Endometriosis and Cancer: Epidemiology

Paola Viganò, Edgardo Somigliana, Fabio Parazzini, Paolo Vercellini
Endometriosis · 2011 · pp. 501–511 · doi:10.1002/9781444398519.ch49 · W1505459170
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While overall cancer risk in women with endometriosis is debated, studies indicate an increased risk of ovarian cancer, particularly endometrioid and clear cell subtypes, with possible shared genetic predispositions or endometriotic tissue mutations contributing.

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Abstract

Endometriosis is an estrogen-dependent and inflammatory disease, characterized by implantation and growth of endometrial tissue outside the uterine cavity. Whether affected women are at increased risk of malignant tumors is a matter of current controversy. Population-based and observational studies do not unequivocally support an overall increased risk. Nevertheless, these patients may be at increased risk of specific forms of cancer. Evidence supporting an association, whether causative or not, with breast cancer, melanoma and non-Hodgkin lymphoma is generally scanty. Conversely, most cohort and case–control studies performed with the aim of evaluating the risk of ovarian cancer in women with endometriosis have reported a significant increased risk, with standardized incidence ratios or odds ratios varying between 1.3 and 3. A stronger association emerged when the relationship between endometriosis and particular histotypes of ovarian cancer, namely endometrioid and/or clear cell carcinomas, was specifically investigated. However, it is still unclear whether the link between endometriosis and ovarian cancer might be explained by a cause–effect relationship rather than by the sharing of similar predisposing factors and/or antecedent mechanisms. While some risk factors (nulliparity, menstrual characteristics) are common to both the conditions, some molecular observations support the possibility that endometriotic tissue may harbor mutations in genes and aberrant expression of proteins that are involved in the early step of carcinogenesis. The application of Bradford Hill criteria to address causation hints at a cautious position.

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Condition tags

endometriosis

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