Transcript Endometriosis and Cancer…Is there a Causal Link?

Endometriosis and Cancer…Is there a
Causal Link?
Paula Payton
Masters Project
2/22/06
Advisor: Prof Eileen VanDyke
Background
• Endometriosis is a chronic, progressive
disease that affects women of child
bearing age.
• It affects approximately 10% of women
and is linked to female infertility.
• Endometriosis is the third leading cause of
gynecological hospitalizations and
hysterectomies.
Background
• Women with endometriosis begin growing
endometrial tissues on the outside of the
uterus.
• Instead of leaving the body as it should
with the normal menstrual flow, the tissue
begins to insert itself in different places
within the body.
Background
• Most common S/Sx
– Infertility
– Abdominal pain
– Pain during intercourse
– Pain during menstruation
– No S/Sx
Risk Factors
• Risk factors
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First degree relative w/ endometriosis
Delayed childbirth
Shorter menstrual cycles
Heavier menstrual blood flow
The Purpose
• The purpose of this project was to review
and analyze the information available
regarding the following questions:
– Does endometriosis put women at an
increased risk for cancer?
– If these women are at increased risks for
cancer, what kind of cancers do they need to
be concerned about?
The Massachusetts Institute for
Technology Center for Cancer Research
• Study performed on mice
• The researchers found that due to a mutation in
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the Kras oncogene or the Pten tumor suppressor
gene in the mouse ovary, the mice developed
ovarian endometriosis-like lesions.
MIT CCR was able to link the mutation to
ovarian cancer.
MIT CCR (cont.)
• Kras oncogene and Pten tumor suppressor
genes are often mutated in human ovarian
cancer.
• Research conclusion:
– Patients with endometriosis could be at
increased risk for ovarian cancer
Ness et al. Research
• Conducted 4 studies in an effort to link
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endometriosis and ovarian cancer
Studies involved a combined total of 2098
subjects who had ovarian cancer and 2953
subjects who served as a control group
177 (8.5%) of the ovarian cancer patients and
184 (6.3%) of the control patients reported
being diagnosed with endometriosis
Information about sexual history, fertility,
breastfeeding, oral contraceptive use, and
gynecological procedures were obtained from all
of the subjects.
Ness et al. Research (cont.)
• Multivariable unconditional logical regression
methods were then used to see if women with
endometriosis were at an increased risk for
ovarian cancer over those women without
endometriosis
• Research conclusion:
– Women with endometriosis had a 30%
increased chance of developing ovarian
cancer
Swedish National Board of Health
and Welfare Research
• Researchers obtained 20,686 subjects from the
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Swedish Inpatient Register from the period of
1969-1983 who had been hospitalized for
endometriosis.
These records were then linked up to the
National Swedish Cancer Registry through 1989.
Research Conclusion:
– Patients with endometriosis were more than
20% more likely to develop ovarian cancer
over the general population.
Endometriosis and its link to other
forms of cancers?
• The Swedish study revealed that patients were
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at an increased risk for both breast cancer and
Non-Hodgkin’s Lymphoma.
An increase in breast cancer may be due to the
shared hormonal factors between the two
disease states- disturbances of ovulation and
excessive estradiol levels.
The finding of an increased incidence of NonHodgkin’s Lymphoma suggests that there may
be a causal link associated with the
advancement of treatment in more recent yearshigh potency progesterons and danazol
Proposed cause and effect
relationship
• One purposed hypothesis for the
relationship between endometriosis and
cancer looks at survivin, an inhibitor of
apoptosis, as the link between the two
disease states.
• Its presence is relatively undetected in
normal tissue.
Proposed cause and effect
relationship (cont.)
• The study took samples of endometrioic
tissue from 35 women w/ endometriosis
and 12 women w/o endometriosis.
• Survivin was significantly elevated in those
women with endometriosis and
undetected in those women without the
disease.
Proposed cause and effect
relationship (cont.)
• Research conclusions
– Survivin is found in endometrioic tissue of
women with endometriosis.
– Survivin inhibits apoptosis and is associated
with several metastatic cancers- oral,
esophageal, and ovarian cancer.
– The presence of survivin could be the link
between endometriosis and ovarian cancer.
Conclusion
• There is a limited amount of research
available that looks at the link between
endometriosis and cancer.
• However, all of the currently available
studies DO link endometriosis and cancer.
• This research provides a framework for
which future research can be based.
References
American Cancer Society. What Are the Key Statistics About
Ovarian Cancer? November 9, 2005.
Aphrodite Women’s Health. Endometriosis linked to cancer
risk.January 1, 2004.
Birnbaum, Michael. Endometriosis and Cancer. 2003.
Available via World Wide Web:
http://www.infertilityphysician.com/endometriosis/cancer
.html
Brinton, L., et al.. Cancer risk after a hospital discharge
diagnosis of endometriosis. American Journal of
Obstetrics and Gynecology March 1997; 176(3): 572579.
Frackiewicz, E.. Endometriosis: An overview of the disease
and its treatment. Journal of the American
Pharmaceutical Association 2000; 40(5):645-657
References (cont.)
Gebel, H., et al. Spontaneous apoptosis of endometrial
tissue is impaired in women with endometriosis. Fertility
and Sterility 1998; 69(6): 1042-1047.
Modugno, F., et al.. Oral contraceptive use, reproductive
History, and risk of epithelial ovarian cancer in women
With and without endometriosis. American Journal of
Obstetrics and Gynecology 2004; 191(3): 733-740.
Ueda, M., et al. Survivin gene expression in endometriosis.
The Journal of Clinical Endocrinology & metabolism
2002; 87(7): 3452-3459.
Yoon, C.. Endometriosis and ovarian cancer modeled in
mouse. Center for Cancer Research. January 7,2005.
www.endofacts.com