individual unsuccessful hormone therapy for non-atypical endometrial hyperplasia or progression of the disease even in the course of treatment [3] has prompted clinicians and researchers to look for new approaches to the management of this disease.…”