- Can PCOS lead to cancer?
- PCOS linked to increased cancer risk in premenopausal women
- Polycystic ovary syndrome associated with increased cancer risk
- Endometrial Cancer Risk Factors
- Hormone factors
- Using an intrauterine device
- Diet and exercise
- Family history
- Breast or ovarian cancer
- Endometrial hyperplasia
- Prior pelvic radiation therapy
- PCOS and Endometrial Cancer Risk
- Polycystic ovarian syndrome (PCOS)
- Review Preventing endometrial cancer risk in polycystic ovarian syndrome (PCOS) women: Could metformin help?
Can PCOS lead to cancer?
PCOS increases the risk of some types of cancer.
For instance, some research has shown that risk of cancer of the endometrium (pronounced en-doh-MEE-tree-uhm), the inside lining of the uterus, may be higher for women with polycystic ovary syndrome (PCOS) than it is for women without PCOS.1 Irregular periods, or a lack of periods, can cause the endometrium to build up and become thick. This thickening can lead to endometrial cancer.2,3,4
Data on links between breast cancer, ovarian cancer, and PCOS are limited. While some small studies have suggested that a lack of ovulation, as occurs with PCOS, is linked with an increased risk of breast cancer, other studies have not shown an association.1 While some research has shown more than a doubling of the risk of ovarian cancer in women with PCOS,5 scientists have not confirmed these links in large population studies, and further studies hint that women with PCOS may have a lower risk of ovarian cancer.1,2,6 Therefore, any associations between breast or ovarian cancers and PCOS remain inconclusive.
Learn more about these different types of cancers on the National Cancer Institute website:
- Breast cancer
- Endometrial cancer
- Ovarian cancer
Are there disorders or conditions associated with PCOS?
Can it lead to cancer?
Can I still get pregnant?
Does PCOS affect pregnancy?
A diagnosis of polycystic ovarian syndrome was associated with an increased risk of several cancers, based on an analysis of nearly 3.5 million women in a large Swedish database.
Women with PCOS had a sixfold increased risk of endometrial cancer, a tripling of endocrine gland cancers, and more than a doubling in the risk of ovarian and pancreatic cancers. Once women reached menopausal status, however, their cancer risk was comparable to that of women without a history of PCOS.
“Several carcinogenic processes are associated with PCOS, including dyslipidemia, hyperinsulinemia, and chronic inflammation,” wrote Weimin Ye, MD, PhD, of the Karolinska Institutet, Stockholm, and his colleagues. “Our study indicates that cancer may need to be added to the spectrum of long-term health consequences of PCOS and warrants increased surveillance among those patients.”
The research letter was published online in JAMA Oncology.
The team examined the relationship between PCOS and primary cancers in about 3.5 million women over a span of up to 24 years (1985-2009), although the mean follow-up time was not mentioned. To examine the potential impact of menopause, they conducted separate multivariate logistic regression analyses for those younger than 51 years, and those aged 51 years or older. The analyses controlled for use of some medications (metformin, oral contraceptives, and hormone therapy); as well as educational level (a proxy for socioeconomic status); smoking; parity (a proxy for fertility); parental cancers; and diabetes.
Overall, 14,764 women had been diagnosed with PCOS; they were a mean of 28 years at baseline and 182 developed a primary cancer 1 year or more after PCOS diagnosis.
These women had a 15% overall increased risk of cancer, compared with women without PCOS.
The authors had no relevant financial disclosures.
SOURCE: Yin W et al. JAMA Oncol. 2018 Nov 29. doi:10.1001/jamaoncol.2018.5188.
Polycystic ovary syndrome associated with increased cancer risk
medwireNews: Women with polycystic ovary syndrome (PCOS) may have an increased likelihood for developing cancer, although the excess risk appears to be primarily restricted to those who are premenopausal, indicates a population-based study.
Using data from Swedish registers on 3,493,604 women aged 15–50 years, the researchers found that the overall cancer risk was a significant 1.15-fold higher for the 14,764 women who had a diagnosis of PCOS than for their counterparts without PCOS after adjusting for factors such as attained age, calendar year, and family history.
But further analysis by menopausal status showed that it was premenopausal women who were mainly at risk. The overall risk for cancer was a significant 1.22 times greater for women with versus without PCOS in this subgroup, while the association was not significant in the postmenopausal subgroup.
Of note, PCOS was associated with an elevated risk for not only cancers of the endometrium and ovaries, but also the pancreas, kidneys, and endocrine glands, both in the overall cohort and the premenopausal subgroup.
Among postmenopausal women, PCOS was linked to an increased risk for thyroid cancer alone, report Weimin Ye (Karolinska Institutet, Stockholm, Sweden) and co-authors in JAMA Oncology.
And they conclude: “Our study indicates that cancer may need to be added to the spectrum of long-term health consequences of PCOS and warrants increased surveillance among these patients.”
By Shreeya Nanda
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group
Endometrial Cancer Risk Factors
A risk factor is anything that raises your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking or sun exposure, can be changed. Others, like a person’s age or family history, can’t be changed.
Although certain factors can increase a woman’s risk for endometrial cancer, they don’t always cause the disease. Many women with risk factors never develop endometrial cancer.
Some women with endometrial cancer don’t have any known risk factors. Even if a woman with endometrial cancer has one or more risk factors, there’s no way to know which, if any, of them caused her cancer.
Many factors affect the risk of developing endometrial cancer, including:
- Things that affect hormone levels, like taking estrogen after menopause, birth control pills, or tamoxifen; the number of menstrual cycles (over a lifetime), pregnancy, certain ovarian tumors, and polycystic ovarian syndrome (PCOS)
- Use of an intrauterine device (IUD)
- Diet and exercise
- Type 2 diabetes
- Family history (having close relatives with endometrial or colorectal cancer)
- Having had breast or ovarian cancer in the past
- Having had endometrial hyperplasia in the past
- Treatment with radiation therapy to the pelvis to treat another cancer
Some of these, like pregnancy, birth control pills, and the use of an intrauterine device are linked to a lower risk of endometrial cancer, while many are linked to a higher risk. These factors and how they affect endometrial cancer risk are covered in more detail below.
Obesity is a strong risk factor for endometrial cancer and linked to hormone changes, which are covered in more detail below. A woman’s ovaries produce most of her estrogen before menopause. But fat tissue can change some other hormones (called androgens) into estrogens. This can impact estrogen levels, especially after menopause. Having more fat tissue can increase a woman’s estrogen levels, which increases her endometrial cancer risk.
In comparison with women who stay at a healthy weight, endometrial cancer is twice as common in overweight women (BMI 25 to 29.9), and more than 3 times as common in obese women (BMI > 30). You can find your BMI using our body mass index (BMI) calculator.
Gaining weight as you get older age and weight cycling (gaining and losing a lot of weight many times in your life) have also been linked to a higher risk of endometrial cancer after menopause.
A woman’s hormone balance plays a part in the development of most endometrial cancers. Many of the risk factors for endometrial cancer affect estrogen levels. Before menopause, the ovaries are the major source of the 2 main types of female hormones — estrogen and progesterone.
The balance between these hormones changes each month during a woman’s menstrual cycle. This produces a woman’s monthly periods and keeps the endometrium healthy. A shift in the balance of these hormones toward more estrogen increases a woman’s risk for endometrial cancer.
After menopause, the ovaries stop making these hormones, but a small amount of estrogen is still made naturally in fat tissue. Estrogen from fat tissue has a bigger impact after menopause than it does before menopause.
Treating the symptoms of menopause with hormones is known as menopausal hormone therapy (or sometimes hormone replacement therapy). Estrogen is the major part of this treatment. Estrogen treatment can help reduce hot flashes, improve vaginal dryness, and help prevent the weakening of the bones (osteoporosis) that can occur with menopause.
But using estrogen alone (without progesterone) can lead to endometrial cancer in women who still have a uterus. To lower that risk, a progestin (progesterone or a drug like it) must be given along with estrogen. This is called combination hormone therapy.
Women who take progesterone along with estrogen to treat menopausal symptoms do not have an increased risk of endometrial cancer. Still, taking this combination increases a woman’s chance of developing breast cancer and also increases the risk of serious blood clots.
If you are taking (or plan to take) hormones after menopause, it’s important to discuss the possible risks (including cancer, blood clots, heart attacks, and stroke) with your doctor.
Like any other medicine, hormones should be used at the lowest dose needed and for the shortest possible time to control symptoms. As with any other medicine you take for a long time, you’ll need to see your doctor regularly. Experts recommend yearly follow-up pelvic exams. If you have any abnormal bleeding or discharge from your vagina you should see a health care provider right away. (Do not wait until your next check-up).
For more information about the cancer risks linked to hormone treatment after menopause, see Menopausal Hormone Therapy and Cancer Risk.
Birth control pills
Using birth control pills (oral contraceptives) lowers the risk of endometrial cancer. The risk is lowest in women who take the pill for a long time, and this protection lasts for at least 10 years after a woman stops taking the pill. But it’s important to look at all of the risks and benefits when choosing a contraceptive method; endometrial cancer risk is only one factor to consider. It’s a good idea to discuss the pros and cons of different types of birth control with your provider.
Total number of menstrual cycles
Having more menstrual cycles during a woman’s lifetime raises her risk of endometrial cancer. Starting menstrual periods (menarche) before age 12 and/or going through menopause later in life raises the risk. Starting periods early is less a risk factor for women with early menopause. Likewise, late menopause may not lead to a higher risk in women whose periods began later in their teens.
The hormonal balance shifts toward more progesterone during pregnancy. So having many pregnancies helps protect against endometrial cancer. Women who have never been pregnant have a higher risk, especially if they were also infertile (unable to become pregnant).
Tamoxifen is a drug that is used to help prevent and treat breast cancer. Tamoxifen acts as an anti-estrogen in breast tissue, but it acts like an estrogen in the uterus. In women who have gone through menopause, it can cause the uterine lining to grow, which increases the risk of endometrial cancer.
The risk of developing endometrial cancer from tamoxifen is low (less than 1% per year). Women taking tamoxifen must balance this risk against the benefits of this drug in treating and preventing breast cancer. This is an issue women should discuss with their providers. If you are taking tamoxifen, you should have yearly gynecologic exams and should be sure to report any abnormal bleeding, as this could be a sign of endometrial cancer.
A certain type of ovarian tumor, the granulosa cell tumor, often makes estrogen. Estrogen made by one of these tumors isn’t controlled the way hormone release from the ovaries is, and it can sometimes lead to high estrogen levels. The resulting hormone imbalance can stimulate the endometrium and even lead to endometrial cancer. In fact, sometimes vaginal bleeding from endometrial cancer is the first symptom of one of these tumors.
Polycystic ovarian syndrome
Women with a condition called polycystic ovarian syndrome (PCOS) have abnormal hormone levels, such as higher androgen (male hormones) and estrogen levels and lower levels of progesterone. The increase in estrogen relative to progesterone can increase a woman’s chance of getting endometrial cancer. PCOS is also a leading cause of infertility in women.
Using an intrauterine device
Women who used an intrauterine device (IUD) for birth control seem to have a lower risk of getting endometrial cancer. Information about this protective effect is limited to IUDs that do not contain hormones. Researchers have not yet studied whether newer types of IUDs that release progesterone have any effect on endometrial cancer risk. But these IUDs are sometimes used to treat pre-cancers and early endometrial cancers in women who wish to be able to get pregnant in the future.
The risk of endometrial cancer increases as a woman gets older.
Diet and exercise
A high-fat diet can increase the risk of many cancers, including endometrial cancer. Because fatty foods are also high-calorie foods, a high-fat diet can lead to obesity, which is a well-known endometrial cancer risk factor. Many scientists think this is the main way in which a high-fat diet raises endometrial cancer risk. Some scientists think that fatty foods may also have a direct effect on how the body uses estrogen, which increases endometrial cancer risk.
Physical activity lowers the risk of endometrial cancer. Many studies have found that women who exercise more have a lower risk of endometrial cancer, while others suggest that women who spent more time sitting have a higher risk. To learn more, read the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention.
Endometrial cancer may be about twice as common in women with type 2 diabetes. But diabetes is more common in people who are overweight and less active, which are also risk factors for endometrial cancer. This makes it hard to find a clear link.
Endometrial cancer tends to run in some families. Some of these families also have a higher risk for colon cancer. This disorder is called hereditary nonpolyposis colon cancer (HNPCC). Another name for HNPCC is Lynch syndrome. In most cases, this disorder is caused by a defect in either the mismatch repair gene MLH1 or the gene MSH2. But at least 5 other genes can cause HNPCC: MLH3, MSH6, TGBR2, PMS1, and PMS2. An abnormal copy of any one of these genes reduces the body’s ability to repair damage to its DNA or control cell growth. This results in a very high risk of colon cancer, as well as a high risk of endometrial cancer. Women with this syndrome have a up to a 70% risk of developing endometrial cancer at some point. (The risk for women in general is about 3%.) The risk of ovarian cancer is also increased. General information about inherited cancer syndromes can be found in Family Cancer Syndromes.
Some families have a higher rate of only endometrial cancer. These families may have a different genetic disorder that hasn’t been found yet.
Breast or ovarian cancer
Women who have had breast cancer or ovarian cancer may have an increased risk of endometrial cancer, too. Some of the dietary, hormone, and reproductive risk factors for breast and ovarian cancer also increase endometrial cancer risk.
Endometrial hyperplasia is an increased growth of the endometrium. Mild or simple hyperplasia, the most common type, has a very small risk of becoming cancer. It may go away on its own or after treatment with hormone therapy. If the hyperplasia is called “atypical,” it has a higher chance of becoming a cancer. Simple atypical hyperplasia turns into cancer in about 8% of cases if it’s not treated. Complex atypical hyperplasia (CAH) has a risk of becoming cancer in up to 29% of cases if it’s not treated, and the risk of having an undetected endometrial cancer is even higher. For this reason, CAH is usually treated. (Treatment is discussed in Can endometrial cancer be prevented?)
Prior pelvic radiation therapy
Radiation used to treat some other cancers can damage the DNA of cells, sometimes increasing the risk of a second type of cancer such as endometrial cancer.
AUGUSTA, Ga. (WJBF) – You may be familiar with breast cancer, lung cancer or prostate cancer. But there’s another type of cancer that many women are at risk of developing. Preventing it starts with making sure that certain women do one specific thing each month.
Having a period each month can be a dreadful activity for some women. But it’s also a life saver. Women battling PCOS and irregular menstrual cycles can develop endometrial cancer and doctors here say they are diagnosing more cases.
“In the last three to four years I’ve seen about 12 patients with PCOS related endometrial cancer,” said Dr. Bunja Rungruang, Associate Professor, MCG at Augusta University for Gynecological Oncology.
No one wants to hear the word cancer. But doctors who treat Polycystic Ovary Syndrome at Augusta University are seeing more and more of it in one in 10 women of childbearing age who battle the chronic disorder.
Dr. Rungruang said, “With PCOS you have a relative increase of estrogen relative to the levels of progesterone, which is the other female hormone and this causes thickening over time of the endometrial lining.”
She added that because women with PCOS have irregular periods, not enough progesterone is produced to oppose the abundance of estrogen in the polycystic ovaries. Extra estrogen also comes from fat tissues, another danger because women with PCOS have difficulties with weight loss. Endometrial cancer is most common in postmenopausal women between ages 50 and 70, but younger women battling infertility are getting it too, with her youngest patient just 21 years old.
“Unfortunately, when I’m seeing women in their 20s and 30s who haven’t had kids yet and really want to maintain their fertility talking with them about a hysterectomy becomes a major problem,” Dr. Rungruang said.
Hormone treatments help. And that’s where Doctor Larisa Gavrilova-Jordan steps in.
“If your periods are 35 days or longer and you’re not pregnant it’s time to get progesterone,” said Dr. Jordan, who added that some women can go up to 90 days or longer without a cycle and that is not advised.
Jordan, who works as the Director of Fertility Preservation and IVF service, adds that birth control helps regulate the cycle for women with PCOS, but those trying to conceive come off of that regimen and are at risk for endometrial cancer.
“Unpredictable menstrual periods can also lead to other problems such as endometrial polyps. Endometrial polyps are commonly benign and lead to excessive bleeding and clotting, causing women prolonged periods of bleeding when it comes and eventually still can turn into the cancer,” Dr. Jordan added.
Taking progesterone is really not that difficult. Doctor Jordan added it is typically an oral medication taken over ten days. And that brings on the much needed menstrual cycle and helps those women with PCOS avoid the cancer risk.
As for detecting the thickness of the uterine lining, Dr. Jordan said that can be done through an ultrasound in her reproductive endocrinology office.
Northwestern University is conducting a study for women of color with PCOS who have irregular periods. The paid study is to help researchers collect data from women who:
- Are 18 – 40 years of age
- Have 8 or fewer menstrual periods per year or irregular menstrual periods in the past
- Are not using birth control pills, patches, rings or hormone-releasing IUDs, unless previously diagnosed with PCOS by hormonal testing
You can contact [email protected] if interested in this paid study.
Also, women wanting to learn more about PCOS from doctors and other people in the medical industry can attend a symposium and 5K on the disorder in Atlanta September 16 & 17. It is sponsored by PCOS Challenge, Inc. and you can learn more about it here.Photojournalist: Gary Hipps
PCOS and Endometrial Cancer Risk
Endometrial cancer is the form of uterine cancer that’s most commonly diagnosed. Women can be at higher risk for endometrial cancer for several reasons, including health conditions and lifestyle factors that can boost their estrogen levels. Polycystic ovarian syndrome, or PCOS, is one of those health conditions known to increase a woman’s chances of developing endometrial cancer.
Ovaries produce the hormone estrogen and the egg that is released monthly — a process called ovulation — during a woman’s reproductive years. PCOS is a condition of the female reproductive system that causes a bunch of small cysts, which are tiny sacs of fluid, to form on the ovaries. Women with PCOS typically don’t ovulate and have abnormally high levels of androgen hormones, often called “male” hormones.
Women with PCOS also have increased levels of estrogen and abnormally low levels of progesterone, another hormone.
The Estrogen Factor
Hormone levels play a big role when it comes to cancer risk — particularly types of uterine cancer like endometrial cancer. Women with PCOS and other factors that increase estrogen levels — including obesity, diabetes, or taking medications like tamoxifen (Nolvadex, Tamosin, Tamofen, Tamoxen) or estrogen replacement therapy — are more likely to develop endometrial cancer than those without these factors. The abnormal amounts of estrogen are particularly risky when not balanced by sufficient progesterone levels in the blood. This is why post-menopausal women who have not had a hysterectomy and who need treatment for severe menopausal symptoms will be prescribed both estrogen and progesterone, instead of estrogen alone.
Progesterone is the hormone responsible for the monthly “shedding” process of the endometrium — or the lining of the uterus. This process results in monthly menstruation, which many women with PCOS don’t have because of insufficient progesterone levels. Without progesterone and monthly periods, the endometrium becomes thick and the cells may become altered, leading to a precancerous condition called endometrial hyperplasia. Eventually, endometrial cancer may develop if PCOS is left untreated.
Reducing Your Endometrial Cancer Risk
While you can’t prevent PCOS, it’s important to know your risk for endometrial cancer and figure out what you can do to protect your health and minimize that risk.
If you have PCOS, do what you can to keep other risk factors for endometrial cancer in check:
- Treat your PCOS. If left untreated, hormone levels will remain abnormal and affect your whole body and your cancer risk. Seek treatment for PCOS early and regulate hormone levels. You can do this with oral contraceptives — progesterone-only pills are best to reduce endometrial cancer risk — or metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet), the diabetes medication, to manage hormone production. Surgery may also be an option.
- Reach and maintain a healthy body weight. Most often, women with PCOS are obese or overweight. And obesity is a known risk factor for endometrial cancer because it also increases estrogen levels. By getting regular exercise and sticking to a healthy diet, you can lose excess pounds and minimize your endometrial cancer risk, even if you have PCOS.
- Avoid fat in your diet. Besides helping avoid unwanted pounds, trimming the fat from your diet can reduce endometrial cancer risk. It’s thought that fat affects the way that estrogen is metabolized and used by the body, which can also raise the chances of developing endometrial cancer.
- Get regular Pap smears and pelvic exams. If you already know you’re at a greater risk for endometrial cancer because of your PCOS, it’s important to keep an eye out for early signs of cancer. Having a regular pelvic exam done by your gynecologist can help to identify endometrial cancer and begin treatment.
Having PCOS doesn’t mean you’re destined to develop endometrial cancer, but it does mean that you’re at an increased risk for the disease. So take good care of yourself by focusing on preventive care, maintaining a fit body, and living a healthy lifestyle to reduce your endometrial cancer risk.
Polycystic ovarian syndrome (PCOS)
There is no conclusive evidence that having polycystic ovary syndrome (PCOS)* is associated with risk of endometrial cancer. Only a small number of studies have been done to date and these have been of poor quality.
PCOS is associated with known endometrial cancer risk factors, such as obesity, diabetes, and metabolic syndrome. It is possible that this association results in an increase in risk of endometrial cancer in women with PCOS. It is also possible that PCOS itself results in an increased risk of endometrial cancer due to effects on the body’s metabolism.
Other factors that are common in women with PCOS, such as not having children, age at first pregnancy, use and/or length of use of hormone replacement therapy or oral contraceptives, may also affect risk of endometrial cancer. This makes the results of studies difficult to interpret.
* Polycystic ovary syndrome is a condition that affects around 8–13% of women during their reproductive years. Symptoms include irregular or no menstrual periods, difficulty getting pregnant, pelvic pain, skin and hair changes, and cysts on the ovaries.
Preventing endometrial cancer risk in polycystic ovarian syndrome (PCOS) women: Could metformin help?
Current data indicate that there is a significant risk of endometrial cancer (EC) in women with polycystic ovarian syndrome (PCOS), although further research needed to clarify the exact molecular mechanisms. Endometrial hyperplasia is a premalignant condition that usually heralds EC and it shares identical risk factors with EC. Metabolic syndrome with a triad of obesity, hyperinsulinaemia and diabetes, which is commonly observed in PCOS appears to be a key mechanism in EC pathogenesis. Measures to improve insulin resistance could therefore play a role in reducing the risk of EC in women with PCOS. Metformin is an insulin sensitising agent which is safe, widely available and currently licensed for type-2 diabetes. It has been clearly shown in both animal and human studies that metformin is of value in reversing endometrial hyperplasia. Metformin may therefore prevent EC in PCOS. This article reviews the use of metformin in reducing EC risk in PCOS and makes a case for future research on this topic.