Epidemiology and EC risk factors

Question 1

Give EC risk factors

Answer 1

• Obesity
• Diabetes
• PCOS
• other conditions associated with metabolic syndrome
• Conditions associated with excess estrogen e.g. estrogen-secreting tumors and HRT with unopposed estrogen

Question 2

What’s the risk of EC with tamoxifen?

Answer 2

• Doubles risk for both endometrioid and non-endometrioid histoloigies
• Up to 4x increased risk with tamoxifen use > 5 years

Question 3

What are protective factors for EC?

Answer 3

• Parity
• hormonal contraception

Question 4

What’s the decrease in risk of EC with OCP use?

Answer 4

• OCP reduces EC risk by 30 - 40%
• longer use is associated with greater protection, even decades after cessation

Question 5

Obesity

• What proportion of EC is attributable to obesity?
• what’s the lifetime risk of EC with a normal BMI?
• 5-unit increase in BMI –> increased EC by ____%
• Trend with age of diagnosis of EC under 50 years old?

Answer 5

• >50% (57%) is attributable to obesity in the US
• normal BMI has a 3% lifetime risk of EC
• 5 unit increase in BMI –> increase in EC by 50%
• Increasing trend of more women with EC under 50 years old.

Question 6

Average age of EC?

Answer 6

• 63

Question 7

Reason why obesity results in higher risk of EC in childbearign women?

Answer 7

• Many of these women are anovulatory, which causes overstimulation of the endometrium due to excess estrogen
  and lack of progestin.
• Adipose tissue has aromatase enzyme resulting higher levels of estrone (androstenedione –> estrone)

Question 8

• Oral progestins in treatment of CAH and G1 EC
  
  • CR rate?
  • Recurrence rate?
• IUD in treatment of CAH and G1 EC
• Which patients are NOT candidates for fertility sparing treatment of EC?

Answer 8

• In a meta-analysis that included women using mostly oral progestins, a complete response was seen in 65.8% of women with CAH and 48.2% of women with endometrial cancer; however, recurrence rates were 23.2% and 35.4%, respectively
• 91% of women with CAH and 54% of women with endometrial
  cancer had a complete response at 12 months
• Higher-grade tumors or tumors invading the myometrium, as seen on magnetic resonance imaging, are not candidates for conservative management. The standard of care for
  such women is hysterectomy.

Question 9

• Lifetime risk of EC with
  
  • without any mutation
  • MLH1 or MSH2 gene mutation?
  • MSH6
• Median age of EC
  
  • without any mutation
  • MLH1 or MSH2 gene mutation
  • MSH6

Answer 9

• Lifetime risk
  
  • without any mutation: ____
  • MLH1 or MSH2 mutation: 40 -60%
  • MSH6: _____
• Median age of EC
  
  • without any mutation: 63 y.o.
  • MLH1 or MSH2 mutation: 48 y.o.
  • MSH6: 53 y.o.

Question 10

Lynch syndrome accounts for ___% of all endometrial cancers and __% of all EC under age 50

Answer 10

• 3%
• 9-10%

Question 11

As with colon cancer, many groups recommend screening all patients with EC with use of IHC for which markers?

Answer 11

Use of immunohistochemical tests for MLH1, MSH2, MSH6, and PMS2 or polymerase chain reaction–based MSI analysis or both types of testing

Question 12

What are some disparities with EC and ethnicity?

Answer 12

• higher rate of increase among Black women of tumors with aggressive, nonendometrioid histologic features
• Even when adjusted for stage and histologic featuresmortality rates remain highest among Black women. Access to appropriate care may also contribute to these differences.