Does endometriosis increase my risk of cancer?

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  • Poole, E. M., Lin, W. T., Kvaskoff, M., De Vivo, I., Terry, K. L., & Missmer, S. A. (2017). Endometriosis and risk of ovarian and endometrial cancers in a large prospective cohort of US nurses. Cancer Causes & Control28(5), 437-445. Retrieved from https://link.springer.com/article/10.1007/s10552-017-0856-4 

“This study adds to the evidence that endometriosis is not strongly linked to endometrial cancer risk and that the association with ovarian cancer is robust to misclassification, diagnostic delay, and changes in exposures post-endometriosis diagnosis. Our analysis suggests that confounding and misclassification do not obscure a weak association for endometrial cancer risk, although our results should be replicated.”

  • Szubert, M., Suzin, J., Obirek, K., Sochacka, A., & Łoszakiewicz, M. (2016). Clear cell ovarian cancer and endometriosis: is there a relationship?. Przeglad menopauzalny= Menopause review15(2), 85. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993982/ 

“According to the most recent systematic review of the literature, the risk is small and is 1.321.7//1.3217 (95% CI) [7]. There are many publications on the relationship of endometriosis with ovarian clear cell carcinoma, however, it is not known whether these two diseases have a common aetiology and whether the relationship is sequential in nature, i.e. endometriosis developing into cancer through malignant transformation [8]…. In our clinical material, OCCC is a rare histopathological specimen with prognosis comparable to that of serous ovarian cancer. Establishing the cause-and-effect relationship between this histopathological subtype and endometriosis cannot be proved based on clinical material of only one clinic or operative ward.”

“Endometriosis was associated with increased risks for ovarian cancer (SIR 1.34; 95% CI: 1.16–1.55), due primarily to endometrioid (SIR 1.64; 95% CI: 1.09–2.37) and clear-cell types (SIR 3.64; 95% CI: 2.36–5.38). An excess risk was also observed for endometrial cancer (SIR 1.43; 95% CI: 1.13–1.79), primarily of type 1 (SIR 1.54; 95% CI: 1.20–1.96); and the risk for breast cancer was increased among women aged ≥ 50 years at first diagnosis of endometriosis (SIR 1.27; 95% CI: 1.12–1.42). Conclusions: The results corroborate previous findings of increased risks for endometrioid and clear-cell ovarian cancer in women with endometriosis. As the first cohort study to date, we observed a significantly increased risk for endometrial cancer in women with a diagnosis of endometriosis. The increased breast cancer risk among women with endometriosis diagnosed at ≥ 50 years of age should be studied further.”

“Unlike epithelial cells, endometriotic stromal cells are mutation free but contain widespread epigenetic defects that alter gene expression and induce a progesterone-resistant and intensely inflammatory environment, driven by estrogen via estrogen receptor-β. The resulting increased estrogenic action in the stroma drives inflammation and sends paracrine signals to neighboring epithelial cells to enhance proliferation. In addition, massively high concentrations of estrogen in the ovary may exert an additional and direct genotoxic effect on DNA and cause accumulation of additional mutations and malignant transformation in initially mutated endometriotic epithelial cells in an ovarian endometrioma, which may initiate epithelial ovarian cancer. The same epithelial mutations and inflammatory processes in stroma are seen in extraovarian deep-infiltrating endometriosis, but carcinogenesis does not occur. We provide a focused review of the literature and discuss the implications of recent genetic breakthroughs linking endometriosis and ovarian cancer.”

“A majority of the serous tumors appear to originate from dysplastic lesions in the distal fallopian tube. Therefore, what we have traditionally considered “ovarian” cancer may in fact be tubal in origin.”