What are the risk factors for endometrial carcinoma?

Updated: Jun 19, 2018
  • Author: William T Creasman, MD; Chief Editor: Warner K Huh, MD  more...
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Answer

Multiple epidemiological risk factors have been identified in patients who have adenocarcinoma of the endometrium.

Endogenous factors

Obesity

Nulliparity

An individual who has had a late menopause (aged >52 y)

Unopposed estrogen

Unopposed estrogen, either as replacement therapy or endogenously produced (eg, granulosa cell tumor, polycystic ovarian disease), increases the risk of endometrial cancer.

Obesity is known to increase endogenous estrogen because the presence of fat appears to be responsible for the conversion of androstenedione to estrogen compounds at a much higher rate than if fat is not present.

Anovulation, which may be secondary to unopposed estrogen, also appears to contribute to this situation.

Tamoxifen

The most widely used anticancer drug is tamoxifen, and this drug has been suggested by some studies to cause an increased incidence of adenocarcinoma of the endometrium. These data were derived from retrospective analyses in which adenocarcinoma of the endometrium was not an end point in multiple prospective randomized studies evaluating the role of tamoxifen in patients with breast cancer.  [3]

A case control study using the SEER database indicates that when confounding factors have been corrected, the risk of endometrial cancer does not appear to be increased in patients taking tamoxifen. [4]  This study is very reassuring because the potential for an increased number of women taking tamoxifen is becoming apparent, particularly as the prophylactic role of tamoxifen has been recommended for high-risk women.


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