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The risk of developing ovarian cancer is Endometriosiscompared with women who have not been diagnosed with the disease, study find.
Scientists have known that endometriosis may be associated with an increased risk of ovarian cancer, but this study details how that risk varies depending on the subtype of endometriosis.
Endometriosis is a common and painful condition that occurs when tissue similar to the endometrium grows outside the uterus. More than 11% of women Ages 15 to 44 across the United States.
Women with severe endometriosis (deep infiltrating endometriosis, Ovarian endometriosis Women who have endometriosis or both have a “significantly increased” overall risk of ovarian cancer — about 9.7 times higher — compared with women without endometriosis, a study from the National Cancer Center found. The study was published Wednesday in the medical journal JAMAFormat Deeply penetrating endometriosis Located deep within tissues and organs, Ovarian endometriosisA chocolate cyst is a cyst that forms on the ovaries and is sometimes called a “chocolate cyst.”
Research also shows that women with deep infiltrating endometriosis, ovarian endometriosis, or both have about a 19-fold increased risk of type I ovarian cancer, which tends to grow more slowly, compared with women without endometriosis.
But experts say endometriosis sufferers shouldn’t panic over the new findings, because ovarian cancer itself is still rare.
Approximately 1.1 percent of American women will be diagnosed with ovarian cancer at some point in their lifetime. National Cancer InstituteIt is estimated that there will be about 20,000 new cases of ovarian cancer this year, and about 13,000 women will die from the disease.
“Because ovarian cancer is a rare disease, it’s noteworthy that endometriosis was associated with only 10 to 20 additional cancer cases per 10,000 women,” said Karen Schlieb, lead author of the new study and associate professor in the School of Public Health at the University of Utah School of Medicine.
“At this time, we are not recommending any changes in clinical care or policy,” she added. “The best way to prevent ovarian cancer is to encourage physical activity, not smoking or alcohol restriction.” Family History Ovarian, breast, and colon cancer Important risk factors In the case of ovarian cancer.
Overall, people with endometriosis should look out for warning signs of ovarian cancer, such as abdominal bloating, abdominal pain and changes in bowel or bladder function, says gynecologic oncologist Medical Director, Cedars-Sinai Office of Cancer Clinical Trials“The study is a very important step forward for the research team,” he said in an email, though he was not involved in the study.
“If I had endometriosis and my doctor recommended oral contraceptives, either for treatment or just to prevent pregnancy, I would definitely consider taking them,” Rimmel says. “Oral contraceptives are Reduced risk of ovarian cancer That is great news.”
For the new study, a team of US researchers analysed data on almost half a million women aged 18 to 55 in Utah. Utah Population Database Huntsman Cancer Institute researchers looked at the number of women diagnosed with endometriosis in electronic health records based on the Utah Cancer Registry and how many of them developed ovarian cancer between 1992 and 2019.
The researchers found that women with endometriosis had a 4.2-fold increased risk of all types of ovarian cancer compared with women without the disease. The risk of type I ovarian cancer in particular was “particularly elevated,” the study found, with women with endometriosis showing a roughly 7.5-fold increased risk, and they were roughly 2.7-fold more likely to develop type II ovarian cancer, which can be more aggressive.
“The magnitude of these associations varied by endometriosis subtype; individuals diagnosed with deep invasive endometriosis and/or ovarian endometriosis had a 9.66-fold increased risk of ovarian cancer compared with individuals without endometriosis,” the researchers wrote.
The researchers found that compared with women without any type of endometriosis, women with deep invasive endometriosis had the highest risk of ovarian cancer overall (about 18.8 times higher), and women with deep invasive endometriosis and ovarian endometriosis had the second highest risk (about 13 times higher).
Such a dramatic increase came as a surprise to Schlieb and his colleagues.
“As an epidemiologist, to see this 10-fold jump, a pretty narrow confidence interval between 8 and 12, and a 19-fold higher risk, you don’t always see relationships like this,” Schliep said. “That’s the part that was shocking to me from an epidemiology perspective.”
The study data did not indicate which women with endometriosis were specifically treated with oral contraceptives or gonadotropin-releasing hormone agonists, which may slightly skew the data because contraceptives are associated with a lower risk of ovarian cancer, and it is unclear how gonadotropin-releasing hormone agonists relate to cancer risk. Additionally, some of the women the data showed did not have endometriosis may have been undiagnosed or misdiagnosed.
But overall, the study adds to the body of research suggesting a link between endometriosis and ovarian cancer risk, Dr. Michael McHale of the University of California, San Diego, wrote in an editorial about the new study in JAMA.
“Furthermore, these data support the importance of counseling women with deep infiltrating endometriosis and ovarian endometriosis about their increased risk of ovarian cancer. Although the absolute numbers are limited, the increased risk is significant,” he wrote. “For women who have completed childbearing and/or have other fertility treatment options, more radical surgery should be discussed and considered. As always, shared decision-making is essential given these evolving data.”
The new study shows the strongest link yet between endometriosis and ovarian cancer risk, Mayo Clinic Minimally Invasive Gynecologic Surgery Specialist The Rochester, Minnesota, resident is not involved in the study but specializes in endometriosis.
He added that the association could be caused by several factors.
“In endometriosis, you have abnormal cell growth, which is a genetic phenomenon. Cells acquire the ability to migrate and be in places they shouldn’t be, and there appears to be something genetic about it,” Barnett said.
“But there are a lot of other potential associations, from inflammatory links to immunological factors,” he said. “There are multiple potential associations, so I don’t think you can effectively infer anything specific.”
Still, Burnett said people with endometriosis don’t need to panic about the link.
“Overall, the risk is still on the low side of cancer risk,” he said. “Currently, we do not recommend universal screening for endometriosis patients, despite knowing the risk level, and I don’t see that necessarily changing. We already follow women with endometriosis or cystic endometriosis with ultrasound to rule out the development of malignancies, so I don’t see this changing our recommendations at this time.”
Endometriosis itself is a poorly understood diagnosis, and its connection to ovarian cancer is also difficult to fully understand, she said. Gynecologic Oncologist at Perlmutter Cancer Center, NYU Langone Hospital Long Island The New York researchers were not involved in the new study.
The link may have a genetic component, and the inflammation common in endometriosis may increase the risk of ovarian cancer, but hormonal factors may also be driving the association, she said.
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Patients should remember that “the risk of ovarian cancer in the general population is extremely low.” “The risk is less than 2 percent, which is much lower than common cancers like breast cancer,” Gerber says. “So even with the four-fold increase in risk of ovarian cancer in this study, women’s risk remains very low.”
The new study shows an association between endometriosis and ovarian cancer, but it doesn’t prove a causal relationship, and the exact cause of the association remains unclear, says Cedars-Sinai’s Rimell.
“Several mechanisms have been proposed, but none are conclusively proven. Mutations in genes such as ARID1A have been associated with endometriosis and endometrial cancer and may link the two,” Rimell said in an email.
She added that another possible mechanism may involve how endometriosis forms and how it damages tissue, creating an environment in which cancer can develop, but that more research is needed.
