TY - JOUR
T1 - Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia
T2 - The 34-year experience in a large health plan
AU - Lacey, J. V.
AU - Ioffe, O. B.
AU - Ronnett, B. M.
AU - Rush, B. B.
AU - Richesson, D. A.
AU - Chatterjee, N.
AU - Langholz, B.
AU - Glass, A. G.
AU - Sherman, M. E.
N1 - Funding Information:
We thank Stella Munuo, MSc, and Ruth Parsons, BA, at IMS Inc., for data management. We thank J Danny Carreon, MPH, at the Division of Cancer Epidemiology and Genetics, NCI, for technical assistance. We thank Kris Bennett, Chris Eddy, BS, Beverly Battaglia, and the rest of the KPCHR staff. The National Cancer Institute’s Intramural Research Program (Division of Cancer Epidemiology and Genetics) funded this study.
PY - 2008/1/15
Y1 - 2008/1/15
N2 - Classifying endometrial hyperplasia (EH) according to the severity of glandular crowding (simple hyperplasia (SH) vs complex hyperplasia (CH)) and nuclear atypia (simple atypical hyperplasia (SAH) vs complex atypical hyperplasia (CAH)) should predict subsequent endometrial carcinoma risk, but data on progression are lacking. Our nested case-control study of EH progression included 138 cases, who were diagnosed with EH and then with carcinoma (1970-2003) at least 1 year (median, 6.5 years) later, and 241 controls, who were individually matched on age, date, and follow-up duration and counter-matched on EH classification. After centralised pathology panel and medical record review, we generated rate ratios (RRs) and 95% confidence intervals (CIs), adjusted for treatment and repeat biopsies. With disordered proliferative endometrium (DPEM) as the referent, AH significantly increased carcinoma risk (RR=14, 95% CI, 5-38). Risk was highest 1-5 years after AH (RR=48, 95% CI, 8-294), but remained elevated 5 or more years after AH (RR=3.5, 95% CI, 1.0-9.6). Progression risks for SH (RR=2.0, 95% CI, 0.9-4.5) and CH (RR=2.8, 95% CI, 1.0-7.9) were substantially lower and only slightly higher than the progression risk for DPEM. The higher progression risks for AH could foster management guidelines based on markedly different progression risks for atypical vs non-atypical EH.
AB - Classifying endometrial hyperplasia (EH) according to the severity of glandular crowding (simple hyperplasia (SH) vs complex hyperplasia (CH)) and nuclear atypia (simple atypical hyperplasia (SAH) vs complex atypical hyperplasia (CAH)) should predict subsequent endometrial carcinoma risk, but data on progression are lacking. Our nested case-control study of EH progression included 138 cases, who were diagnosed with EH and then with carcinoma (1970-2003) at least 1 year (median, 6.5 years) later, and 241 controls, who were individually matched on age, date, and follow-up duration and counter-matched on EH classification. After centralised pathology panel and medical record review, we generated rate ratios (RRs) and 95% confidence intervals (CIs), adjusted for treatment and repeat biopsies. With disordered proliferative endometrium (DPEM) as the referent, AH significantly increased carcinoma risk (RR=14, 95% CI, 5-38). Risk was highest 1-5 years after AH (RR=48, 95% CI, 8-294), but remained elevated 5 or more years after AH (RR=3.5, 95% CI, 1.0-9.6). Progression risks for SH (RR=2.0, 95% CI, 0.9-4.5) and CH (RR=2.8, 95% CI, 1.0-7.9) were substantially lower and only slightly higher than the progression risk for DPEM. The higher progression risks for AH could foster management guidelines based on markedly different progression risks for atypical vs non-atypical EH.
KW - Atypical hyperplasia
KW - Counter-matching
KW - Endometrial adenocarcinoma
KW - Histopathology
KW - Uterine cancer
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U2 - 10.1038/sj.bjc.6604102
DO - 10.1038/sj.bjc.6604102
M3 - Article
C2 - 18026193
AN - SCOPUS:38049032040
SN - 0007-0920
VL - 98
SP - 45
EP - 53
JO - British journal of cancer
JF - British journal of cancer
IS - 1
ER -