Endometrial Cancer in Pre-Menopausal Women and Younger: Risk Factors and Outcome

Abstract

Endometrial cancer is the sixth most common malignancy in women, and it is known to be a disease among postmenopausal women, but there is rising in the number of endometrial cancers among premenopausal women. This study aims to determine the clinical characteristic, risk factors, outcomes, and survival in pre and postmenopausal women with endometrial cancer in Malaysia. A retrospective study was conducted in Hospital Melaka that involved all women who were diagnosed with endometrial cancer in Hospital Melaka from January 2002 until July 2020. All subjects’ histopathological examination result was confirmed, and their clinical data were extracted and transferred into a standardized data checklist and analysed. A total number of 392 cases was obtained from the Annual Cancer Registry Hospital Melaka. However, only 281 cases were studied, including 44.8% premenopausal and 55.2% postmenopausal women. In the premenopausal group, there were higher incidence of obesity (30.8 + 8.6 vs. 28.9 + 7.1), younger age at menarche (12.7 + 1.5 vs. 13.3 + 1.6), lesser parity (1.47 vs. 3.26), and a higher number of nulliparous women (46.8% vs. 19.4%) as compared to postmenopausal group. The premenopausal group tends to be presented with a well-differentiated grading of tumour (52.4%) and a higher incidence of having concomitant endometrial hyperplasia (41.3%). The mean survival among the premenopausal group (200.3 + 7.9 months) is higher compared to postmenopausal group (153.9 + 6.5 months). These findings correlate with good survival and prognosis among the premenopausal group compared to the postmenopausal group.

The global incidence, mortality, and burden of uterine cancer in 2019 and correlation with SDI, tobacco, dietary risks, and metabolic risk factors: An ecological study

“…In recent years, the role of fertility changes in increasing the incidence of EC has been the focus of many researchers. Accordingly, early menarche, late menopause, increased number of menstrual cycles and nulliparity increase the risk of EC 4,6,34 . In this regard, results of a study showed that obesity, nulliparity, and early menarche are risk factors for EC in premenopausal women 6 …”

“…Accordingly, early menarche, late menopause, increased number of menstrual cycles and nulliparity increase the risk of EC. 4,6,34 In this regard, results of a study showed that obesity, nulliparity, and early menarche are risk factors for EC in premenopausal women. 6 SDI is associated with lifestyle, dietary patterns, and disease risk factors.…”

“…4,6,34 In this regard, results of a study showed that obesity, nulliparity, and early menarche are risk factors for EC in premenopausal women. 6 SDI is associated with lifestyle, dietary patterns, and disease risk factors. The incidence of EC in high SDI areas is higher than in low SDI areas, and this trend has increased in the last three decades, which can be attributed to the westernization diet and aging of the population in these countries.…”

“…EC is mainly a postmenopausal disease and the average age of patients diagnosed with this cancer is 60 years 5 . The incidence of EC in premenopausal ages is between 14% and 20% 6 . Most of the young women with EC have more favorable histology with better prognosis, and are diagnosed in early stages of cancer with less involvement of myometrium and the absence of lymphatic vascular invasion 6,7 .…”

“…6 Most of the young women with EC have more favorable histology with better prognosis, and are diagnosed in early stages of cancer with less involvement of myometrium and the absence of lymphatic vascular invasion. 6,7 Most patients seek treatment with symptoms such as postmenopausal bleeding or abnormal uterine bleeding, and in advanced stages, they may have pain, abdominal bloating, bowel and bladder dysfunction, premature fullness, dyspnea, and dyspareunia. 5 Due to the fact that the awareness about the incidence trend, mortality, geographical diversity, and also the level of social development and the income of countries are basis for global studies, this study was conducted with the aim of investigating the trend of EC in the world in 2019.…”