Risk of endometrial cancer in patients with polycystic ovarian syndrome: A meta‑analysis

Abstract

While existing literature suggests an association between polycystic ovarian syndrome (PCOS) and endometrial cancer, the sparsity and inconsistency of current evidence indicates a lack of clarity regarding the exact strength of this association. It also remains uncertain whether the degree of risk of disease is affected by confounding factors, such as age and body mass index (BMI). The present meta-analysis is aimed to quantify the risk of endometrial cancer in female subjects with PCOS compared to those without PCOS. PubMed, MEDLINE, EMBASE, Scopus and Cochrane were searched from inception to October 31, 2022, to identify peer-reviewed case-control, cohort and cross-sectional studies that assessed the association between endometrial cancer and PCOS and contained original data. Two researchers independently extracted data and performed quality assessment using the Newcastle-Ottawa criteria. Pooled odds ratios (ORs) were calculated using the random-effect model and inverse variance. The degree of heterogeneity was assessed using I 2 statistics. A total of 10 relevant studies were identified and included in the meta-analysis (comprising 12,248 female patients with PCOS and 54,120 controls). Females with PCOS had a significantly increased odds of developing endometrial cancer as compared to those without PCOS [OR, 4.07; 95% confidence interval (CI), 2.13-7.78; P<0.0001]. When postmenopausal subjects (age, >54 years) were excluded from the meta-analysis, the odds increased further (OR, 5.14; 95% CI, 3.22-8.21; P<0.00001). Patients with PCOS are up to 5 times more likely to develop endometrial cancer compared to those without PCOS. Larger, prospective studies that are well-controlled for confounding factors, such as BMI, are required.

Concerns and expectations in women with polycystic ovary syndrome vary across age and ethnicity: findings from PCOS Pearls Study

“…The hallmarks of PCOS include hyperandrogenism, oligo/anovulation and polycystic ovarian morphology. It is also associated with cardio-metabolic diseases such as obesity and diabetes ( 3 ), psychological disorders ( 4 ) and increased cancer risk ( 5 , 6 ). The disease is multifactorial, and its complex pathophysiology involves multiple pathways ( 7 ).…”

Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort

“… 6 , 32 The prevalence of endometrial cancer has been reported to be increased 3-5 fold in those with PCOS in the postmenopause years, and an increased risk for ovarian cancer has been reported in younger women with PCOS in the premenopause years. 6 , 123 , 124 , 125 In our cohort, we have shown that all malignancy was increased by 30% in those with PCOS, suggesting that increased awareness and screening may be warranted.…”

Comparative effects of progestin-based combination therapy for endometrial cancer or atypical endometrial hyperplasia: a systematic review and network meta-analysis

“…This is consistent with the results of a number of meta-analyses of which we are aware. For example a meta-analysis that included 10 studies showed that women with PCOS had a significantly increased risk of endometrial cancer compared to controls (69), with a further increase in risk when postmenopausal people were excluded from the meta-analysis. Similarly, adenomyosis is a benign gynaecological disease, whereas EC can originate from malignant transformation of ectopic endometrium within the adenomyosis lesion, leading to endometrial carcinoma arising in adenomyosis (EC-AIA).…”