ATYPICAL ENDOMETRIAL HYPERPLASIA AND CANCER

NEW YORK (Reuters Health) Feb 02 - The cumulative 20-year risk of endometrial carcinoma for women with atypical endometrial hyperplasia is 28%, compared with a combined rate of less than 5% for women with simple or complex hyperplasia, according to a new report.

"Before our study there were major questions about how likely each of the types of endometrial hyperplasia -- simple hyperplasia, complex hyperplasia, and atypical hyperplasia -- was to progress," senior author Dr. James V. Lacey, Jr., from City of Hope, Duarte, California, told Reuters Health.

Dr. Lacey and his colleagues conducted a case-control study nested in a cohort of 7947 women with endometrial hyperplasia. Case patients (n = 138) were diagnosed with carcinoma an average of 6 years after their diagnosis of hyperplasia. Control patients (n = 241) were matched to case patients on age at hyperplasia diagnosis, date of diagnosis, duration of follow-up, and hyperplasia severity. Original slides and medical records of cases and controls were reviewed.

In the January 10th online issue of the Journal of Clinical Oncology, the researchers report that in women without atypical endometrial hyperplasia (i.e., women with simple or complex hyperplasia), the cumulative risk of progression to cancer after the index biopsy increased from 1.2% through 4 years, to 1.9% through 9 years, to 4.6% through 19 years. For atypical hyperplasia, the cumulative risk increased from 8.2% through 4 years, to 12.4% through 9 years, to 27.5% through 19 years.

Hormonal treatment for endometrial hyperplasia and follow-up biopsies were similar between case patients and controls. All case patients with atypical hyperplasia who were diagnosed with carcinoma at least 5 years after index biopsy received hormonal treatment, and 89% received at least one follow-up biopsy.

"For women who are diagnosed with endometrial hyperplasia and the health care providers who treat them, our data provide the most accurate estimates to date of how likely those women are to clinically progress to carcinoma in the 5, 10, and 20 years after being diagnosed with endometrial hyperplasia," Dr. Lacey noted.

"Numbers like that, expressed as absolute risks," he added, "can be especially helpful in weighing the pros and cons of whether to pursue a course of definitive treatment, like hysterectomy, or whether to pursue a course of nonsurgical clinical management that includes progestin-based therapy and continued observation."

J Clin Oncol 2010.