A groundbreaking study has revealed that women with severe endometriosis are ten times more likely to develop ovarian cancer compared to those without the condition. Published in the journal JAMA, this research marks a significant advancement in understanding the link between endometriosis and ovarian cancer.
Researchers utilized the Utah Population Database (UPDB), housed at Huntsman Cancer Institute, to analyze the incidence rates of various types of endometriosis and subtypes of ovarian cancer. This study involved over 78,000 women with endometriosis, evaluating the association between endometriosis and ovarian cancer incidence overall and by histotype. The cohort included women aged 18 to 55 years with at least one diagnosis of endometriosis, using inpatient records, statewide ambulatory surgery records, and electronic health records (EHRs) from the University of Utah and Intermountain Health.
Among the 597 women with ovarian cancer, those with endometriosis had a significantly higher risk of developing ovarian cancer compared to those without. The adjusted hazard ratio (aHR) for ovarian cancer was 4.20, with the risk being notably higher for type I ovarian cancer. The highest risk was observed in women with deep infiltrating endometriosis and/or ovarian endometriomas.
The researchers discovered that women with more severe forms of endometriosis are more likely to develop type I ovarian cancer. Barnard and colleagues described the findings as striking, noting a 19-fold increased risk, comparable to the connection between smoking and lung cancer. Additionally, the study found that women with any type of endometriosis have a 4.2-fold increased risk of developing ovarian cancer compared to those without the condition. Specifically, these women have over seven times the risk of developing type I ovarian cancer, which is slow to develop but does not respond well to chemotherapy.
Previous studies have shown modest associations between endometriosis and ovarian cancer. A systematic review and meta-analysis by Kvaskoff et al. found that endometriosis nearly doubled the risk of ovarian cancer, although associations varied by ovarian cancer histotype. Kralickova et al. also concluded that patients with endometriosis have a higher risk of developing ovarian cancer.
Endometriosis affects approximately 11% of reproductive-aged women, including 50% to 60% of women and teenage girls with pelvic pain and up to 50% of women with infertility. In addition to pelvic pain and infertility, ovarian, breast, and endometrial cancers have been theorized as comorbidities linked to endometriosis. As a preventive measure, women with endometriosis might consider surgeries, including a hysterectomy or removal of the ovaries. However, these are invasive procedures, and further research is necessary to determine the best course of action.
The researchers highlighted the significance of these findings, emphasizing their impact on clinical care for individuals with severe endometriosis. These patients could benefit from counseling on ovarian cancer risk and prevention. Additionally, this research paves the way for further studies to explore the mechanisms by which specific types of endometriosis contribute to different forms of ovarian cancer. The ultimate goal is to improve prevention, diagnosis, and treatment strategies for women affected by endometriosis and at risk of ovarian cancer.
References
- Barnard ME, Farland LV, Yan B, Wang J, Trabert B, Doherty JA, et al. Endometriosis Typology and Ovarian Cancer Risk. JAMA [Internet]. 2024 Jul 17 [cited 2024 Jul 18]; Available from: https://doi.org/10.1001/jama.2024.9210
- Kvaskoff M, Mahamat-Saleh Y, Farland LV, Shigesi N, Terry KL, Harris HR, et al. Endometriosis and cancer: a systematic review and meta-analysis. Human Reproduction Update. 2021 Mar 1;27(2):393–420.
- Králíčková M, Laganà AS, Ghezzi F, Vetvicka V. Endometriosis and risk of ovarian cancer: what do we know? Arch Gynecol Obstet. 2020 Jan;301(1):1–10.