MEDICAL JOURNAL UPDATESLacey JV et al., Journal of Clinical Oncology 2010; 25(5)
This paper aims to estimate the absolute risk of clinical progression of Endometrial Hyperplasia (EH) to endometrial (womb) cancer. It analyzes a cohort of 7,947 women diagnosed with Endometrial Hyperplasia from 1970-2002.
The findings of this large, population-based study shows women with non-atypical EH, the cumulative progression risk increases from 1.2% through 4 years to 1.9% through 9 years to 4.6% through 19 years after EH diagnosis.
Alternatively, for atypical hyperplasia (AH), cumulative risk increases from 8.2% to 14.6% through 4 years to 12.4% through 9 years to 27.5% through 19 years after AH.
It concludes that the cumulative 20-year progression risk among women is less than 5% for non-atypical EH but is 28% for AH.
This paper provides an estimate of progression risk of endometrium (womb) cancer when endometrial hyperplasia is diagnosed following an abnormal uterine bleeding.
It is reassuring that fewer than one in 20 women with EH developed cancer during the 20 years follow-up. In contrast, one in eight women with AH developed cancer within 10 years, and one in three developed carcinoma within 20 years.
In this study, almost one third of women with AH who did not undergo hysterectomy were diagnosed with carcinoma within 20 years. The doubling of cumulative risk after 10 years from 12% to 28% may help inform decision- making regarding how long patients might wish to rely on hormonal treatment and repeat assessment if hysterectomy is not performed within the first year after a diagnosis of AH.
The lower risks for women with non- atypical EH compared to AH can assist decision making for nonsurgical clinical management of EH, whereas the higher risks of AH progressing to carcinoma warrant consideration of appropriately aggressive approaches.
The overall progression risk for EH is three times higher than the average population risk of endometrial carcinoma. Fewer than 5% of women with non- atypical EH will experience progression to carcinoma, but 28% of women with AH progress to carcinoma during 20 years.